Anaphylactic reaction?
Airway, Breathing, Circulation, Disability, Exposure
Diagnosis - look for:
  • Acute onset of illness
  • Life-threatening Airway and/or Breathing and/or Circulation problems 1
  • And usually skin changes
  • Call for help
  • Lie patient flat
  • Raise patient's legs
Adrenaline 2
When skills and equipment available:

  • Establish airway
  • High flow oxygen
  • IV fluid challenge 3
  • Chlorphenamine 4
  • Hydrocortisone 5

Monitor:

  • Pulse oximetry
  • ECG
  • Blood pressure

1. Life-threatening problems:
Airway: swelling, hoarseness, stridor
Breathing: rapid breathing, wheeze, fatigue, cyanosis, SpO2 < 92%, confusion
Circulation: pale, clammy, low blood pressure, faintness, drowsy/coma

2. Adrenaline (give IM unless experienced with IV adrenaline)

IM doses of 1:1000 adrenaline (repeat after 5 min if no better)
Adult: 500 micrograms IM (0.5 mL)
Child more than 12 years: 500 micrograms IM (0.5 mL)
Child 6 -12 years: 300 micrograms IM (0.3 mL)
Child less than 6 years: 150 micrograms IM (0.15 mL)


Adrenaline IV to be given only by experienced specialists
Titrate: Adults 50 micrograms; Children 1 microgram/kg

3. IV fluid challenge:

Adult - 500 - 1000 mL
Child - crystalloid 20 mL/kg

Stop IV colloid if this might be the cause of anaphylaxis


4. Chlorphenamine (IM or slow IV)
Adult or child > 12 yrs10 mg
Child 6 - 12 yrs5mg
Child 6 months to 6 yrs2.5mg
Child < 6 months250 micrograms/kg

5. Hydrocortisone (IM or slow IV)
Adult or child > 12 yrs200mg
Child 6 - 12 yrs100mg
Child 6 months to 6 yrs50mg
Child < 6 months25mg