510 ANAPHYLACTIC REACTION

1. Begin Basic Life Support Anaphylactic Reaction procedures.
2. If the patient is exhibiting obvious airway compromise, perform Endotracheal Intubation, and administer Epinephrine 1.0 mg (10 ml of a 1:10,000 solution), via the Endotracheal Tube.
3. If Endotracheal Intubation has not been accomplished, administer Epinephrine 0.3 mg (0.3 ml of a 1:1,000 solution), subcutaneously.
4. Monitor vital signs every 5 minutes.
5. Begin Cardiac Monitoring, record and evaluate EKG strip.
6. Begin an IV infusion of Ringer's Lactate (RL) via a large bore (14-16 gauge) catheter to keep vein open.
7. If the patient has signs of shock, begin rapid IV infusion of Ringer's Lactate (RL), up to 3.0 liters.
8. Administer Diphenhydramine 50 mg, IV bolus, or IM if IV access has not been established.
• NOTE:
  DIPHENHYDRAMINE HYDROCHLORIDE HAS AN ATROPINE-LIKE ACTION AND THEREFORE SHOULD BE USED WITH CAUTION IN PATIENTS WITH A HISTORY OF BRONCHIAL ASTHMA, INCREASED INTRAOCULAR PRESSURE, HYPERTHYROIDISM, CARDIOVASCULAR DISEASE OR HYPERTENSION. USE WITH CAUTION IN PATIENTS WITH LOWER RESPIRATORY DISEASE, INCLUDING ASTHMA.
9. Contact Medical Control for implementation of one or more of the following options:

MEDICAL CONTROL OPTIONS

OPTION A:

Repeat any of the above Standing Orders.

OPTION B:

Administer Epinephrine 1.0 mg (10 ml of a 1:10,000 solution), IV bolus, cautiously. Repeat as necessary.

OPTION C:

Administer Dopamine 5.0 mcg/kg/min IV drip. If there is insufficient improvement in hemodynamic status, the infusion rate may be increased until desired therapeutic effects are achieved or adverse effects appear. (Maximum dosage of 20 mcg/kg/min.)

OPTION D:

Transportation decision.

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