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Hives (uticaria) |
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Discontinue injection if not completed
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No treatment needed in most cases - reassure the patient
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Consider diphenhydramine (Benadryl®) PO/IM/IV 25-50 mg
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If severe/widely disseminated: Epinephrine SC (1:1,000) 0.1-0.3 ml (=0.1-0.3 mg) (if no cardiac contraindications)
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Facial or Laryngeal Edema |
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0.1-0.3 ml epinephrine SC or IM (1:1,000) (=0.1-0.3 mg) or, if hypotensive, 1 ml epinephrine IV (1:10,000) slowly (=0.1 mg). Repeat as needed up to 1 mg.
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Give oxygen 6-10 L/min (via mask)
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If not responsive to therapy or if there is obvious acute laryngeal edema, seek appropriate assistance (e.g., cardiopulmonary arrest response team).
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Bronchospasm |
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Give oxygen 6-10 L/min (via mask)
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Monitor: ECG, O2 saturation (pulse oximeter), and BP
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Give beta-agonist inhalers, such as metaproterenol (Alupent®), terbutaline (Brethaire®), or albuterol (Proventil®)(Ventolin®) 2-3 puffs; repeat as needed
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If unresponsive, epinephrine SC or IM (1:1,000) 0.1-0.3 ml (=0.1-0.3 mg) or, if hypotensive, epinephrine (1:10,000) slowly IV 1 ml (=0.1 mg) - Repeat up to 1 mg
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Alternatively, give aminophylline 6 mg/kg IV in D5W over 10-20 minutes (loading dose), then 0.4-1 mg/kg/hr, as needed (caution: hypotension)
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Call for assistance for severe bronchospasm or if O2 saturation < 88% persists
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Hypotension with Tachycardia |
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Legs elevated 60° or more (preferred) or Trendelenburg position
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Monitor: ECG, O2 saturation (pulse oximeter), and BP
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Give oxygen 6-10 L/min (via mask)
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Rapid large volumes of IV isotonic Ringer’s lactate or normal saline
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If poorly responsive: Epinephrine (1:10,000) slowly IV 1 ml (=0.1 mg) (if no cardiac contraindications). Repeat as needed up to a maximum of 1 mg
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If still poorly responsive seek appropriate assistance (e.g., arrest team).
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Hypotension with Bradycardia (Vagal Reaction) |
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Monitor: ECG, O2 saturation (pulse oximeter), and BP
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Legs elevated 60° or more (preferred) or Trendelenburg position
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Secure airway and give oxygen 6-10 L/min (via mask)
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Rapid large volumes of IV isotonic Ringer’s lactate or normal saline
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If unresponsive, atropine 0.6-1 mg IV slowly - repeat up to 2-3 mg in adult
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Ensure complete resolution of hypotension and bradycardia prior to discharge.
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Severe Hypertension |
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Give oxygen 6-10 L/min (via mask)
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Monitor: ECG, O2 saturation (pulse oximeter), and BP
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Give nitroglycerine 0.4-mg tablet, sublingual (may repeat x 3)
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Transfer to intensive care unit or emergency department
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For pheochromocytoma—phentolamine 5 mg IV
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Seizures or Convulsions |
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May be consequence of hypotension, primary treatment should be as indicated
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Lateral decubitus position, give oxygen, 6-10 L/min by mask
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Consider diazepam (Valium®) 5 mg or more or midazolam (Versed®) 0.5-1 mg IV
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If longer effect needed, obtain consultation; consider phenytoin (Dilantin®) infusion – 15-18 mg/kg at 50 mg/min.
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Careful monitoring of vital signs, particularly of pO2 (respiratory depression)
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Consider using cardiopulmonary arrest response team for intubation
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Pulmonary Edema |
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Elevate torso; rotating tourniquets (venous compression)
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Give O2 6-10 liters/min (via mask)
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Give diuretics – furosemide (Lasix®) 20-40 mg IV, slow push
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Consider giving morphine (1-3 mg IV)
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Transfer to intensive care unit or emergency department
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Corticosteroids optional
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Unconscious, Unresponsive, Pulseless, or Collapsed Patient |
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CALL CODE
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Institute Basic Life Support
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Establish airway, head tilt, chin lift
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Initiate ventilation and external chest compression
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Continue uninterrupted until help arrives
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