ED Pathway for Evaluation/Treatment of Children with Anaphylaxis
Patient/Parent Education
Auvi-Q/Epipen video
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Clinical Criteria For Diagnosing Anaphylaxis
Anaphylaxis is highly likely when ONE of the following 3 criteria are fulfilled within minutes to 2-3 hours following possible allergen exposure
CRITERIA 1

Acute onset of an illness with involvement of the skin, mucosal tissue, or both
(e.g., generalized hives, pruritis or flushing, swollen lip-tongue-uvula)

AND AT LEAST ONE OF THE FOLLOWING

  • Respiratory compromise
  • Reduced BP or associated symptoms of end-organ dysfunction
  • Persistent GI Symptoms, Significant abdominal pain and/or significant vomiting
CRITERIA 2

Two or more of the following that occur rapidly after exposure to a LIKELY ALLERGEN for that patient:

  • Involvement of the skin-mucosal tissue
  • Respiratory compromise
  • Reduced BP or associated symptoms
  • Persistent gastrointestinal symptoms
CRITERIA 3Reduced BP after exposure to KNOWN ALLERGEN for that patient

MD/CRNP/RN Rapid Assessment

  • Patient meets one of the criteria listed above
  • ADMINISTER EPINEPHRINE IM IMMEDIATELY
  • Repeat dose as clinically indicated q 5-15 minutes
  • Assess need for IV access
  • Assess, Manage ABC's
    • Mental status abnormality
    • Upper airway obstruction
    • Lower airway symptoms
    • Circulatory abnormality
  • ANAPHYLAXIS MEDICATION DOSING
  • Administer antihistamine and steroids to all patients
  • Consider Ranitidine for patients with vomiting, abdominal pain or hives
EPINEPHRINE DOSING
<10 kgEpinephrine IM
(0.01 mg/kg of 1/1000 solution)
10-25 kgEpipen Jr or Auvi-Q (0.15 mg)
>25 kgEpipen or Auvi-Q (0.3 mg)

Anaphylaxis Red Flags

  • History of biphasic or severe reactions
  • Progression of/or persistent symptoms
  • History of severe asthma
  • Current asthma flare
  • Hypotension during ED stay
  • Requires >1 Epinephrine dose
  • Requires fluid bolus

Severe Symptoms

  • Upper airway obstruction
  • Lower airway symptoms
  • Circulatory abnormality
Reassess patient’s symptoms, PE, VS
Symptoms Resolved with 1 dose of Epinephrine (excluding rash)
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Severe or recurrent symptoms
Or Anaphylaxis Red Flags
Posted: June, 2006
Revised: September 2011, October 2014
Authors: J. Lee, MD; T. Brown-Whitehorn, MD; N. Tsarouhas, MD; A. Cianferoni, MD; B. Rodio, RN;
L. Zielinski, RN; J. Molnar, CRNP; S. DaVeiga, MD; M. Ott, CRNP; C. Flanigan, RN; Y. Chi, RN;
C. Jacobstein, MD; J. Lavelle, MD