2.2P Allergic Reaction/Anaphylaxis: Pediatric

FIRST RESPONDER

• 1.0 Routine Patient Care

            In anaphylaxis, if patient is over 6 months age and under 25kg, administer epinephrine    

        0.15mg via auto-injector or IM.  If body weight is over 25 kg, administer epinephrine 0.3mg  

        via auto-injector or IM. 

EMT STANDING ORDERS

When administering IM, EMTs may do so in accordance with Protocol 6.5 Check and Inject Epinephrine by EMT-Basics.   

• Diphenhydramine – 1mg/kg for patients 2years or older, up to a total dose of 25mg, preferably by liquid measured dose, if age appropriate by oral tablets dose.

• MEDICAL CONTROL MAY ORDER Contact Medical Control if second epinephrine auto injection is required after 5-minutes

• First Responders and EMT-Basics must contact Medical Control prior to the administration of epinephrine by auto injector when the patient is under 6 months of age.

ADVANCED EMT STANDING ORDERS

• In anaphylaxis, if the patient is over 6 months of age and under 25kg, administer epinephrine 0.15mg IM-ONLY.    If body weight is over 25 kg, administer epinephrine 0.3mg via auto-injector or IM. 

MEDICAL CONTROL MAY ORDER

• Contact Medical Control if second epinephrine dose required after 5 minutes. 

PARAMEDIC STANDING ORDERS

• Albuterol (via nebulizer):

• If age less than 2 years, 1.25 mg by nebulizer

• If age 2 years or greater, 2.5-3 mg by nebulizer

• Give hydrocortisone 2 mg/kg to max. 100 mg IV/IO/IM, or methylprednisolone 2 mg/kg to max. 125 mg IV/IO/IM.

• Diphenhydramine 1 mg/kg up to max. single dose of 50 mg IV/IO/IM

• Contact Medical Control if second epinephrine dose required after 5 minutes.

MEDICAL CONTROL MAY ORDER

• Additional doses of above medications.

• Epinephrine infusion  0.1-1 mcg/kg/min IV/IO . IV administration by infusion pump ONLY

Red Flag:  CAUTION: Epinephrine for anaphylaxis must be administered by Auto-Injector or IM if trained and authorized to do so in accordance with Medical Director Option Protocol 6.6 Check and Inject Epinephrine by EMT-Basics.

Red Flag: For patients under 12 years old, the airway is in most cases best managed with a BVM or SGA. In some cases, intubation may be preferred. This is at the discretion of the treating paramedic.

Clinical Notes: 

Clinical Criteria for Anaphylaxis:

If one of these criteria is fulfilled, treat for anaphylaxis

• Acute onset of skin or mucosal involvement with at least one of the following:

a. Respiratory compromise

b. Decreased SBP or evidence of end-organ hypoperfusion

• Two or more of these occurring rapidly after exposure to a likely antigen:

a. Skin or mucosal involvement

b. Respiratory compromise

c. Decreased SBP or evidence of end-organ hypoperfusion

d. Persistent GI symptoms

• Decreased BP after exposure to a known allergen for that patient.