4-3 PEDIATRIC ANAPHYLACTIC-ALLERGIC REACTION

Note ** Intravenous Epinephrine Doses are in mL/kg not mg/kg **

EMR - Emergency Medical Responder

1. Establish patient responsiveness. If cervical spine trauma is suspected, manually stabilize the spine.
2. Assess the patient’s airway for patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
3. Open the airway via chin lift or modified jaw thrust.
4. Suction as necessary
5. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
6. Assess patient breathing, including mental status rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
7. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a B-V-M device with 100% oxygen.
8. If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
9. Assess circulation and perfusion.
10. Obtain patient history and perform physical exam, including: history of allergies, what was the patient exposed to and how exposed, effects and progression of symptoms and any interventions attempted so far.
11. Contact MEDICAL CONTROL and report assessment findings and request implementation of epinephrine protocol, if state approved to do so.
12. If authorization for injection obtained, repeat order back to physician including dosage
13. Verify medication is correct dosage, describe procedure to patient and obtain consent if possible.
14. Administer one EpiPen Jr (epinephrine 0.15 mg IM) if weight less than 30 kg or one adult EpiPen (0.3 mg IM) if weight over 30 kg. If the provider is trained and certified to administer IM/SQ epinephrine, then, 0.01 mg/kg epinephrine IM (Max dose 0.3 mg) may be administered in place of the auto-injector method.
15. Call for ALS intercept

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Assess patient breathing, including mental status, rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. Apply ECG monitor and run strip if trained to do so, time allows and after all other interventions are completed.
3. If signs of bronchospasm are present Administer albuterol (Ventolin) 2.5 mg with or without ipratropium (Atrovent) 500 mcg via nebulizer; May repeat once if no relief.
4. Initiate transport and Contact MEDICAL CONTROL to discuss need for ALS intercept and for repeat medication dosing if indicated.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Assess patient breathing, including rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. Consider need for vascular access and administer NS at a TKO rate if indicated. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6 and the patient has findings of poor perfusion, consider IO access. If signs of poor perfusion are present, administer 20 mL/kg NS bolus.
3. If evidence of poor perfusion persists, administer additional 20 mL/kg NS bolus.
4. Contact MEDICAL CONTROL to discuss need for ALS intercept and for orders regarding rate of fluid administration or repeat medication orders.

Intermediate - Perform/Confirm All Above Interventions

1. Establish vascular access. If IV access unlikely or cannot be rapidly established consider IO placement.
2. Evaluate need for advanced airway management and ventilatory support.
3. If evidence of poor perfusion persists, Contact MEDICAL CONTROL for consideration of administration of epinephrine (1:10,000 solution at 0.1 mL/kg  IV/IO (max dose 10 mL)
4. Initiate transport.
5. Contact MEDICAL CONTROL for further orders.

Paramedic - Perform/Confirm All Above Interventions

1. Administer  diphenhydramine (Benadryl) 1 mg/kg IV/IO (max dose 25 mg)