By vgreene, 9 April, 2015 Prescribe auto-injectable epi (pt to carry 2 auto-injectors at all times) w/ action plan on how/when to administer
By vgreene, 9 April, 2015 Identify trigger of anaphylaxis, including obscure/less common ones [M/C]; consider serum tryptase<sup>12</sup> [M/C]
By vgreene, 9 April, 2015 Consider H<sub>1</sub> +/- H<sub>2</sub> blockers and corticosteroids<sup>11</sup> as adjunct tx, but not instead of epi [S/B]
By vgreene, 9 April, 2015 If unresponsive to traditional resuscitative measures, consider ECMO<sup>10</sup> [M/D]
By vgreene, 9 April, 2015 If bronchospasm present/not responding to epi, administer inhaled β-agonist [M/B], eg, albuterol via MDI 2-6 puffs or via neb 2.5-5mg/3mL saline
By vgreene, 9 April, 2015 If any suggestion of airway edema (eg, hoarseness or stridor) or resp compromise, prepare for airway mgmt<sup>9</sup> including intubation if necessary [M/C]
By vgreene, 9 April, 2015 Administer epi 0.01 mg/kg (max 0.5 mg) IM to anterolateral thigh ASAP [S/B]; repeat q5-15min prn<sup>4</sup>
By vgreene, 9 April, 2015 If pt not responding to epi injections, administer IV/IO<sup>5</sup> epi infusion<sup>6</sup> in a monitored setting [M/C], consider differential dx<sup>7</sup> [M/C], determine risk factors for severe anaphylaxis<sup>8</sup> [M/B]
By vgreene, 9 April, 2015 Immediately triage/monitor<sup>1</sup> pts w/ suspected anaphylaxis based on hx/exam [S/C]; administer O<sub>2</sub> [M/D], obtain IV access; anaphylaxis likely when any 1 of 3 criteria met [S/C]:<sup>2</sup>