Maine:Prehospital protocol pediatric anaphylaxis

Perform general assessment

1. Manage airway as appropriate
2. If shock is present refer to shock protocol
3. Request ALS if available

Signs Symptoms of Anapylaxis?

1. Is there a known allergen exposure with hypotension or respiratory distress?
2. Common allergens are peanuts, medications and bee stings

Yes

• Assist in administration of patient's own anaphylaxis kit if available
• IF (weight <25)
  • Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM)
  • If auto injector is not available, give epinephrine 1:1000 (weight *0.01) mg IM
• IF (weight > 25)
  • Give EpiPen IM (0.3mg epinephrine 1:1000 IM)
  • If autoinjector is not available, give epinephrine (1:1000) (weight *0.01) mg IM

Wheezing or Shortness of Breath?

• 2.5mg/3mL NS via Nebulizer may be administered
• Repeat as needed

Give Diphenhydramine 1-2mg/kg IV/IM

• Max dose 50mg

Notify Receiving Hospital

1. Continue transport, and frequent reassessments
2. Contact online medical control if in need of further instructions or repeat epinephrine dosing

Epinephinedrip preparation

This must be performed under OLMC and only with a Maine EMS approved pump

• Preparation: add 1 mL (1mg) epinephrine (1mg/ml 1:1000) to a 250 mL bag NS. This results in 1mg/250mL = 4mcg/mL mix
• Dose: start at 0.05mcg/kg/min Titrate by 0.05 mcg/kg/min every 5 min to desired BP
• Usual dose: is 0.05-0.5 mcg/kg/min. MAX dose 0.5mcg/kg/min

Authors

Daniel Ostermayer, Neil Young