Outpatient Specialty Care and Primary Care Clinical Pathway for Evaluation/Treatment of Children with Anaphylaxis
- Related Pathways
- Anaphylaxis, Emergent Care
- Anaphylaxis, Inpatient
Patients > 5 kg with Suspected Anaphylaxis
Providers: Use individual clinical decision for infants < 5 kg
CRITERIA 1 |
Acute onset of an illness with involvement of the skin, mucosal tissue, or both
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CRITERIA 2 |
Two or more of the following that occur rapidly after exposure to a LIKELY ALLERGEN for that patient:
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CRITERIA 3 | Reduced BP after exposure to KNOWN ALLERGEN for that patient |
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Epinephrine Dosing - IM | ||
5 - 25 kg | 0.15 mg | EpiPen Jr® |
> 25 kg | 0.3 mg | EpiPen® |
Risk Factors for Biphasic Reaction
- History of biphasic or severe reactions
- Progression of / or persistent symptoms
- History of severe asthma
- Hypotension
- Requires > 1 Epinephrine dose
- Requires fluid bolus
- Drug trigger
Severe Symptoms
- Upper airway obstruction
- Lower airway symptoms
- Circulatory abnormality
- Consider the use of the following medications:
- Albuterol
- Antihistamines
- Steroids
- Racemic Epi
- Above medications are available in
BLS carts
- Initial Assessment
- If meets criteria for anaphylaxis:
- ADMINISTER EPINEPHRINE IM IMMEDIATELY
- Repeat Epi dose q 5-15 minutes prn as clinically indicated:
- Signs of upper airway obstruction
- Continued respiratory distress/bronchospasm
- Poor perfusion or hypotension
- Persistent GI symptoms
- INITIATE APPROPRIATE EMERGENCY RESPONSE
- Clinics Outside of Main Campus
- ACTIVATE EMERGENCY RESPONSE
CALL 911
- ACTIVATE EMERGENCY RESPONSE
- Buerger Center
- CALL CODE BLUE - EXT. 4-2633
or 4-CODE
- CALL CODE BLUE - EXT. 4-2633
- Initiate Basic Life Support
- History, physical exam
Mental status | Oxygen |
---|---|
Upper airway obstruction | Racemic epinephrine (should not replace Epi IM) |
Lower airway symptoms | Albuterol |
Circulatory abnormality | Trendelenburg position IV, NS if able |
- While Awaiting Emergency Responders:
- Continue to assess symptoms, manage ABCs
- Repeat Epi IM q 5-15 minutes as clinically indicated
- Administer respiratory and adjunctive medications as clinically indicated
- Event Documentation, Education & Follow-up
Posted: August 2017
Revised: April 2022
Authors: T. Brown-Whitehorn, MD, E. Everly, MD, C. Law, PharmD, M. Mihalko, RN, R. Saltzman, MD, G. Simon, MD, J. Spergel, MD, N. Tsarouhas, MD, P. Devine, RN, AE-C, C. Caraher, MSN, RN, CPN
Revised: April 2022
Authors: T. Brown-Whitehorn, MD, E. Everly, MD, C. Law, PharmD, M. Mihalko, RN, R. Saltzman, MD, G. Simon, MD, J. Spergel, MD, N. Tsarouhas, MD, P. Devine, RN, AE-C, C. Caraher, MSN, RN, CPN
Evidence
- Biphasic Anaphylaxis: Review of Incidence, Clinical Predictors, and Observation Recommendations
- International consensus on (ICON) anaphylaxis
- Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium
- Anaphylaxis — a practice parameter: 2015 Update
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