Table 5.

Basic management of anaphylaxis in adults^a

Preliminary steps:
Remove exposure to trigger, if possible Assess circulation, airway, breathing, mental status, skin and body weight
Steps to perform promptly and simultaneously:
Call for help, if available Inject 0·3–0·5 ml of 1:1000 (1 mg/ml) of IM epinephrine into the thigh, record time of dose and repeat in 5–15 min, if needed Place patient on the back (or in position of comfort if patient is vomiting or in respiratory distress) and elevate lower extremities
Steps to perform at any time, when indicated:
Give high‐flow supplemental oxygen (6–8 l/min) by face mask or oropharyngeal airway Establish IV access with wide‐bore cannulae (14–16 gauge); when indicated, rapidly give 1–2 l 0·9% saline (rate of 5–10 ml/kg in the first 5–10 min) Initiate CPR with continuous chest compression, when indicated
Steps to perform at frequent and regular intervals:
Monitor blood pressure, cardiac rate and function, respiratory status and oxygenation Obtain electrocardiograms Start continuous non‐invasive monitoring, if possible

CPR, cardiopulmonary resuscitation; IM, intramuscular; IV, intravenous; WAO, World Allergy Organization.

^aAdapted from WAO anaphylaxis guidelines 18.