14
Management
Refractory anaphylaxis
15. Advanced airway
management
Use supraglottic airway, endotracheal intubation,
or cricothyroidotomy for marked stridor, severe
laryngeal edema, or when ventilation using the
bag-valve-mask is inadequate and EMS has not
arrived
16. Vasopressors Consider administration of dopamine (in
addition to epinephrine infusion) if patient
is unresponsive to above treatment; this will
likely be in the hospital setting where cardiac
monitoring is available
Optional treatment (efficacy has not been established)
17. H
1
antihistamine Consider giving 25-50 mg of diphenhydramine
intravenously for adults and 1 mg/kg (maximum
50 mg ) for children; use 10 mg of cetirizine if an
oral antihistamine is administered. Once there
is full recovery, there is no evidence that this
medication needs to be continued
18. Corticosteroids Administer 1-2 mg/kg (≤125 mg ) per dose,
intravenously or orally, of methylprednisolone
or an equivalent formulation. Once there is
full recovery, there is no evidence that this
medication needs to be continued
Observation and monitoring
19. Observation in hospital Transport to emergency department by EMS for
further treatment and observation for ≥8 h
20. Observation in office Observe in office until full recovery + additional
30-60 min for all patients who are not candidates
for EMS transport to emergency department
Discharge management
21. Education Educate patient and family on how to recognize
and how to treat anaphylaxis
22. Auto-injectable
epinephrine
Prescribe 2 doses of AIE for patients who have
experienced an anaphylactic reaction and for
those at risk for severe anaphylaxis. Train patient,
patient provider, and family on how to use the
auto-injector
24. Anaphylaxis action plan Provide patients with an action plan instructing
them on how and when to administer
epinephrine
Table 8. Anaphylaxis Treatment Protocol in the Physician's
Office (cont'd)
