- Order Epinephrine IM stat
- May require multiple epinephrine injections.
- Patient may require intubation if unable to protect his airway.
- Remember: Patient may have a second anaphylactic episode (delayed/secondary reaction) 24 hours later! Keep for observation. Some people get intubated -> extubated -> re-intubated (24 hours later).
- IV fluid – Order NS @ 100cc/hr
- Order steroids:
- Dexamethasone 10mg IV X 1 dose
- Solu-Medrol 125mg IV X 1 dose followed by 60mg IV q6hr
- At discharge, consider Prednisone taper X 1 week.
- Order Zyrtec (Cetirizine) 10mg PO qd (H1 blocker).
- Order Pepcid (famotidine) 20 mg IV q12 hours (H2 blocker)
Common example: Patient develops stridor, wheezing, SOB, respiratory distress with possible AMS following bee/wasp sting.
Other: IV Benadryl 50mg, Albuterol breathing treatment, NS IVF @ 100cc/hr