Table 2.

Basic management of anaphylaxis

1. Have a written emergency protocol for the recognition and treatment of anaphylaxis and rehearse it regularly.

2. Remove exposure to the trigger if possible (eg, discontinue an intravenous diagnostic or therapeutic agent that seems to be triggering symptoms).

3. Assess the patient’s circulation, airway, breathing, mental status, skin, and body weight (mass).

Promptly and simultaneously, perform steps 4–6

4. Call for help: resuscitation team (hospital) or emergency medical services (community) if available.

5. Inject epinephrine (adrenaline) intramuscularly in the mid-anterolateral aspect of the thigh (0.01 mg/kg of a 1:1000 (1 mg/mL) solution), maximum of 0.3 mg for children (0.5 mg for adults); record the time of the dose and repeat it in 5–15 min, if needed. Most patients respond to 1 or 2 doses.

6. Place the patient in a position of comfort and elevate the lower extremities. (Note: in adults, fatality can occur within seconds if the patient stands or sits suddenly. It is not known if this also applies to children.)

7. When indicated, give high-flow supplemental oxygen (6–8 L/min) by face mask or oropharyngeal airway.

8. Establish intravenous access using needles or catheters with wide-bore cannulae (14–16 gauge). When indicated, give 1–2 L of 0.9 % (isotonic) saline rapidly (e.g., 10 mL/kg in the first 5–10 min to a child).

9. When indicated at any time, perform cardiopulmonary resuscitation with continuous chest compressions.a

In addition,

10. At frequent, regular intervals monitor patient’s blood pressure, cardiac rate and function, respiratory status, and oxygenation (monitor continuously, if possible).

^aResuscitation guidelines recommend initiating cardiopulmonary resuscitation with chest compressions only (hands-only), before giving rescue breaths. In children, the rate should be at least 100 compressions/min at a depth of 5 cm (4 cm in infants)

(Adapted from Simons et al. [21••])