• 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).

Also order:

  • 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

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