Diagnosis

May have:

Common Causative Agents:

Increase O₂ to 100%, evaluate ventilation
Remove suspected trigger(s)
- If latex is suspected: thoroughly wash area, have surgeons change to non-latex gloves
- If HYPOtensive: turn off anesthetic agents
To restore BP and ↓ mediator release: give epinephrine 1-10 MICROgrams/kg IV/IO as needed, or 10 MICROgrams/kg IM q5-15 min as needed; may need infusion 0.02-1 MICROgrams/kg/min IV
- 1-10 MICROgrams/kg IV/IO or 10 MICROgrams/kg IM q5-15 min
- Consider infusion 0.02-1 MICROgrams/kg/min IV
To restore intravascular volume: give NS or LR 10-30 mL/kg IV/IO rapidly
To ↓ mediator release: give methylprednisolone 2 mg/kg IV/IO (MAX 100 mg)
- 2 mg/kg IV/IO, MAX 100 mg
To ↓ histamine-mediated effects:
- Give diphenhydramine 1 mg/kg IV/IO (MAX 50 mg)
- Give famotidine 0.25 mg/kg IV (MAX 20 mg)
- 1 mg/kg IV/IO MAX 50 mg
- 0.25 mg/kg IV MAX 20 mg
For continued ↓ BP: give vasopressin 10 milliunits/kg IV
- 10 milliunits/kg IV
To ↓ bronchoconstriction: give albuterol 4-10 puffs, repeat as needed
- 4-10 puffs as needed
Send tryptase in 30 minutes to 2 hours
Consider DDx
Crisis Management (If Severe)
Notify surgeon, call for help and code cart
Call for Transesophageal Echocardiography
Start chest compressions
Give epinephrine 10 MICROgrams/kg IV/IO
- 1-10 MICROgrams/kg IV/IO or 10 MICROgrams/kg IM q5-15 min
- Consider infusion 0.02-1 MICROgrams/kg/min IV
If cardiac arrest, go to CARDIAC ARREST
Consider ECMO

May have:

Common Causative Agents:

Increase O₂ to 100%, evaluate ventilation
Remove suspected trigger(s)
- If latex is suspected: thoroughly wash area, have surgeons change to non-latex gloves
- If HYPOtensive: turn off anesthetic agents
To restore BP and ↓ mediator release: give epinephrine 1-10 MICROgrams/kg IV/IO as needed, or 10 MICROgrams/kg IM q5-15 min as needed; may need infusion 0.02-1 MICROgrams/kg/min IV
To restore intravascular volume: give NS or LR 10-30 mL/kg IV/IO rapidly
To ↓ mediator release: give methylprednisolone 2 mg/kg IV/IO (MAX 100 mg)
To ↓ histamine-mediated effects:
- Give diphenhydramine 1 mg/kg IV/IO (MAX 50 mg)
- Give famotidine 0.25 mg/kg IV (MAX 20 mg)
For continued ↓ BP: give vasopressin 10 milliunits/kg IV
To ↓ bronchoconstriction: give albuterol 4-10 puffs, repeat as needed
Send tryptase in 30 minutes to 2 hours
Consider DDx
Crisis Management (If Severe)
Notify surgeon, call for help and code cart
Call for Transesophageal Echocardiography
Start chest compressions
Give epinephrine 10 MICROgrams/kg IV/IO
If cardiac arrest, go to CARDIAC ARREST
Consider ECMO

Drugs

Epinephrine	1-10 MICROgrams/kg IV/IO or 10 MICROgrams/kg IM q5-15 min
Epinephrine	Consider infusion 0.02-1 MICROgrams/kg/min IV
Vasopressin	10 milliunits/kg IV
Albuterol	4-10 puffs as needed
Methylprednisolone	2 mg/kg IV/IO, MAX 100 mg
Diphenhydramine	1 mg/kg IV/IO MAX 50 mg
Famotidine	0.25 mg/kg IV MAX 20 mg