VAN BUREN/CASS DISTRICT HEALTH DEPARTMENT
ANAPHYLAXIS TREATMENT
STANDING ORDER
INTRODUCTION
Personnel administering vaccines must be able to recognize and treat anaphylaxis. Its
occurrence is sudden, dramatic and can be life threatening. This standing order empowers and
requires health department staff and providers to proceed with treatment immediately.
All immunization activity sites must have the following available:
1)
2)
3)
Epinephrine 1:1,000 aqueous
Diphenhydramine (Benadryl)
Oral airways
INDICATION
Anaphyaxis (Anaphylactic Reaction). Anaphylaxis is the acute immediate severe reaction of a
patient to any antigen to which he is hypersensitive. Its occurrence is sudden, dramatic and
unexpected.
Basic Principles
a.
Anaphylactic reactions vary from mild symptoms of itching to severe respiratory
distress and profound chock.
b.
Many agents may initiate this process and may enter the body by any route.
Vaccination agents may very rarely cause such a reaction.
c.
The reaction occurs within seconds or minutes after the exposure so that prompt
recognition and treatment is essential.
d.
Clinically, the picture varies from mild itching and swelling to complete cardiorespiratory collapse.
e.
Sometimes a sense of apprehension precedes the classic clinical manifestations.
Systemic Signs and Symptoms
a.
Skin - pruritis (itching); urticaria (local raised itching); erythema (redness);
angioneurotic edema (swelling due to spasm or paralysis of blood vessels)
b.
Gastrointestinal - nausea and vomiting; diarrhea, colic
c.
Respiratory - Rhinitis; cough; laryngeal edema; hoarseness; bronchospasm with
wheezing or difficult breathing; cyanosis; respiratory insufficiency and arrest.
d.
Cardiovascular - hypotension; circulatory collapse and cardiac arrest.
Anaphylaxis Treatment Standing Order, Page 1 of 3
MANAGEMENT
The most effective management is prevention. An adequate history will eliminate most
candidates who are hypersensitive
1.
2.
Mild Symptom (itching and urticaria)
a.
Epinephrine hydrochloride 1:1000 (adrenaline) subcutaneously
(dose as given in 2c below)
b.
Oral Benadryl (dose as given in 2d below)
c.
Assess vital signs and observe clinically for any deterioration. If deterioration
occurs, then follow procedures for Anaphylactic Shock and transfer to
emergency room.
d.
For mild symptoms which do not require immediate transfer to the Emergency
Room, notify the Medical Director or Deputy Medical Director.
Anaphylactic Shock (unconsciousness, hypotension, absent or feeble pulse)
a.
Ensure an adequate airway.
b.
Activate the emergency response system; assess vital signs; initiate Basic Life
Support if necessary; transfer the patient to the emergency room as soon as this
can be arranged.
c.
Epinephrine hydrochloride 1:1000 (adrenalin) subcutaneously. May be repeated
in 5-10 minutes for unconsciousness and hypotension.
Dose: Under 1 year.................0.1 ml
1 year - 3 years.............0.2 ml
4 years - 6 years...........0.3 ml
7 years - 9 years...........0.4 ml
10 years - Adult.............0.5 ml
d.
If patient is alert enough to swallow medication, administer Benadryl orally.
Otherwise, administer it IM.
Dose: Children <40 kg…………….……..1.25 mg/kg
Adults and Children > 40 kg………..50 mg
e.
Send a report to the emergency facility which includes antigens given,
symptoms, vital signs and treatment given. Transfer must not be delayed by
report writing; a verbal report may be made by phone when transfer is underway.
f.
After all emergency procedures are already underway, notify the Medical
Director or Deputy Medical Director. Treatment and transfer to the emergency
room should not be delayed by lack of availability of the Medical Director.
REFERENCES
1. Ewald G, McKenzie CR (eds.). Manual of Medical Therapeutics, 28th edition. (The
Washington Manual) Boston: Little Brown and Company, 1995.
Anaphylaxis Treatment Standing Order, Page 2 of 3
2. Johnson, Kevin B. (ed.). The Harriet Lane Handbook: A Manual for Pediatric House
Officers. 13th edition. Baltimore: Mosby, 1993.
3. Poscoe, Delmer, Grossman and Moses. Quick Reference to Pediatric Emergencies.
Philadelphia and Toronto: J.B. Lippincott Company, 1984.
DISTRIBUTION
Immunization Manual
Family Planning Manual
STD Manual
Frederick A Johansen, MD, FAAP
Medical Director
Rev: 3/2/2006
StandingOrders/Anaphylaxis-VBC.doc
Anaphylaxis Treatment Standing Order, Page 3 of 3
Date