Anaphylaxis

The clinical syndrome of immediate hypersensitivity.

• cardiovascular collapse
• respiratory compromise
• cutaneous symptoms (urticaria)
• GI symptoms (emesis)

Initial Management

1. ABC's. Establish airway if necessary. 100% O2 as needed. Assess circulation and place IV. Cardiac monitor.
2. Epinephrine 1:1000 (concentration is 1 mg/mL). Give 0.01 mL/kg SC = 0.01 mg/kg. If over 50 kg, give max dose 0.5 mL. Repeat every 15 min as needed.
3. Albuterol: 2.5 mg if <30 kg. 5 mg if > 30 kg. Every 15 min prn
4. H1 receptor antihistamine: benadryl 1-2 mg/kg IM/IV/PO. Max dose 50 mg.
5. Also consider H2 receptor antagonist: Zantac 1 mg/kg IV
6. Corticosteroids: methylprednisolone  2 mg/kg IV bolus, to prevent late phase of allergic response

If hypotensive:

• trendelenburg (head down 30 degrees).
• NS 20 mL/kg rapid IV bolus. Repeat PRN.
• Epinephrine (1:10000) 0.1 mL/kg IV over 2-5 minutes, while an epi or dopamine infusion is being prepared.

Harriet Lane, 16th Edition