POLICY STATEMENT
Timely and effective management of anaphylactic reactions is critical to ensuring safe patient outcomes.
REASON FOR THIS POLICY
To provide standing orders for the immediate treatment of anaphylaxis, maintaining adequate airway and supporting blood pressure.
ENTITIES AFFECTED BY THIS POLICY
Campus Health Services
WHO SHOULD KNOW THIS POLICY
All Campus Health Services medical staff, including all Providers, Registered Nurses, and Medical Assistants.
DEFINITIONS
Anaphylaxis: An acute allergic response to an antigen to which the body has become hypersensitive; often serious and life-threatening.
POLICY
SIGNS & SYMPTOMS OF ANAPHYLACTIC REACTION:
1. Signs and symptoms usually occur within seconds or minutes of receiving an injection, medication, or other allergen, but may be delayed for up to two (2) hours.
a. Initial: Sense of impending doom, generalized warmth or flush, tingling or pruritus, especially on palms of hands and/or soles of feet, lips and genitalia, axillae, scalp, complaints of lump in throat, throat tightness, hoarseness or difficulty swallowing, chest tightness.
b. Life-threatening: Wheezing; respiratory distress; swelling of the lips, face or throat; abdominal cramping; seizures; shock; cardiovascular collapse.
PROCEDURE:
1. Page overhead using intercom (per instructions located on yellow stickers on every phone) or call for help. Stay with patient.
2. Place patient in supine position and elevate lower extremities.
3. Administer epinephrine using 1:1000 dilution:
a. Adult dose: 0.01 mL/kg, given intramuscularly, preferably in the vastus lateralis muscle.
i. For adults weighing 110 lb. or more, give 0.5 ml
ii. For adults weighing 66 to 110lbs, give 0.3ml
4. Initiate supplemental oxygen and pulse oximetry; monitor blood pressure, pulse, and respirations every 5 minutes until provider approves less frequent vital signs.
5. Initiate IV with 0.9% NS; give 250cc bolus then follow provider’s orders.
6. Instruct second person to summon a physician and bring an AED and an Anaphylactic Response Kit* or the Urgent Response Cart** to the location.
7. Maintain airway and perform CPR if necessary.
8. For emergency responders: Call 3-3000 if at CHS (or 523-3000 if outside of CHS).
9. Have immediately available and consider administration of:
a. Benadryl (diphenhydramine) 25-50 mg IV or IM
b. Albuterol SVN (if not responsive to epinephrine)
10. Keep patient in supine position unless experiencing breathing difficulty. If BP is low, keep legs elevated.
11. Record all vital signs, administered medications and patient’s response to treatment in the patient’s health record.
12. Once stable, patient may be moved to observation room via wheelchair or gurney for continued observation.
*Anaphylactic Response Kits are located in the Immunization Room, Allergy Clinic, Nurse Clinic and at nursing stations 2 and 5. One is also available in the portable flu clinic supply box. A larger version of the kit, the Anaphylactic Response Box is located between stations 3 and 4.
**The Urgent Response Cart is located in Urgent Care.
These standing orders/protocol for the treatment of anaphylactic reaction in adult patients shall remain in effect at Campus Health Services until rescinded.
RESPONSIBILITIES
A Registered Nurse will be assigned to maintain the Anaphylactic Response Kits.
PROCEDURES
See policy as written
RELATED INFORMATION
Forms or Tools
There are no forms or tools associated with this policy.
Cross-References
There are no cross-references associated with this policy.
Sources
https://www.uptodate.com/contents/anaphylaxis-emergency-treatment
APPENDIX
None