10
Management
II. Office Management of Anaphylaxis
Î SS 9: Plan for appropriate office response to anaphylaxis by (1)
educating staff and patients, (2) preparing an anaphylaxis emergency
cart, and (3) developing an office action plan for anaphylaxis
management to maintain proficiency in anaphylaxis management.
(S-D)
Î SS 10: Prepare all office staff (clerical, nursing, and primary
providers) to recognize and monitor the patient for the early signs
and symptoms of anaphylaxis in preparation for epinephrine
administration. (S-D)
Î SS 11: At the onset of anaphylaxis, (1) administer epinephrine
intramuscularly in the mid-outer thigh; (2) remove the inciting
allergen, if possible (eg, stop an infusion); (3) quickly assess
airway, breathing, circulation, and mentation and summon
appropriate assistance from staff members; and (4) start, if needed,
cardiopulmonary resuscitation and summon emergency medical
services (EMS). (S-D)
Î SS 12: After administering epinephrine, notify EMS for patients having
severe anaphylaxis and/or patients not responding to epinephrine.
(S-C)
Î SS 13: Place and maintain patients in a supine position, unless
respiratory compromise contraindicates it, to prevent or to counteract
potential circulatory collapse. Place pregnant patients on their left
side. For maintaining hemodynamic stability, intravenous access is
essential. (R-C)
Î SS 14: Administer oxygen to select patients in anaphylaxis. (S-C)
Î SS 15: Make a rapid and ongoing assessment of the patient's airway
status and maintain airway patency using the least invasive but
effective method (eg, bag-valve-mask). (S-D)
Î SS 16: Initiate intravenous fluid replacement with normal saline for
patients with circulatory collapse and for patients who do not respond
to intramuscular epinephrine. (S-C)
Î SS 17: In addition to epinephrine administered for anaphylaxis,
consider administering a nebulized β
2
- agonist (eg, albuterol) for signs
and symptoms of bronchospasm. (R-B)
Î SS 18: In patients receiving β-adrenergic blocking agents, administer
glucagon if they have not responded to epinephrine. (S-C)
Î SS 19: Never administer H
1
or H
2
antihistamines or corticosteroids
as initial therapy for anaphylaxis instead of epinephrine and consider
these agents optional or adjunctive therapy. (S-B)
