Fig 2. Treatment of Anaphylactic Event in the Outpatient Setting
Anaphylaxis preparedness
Patient presents with possible probable acute anaphylaxis
Initial assessment supports potential anaphylaxis?
eg, nonlocalized urticaria aſter immunotherapy
YES
Immediate intervention: > Assess airway, breathing, circulation, mentation
> Inject epinephrine and re-evaluate for repeat injection if necessary
> Supine position (if cardiovascular involvement suspected)
Good clinical response?
YES
Observation: > Length and setting of observation must be individualized
> Auto-injectible epinephrine NO
Subsequent emergency car that may be necessary depending on response to prinephrine: Consider: > Call 911 and request assistance > Recumbent position with elevated legs
> Establish airway
> O2 > Repeat epinephrine injection if indicated
> IV fluids if hypotensive; rapid volume expansion
> Consider inhaled bronchodilators if wheezing
> H1 and H2 antihistamines > Corticosteroids
NO
> Call 911 if not already done Consider: > Epinephrine intravenous infusion > Other intravenous vasopressors > Consider glucagon
Management of anaphylaxis: • General: Patient education > Risk assessment > Consider appropriate discontinuation of ACE inhibitors and b-blockers > Medication: self-administered epinephrine
• Specific: Avoidance (eg, food) > Immunotherapy (eg, hymenoptera) > Desensitization (eg, penicillin) > Graded challenge (eg, local anesthetic) > Premedication (eg, radiocontrast)
9 NO Consider other diagnosis
