- Communication and Immediate Actions
- Alert OR personnel about the urgent situation.
- Have the OR nurse issue an overhead page for assistance.
- Discontinue and flush any IV lines to remove potential allergens.
- Epinephrine Administration
- For adults: Administer IV epinephrine, 10-100 μg bolus based on symptom severity; repeat as needed. Consider epinephrine infusion (1-10 μg/min) or vasopressin (1-2 units IV bolus, repeated as needed, or an infusion of about 2 units/hour) for continuous requirements.
- For pediatric patients: Administer IM epinephrine at 0.01 mg/kg without delaying for IV access establishment.
- Oxygen and Airway Management
- Administer 100% oxygen.
- Intubate to secure the airway if not already established.
- IV Fluids and Fluid Resuscitation
- Initiate with a crystalloid fluid bolus of 0.5-1.0L for severe reactions; repeat as needed. Tailor resuscitation to the patient's medical condition and anaphylaxis severity.
- For parturients with severe anaphylactic suspicion, administer crystalloid fluids immediately; large volumes may be required.
- Pediatric fluid therapy: Start with 20 ml/kg crystalloids, repeat as necessary.
- Additional Medications
- Consider administering diphenhydramine (25-50 mg IV), famotidine (20 mg IV), hydrocortisone (100 mg IV) or methylprednisolone (1-2 mg/kg IV), and albuterol (4-10 puffs).
- Pediatric dosages: Adjust drugs accordingly, including epinephrine bolus and infusion rates, vasopressin, diphenhydramine, famotidine, hydrocortisone, methylprednisolone, and albuterol dosages.
- Advanced Life Support
- Follow ACLS/PALS guidelines in case of cardiovascular collapse.
- Initiate cardiac compressions if systolic BP < 50 mm Hg.
- Consider compressions when end-tidal CO2 < 20 mm Hg, after excluding other causes for low readings.
| Intervention | Adult | Pediatric |
|---|---|---|
| Epinephrine | IV 10–100 mcg bolus based on symptom severity; repeat as needed | IM 0.01 mg/kg, without waiting for IV access |
| Continuous vasopressor | Epinephrine infusion 1–10 mcg/min, or vasopressin 1–2 units IV bolus, repeated as needed, or an infusion of about 2 units/hour | Bolus and infusion rates adjusted for the patient |
| Oxygen and airway | 100% oxygen; intubate if the airway is not already secured | 100% oxygen; intubate if the airway is not already secured |
| Fluid resuscitation | Crystalloid bolus 0.5–1.0 L for severe reactions, repeated as needed; parturients may require large volumes immediately | Crystalloid 20 mL/kg, repeated as necessary |
| Additional medications | Diphenhydramine 25–50 mg IV; famotidine 20 mg IV; hydrocortisone 100 mg IV or methylprednisolone 1–2 mg/kg IV; albuterol 4–10 puffs | Same agents at doses adjusted for the patient |
| Cardiovascular collapse | Follow ACLS; start compressions if systolic BP < 50 mm Hg, and consider them when end-tidal CO2 < 20 mm Hg once other causes are excluded | Follow PALS |
