Adults

Anaphylaxis

Diagnosis

Hypotension, bronchospasm, high peak-airway pressures, decreased breath sounds, tachycardia, urticaria

Diagnosis

Hypotension, bronchospasm, high peak-airway pressures, decreased breath sounds, tachycardia, urticaria

  1. Call for help

    • Ask: "Who will be the crisis manager?"
    • Crisis manager designates checklist reader

  2. Give EPINEPHrine bolus

    • Repeat bolus with increasing dose as needed
    • Consider EPINEPHrine infusion
    • BOLUS: 10 - 50 MICROgrams IV
    • INFUSION: 0.01- 0.1 MICROgrams/kg/min
    • If no IV access, 0.3 mg IM

  3. Establish/secure airway

    • Turn FiO2 to 100% or start supplemental oxygen

  4. Remove potential causative agents

  5. Give fluid bolus

  6. Consider...

    • Minimize volatile anesthetics if patient remains unstable
    • Consider albuterol as adjunctive therapy for bronchospasm unresponsive to EPINEPHrine
    • Vasopressin bolus and/or infusion for patients with hypotension unresponsive to EPINEPHrine
    • Terminate procedure
    • Once hemodynamically stable:
      • Supplemental treatment with diphenhydrAMINE and corticosteroids
      • Tryptase level: Check within first hour, repeat at 4 and 18-24 hours
    • BOLUS: 10 - 50 MICROgrams IV
    • INFUSION: 0.01- 0.1 MICROgrams/kg/min
    • If no IV access, 0.3 mg IM
    • BOLUS: 1-2 units IV
    • INFUSION: 0.03 units/min
    • 2-3 puffs MDI
    • 2.5 mg via nebulizer
    • 25 - 50 mg IV
    • Hydrocortisone 100 mg IV
    • Methylprednisolone 1 mg/kg IV

Critical CHANGES

If Cardiac Arrest develops:

If airway obstruction develops, go to Failed Airway

Patient weight

Between 30 kg and 250 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.