General Approach to All Patients

Allergic Reactions

Basic Life Support

  • Assist patient in self-administration of previously prescribed epinephrine (via auto injector)

Advanced Life Support

Mild Reaction (Itching/Hives)

  • Diphenhydramine (Benadryl) 1 mg/kg IV (Maximum 50 mg)
    • May be administered IM if no IV access available

Moderate Reaction (Dyspnea, Wheezing, Chest tightness)

  • Albuterol (Proventil) 2.5 mg/3 ml and Ipratropium Bromide 0.02% (Atrovent) 0.5 mg/2.5 ml via nebulizer
    • Repeat Albuterol (Proventil)/Ipratropium Bromide (Atrovent) X 2 if wheezing persists
  • Diphenhydramine (Benadryl) 1 mg/kg IV (Maximum 50 mg)
    • May be administered IM if no IV access available
  • Methylprednisolone (Solumedrol) 125 mg IV

Severe Reaction (BP < 90 mm Hg, stridor, severe respiratory distress)

  • Epinephrine 1:1,000 0.3 mg IM for rapidly progressive worsening of symptoms
    • Repeat Epinephrine if signs of severe reaction or shock persist after initial dose
  • Albuterol (Proventil) 2.5 mg/3 ml and Ipratropium Bromide 0.02% (Atrovent) 0.5 mg/2.5 ml via nebulizer
    • Repeat Albuterol (Proventil)/Ipratropium Bromide (Atrovent) X 2 if wheezing persists
  • Diphenhydramine (Benadryl) 1 mg/kg IV (Maximum 50 mg)
    • May be administered IM if no IV access available
  • Methylprednisolone (Solumedrol) 125 mg IV

Cardiac Arrest or Cardiopulmonary Arrest Imminent

  • Epinephrine 1:10,000 0.5 mg IV (instead of 1:1,000 IM)
  • For cardiac arrest, refer to the appropriate protocol based on presenting rhythm
  • In the setting of cardiac arrest, the following items should be performed in the post resuscitative phase, when time allows:
    • Albuterol (Proventil) 2.5 mg/3 ml and Ipratropium Bromide 0.02% (Atrovent) 0.5 mg/2.5 ml via nebulizer
      • Repeat Albuterol (Proventil)/Ipratropium Bromide (Atrovent) X 2 if wheezing persists
    • Diphenhydramine (Benadryl) 1 mg/kg IV (Maximum 50 mg)
    • Methylprednisolone (Solumedrol) 125 mg IV