By vgreene, 9 April, 2015 Identify trigger of anaphylaxis, including obscure/less common triggers [M/C]; consider serum tryptase<sup>27</sup> [M/C]
By vgreene, 9 April, 2015 Consider H<sub>1</sub> +/- H<sub>2</sub> blockers and corticosteroids<sup>26</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>25</sup> [M/D]
By vgreene, 9 April, 2015 Other pressors (norepinephrine, vasopressin, etc) have also been used for refractory hypotension
By vgreene, 9 April, 2015 If parenteral epi and fluid resuscitation fail to restore BP, administer glucagon<sup>24</sup> (esp if pt on β-blocker) [M/B]
By vgreene, 9 April, 2015 If circulatory collapse, aggressively administer large volumes normal saline IV/IO<sup>20</sup> via large-bore catheters [S/B]
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>19</sup>
By vgreene, 9 April, 2015 If pt not responding to epi injections, administer IV/IO<sup>20</sup> epi infusion<sup>21</sup> in a monitored setting [M/C], consider differential dx<sup>22</sup> [M/C], determine risk factors for severe anaphylaxis<sup>23</sup> [M/B]
By vgreene, 9 April, 2015 Immediately triage/monitor<sup>16</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>17</sup>