Immunotherapy Safety for the Primary Care ... - U.S. Coast Guard

outcome. He found that recurrent or prolonged reactions were 2.8 fold more likely if the
onset was 30 or more minutes after exposure to the stimulus.
General therapeutic measures:
• Close monitoring: PFT’s, oxygen saturation, cardiac monitor, serial BPs
• Initial evaluation and treatment should be directed to maintenance of an effective
airway and circulatory system.
• Epinephrine: Nearly an ideal drug. It suppresses mediator release from mast cells and
basophils and reverses many of the end organ effects of the mediators. It both
relaxes bronchial smooth muscle and produces peripheral vasoconstriction
• Dosage: 1:1,000 concentration
Adult: 0.3 to 0.5 ml, SC or IM (Asthma: 0.5 ml)
Child: 0.01ml/kg (up to 0.3 ml), SC or IM
Repeat: after 10 minutes
Avoid: IV bolus administration (arrhythmias)
Caution: elderly or underlying cardiovascular or cerebrovascular disease
• If anaphylaxis from injection/sting (except head, neck, hands, feet)
• Administer 0.1 to 0.2 ml in the injection/sting site
• Apply a tourniquet (released 1-2 minutes every 10 minutes)
• Remove stinger
• Intravenous infusion (1 mg diluted in 500 ml of D5W)
Adult: 2-4 ug/minute (1-2 mi/minute) Child: 0.1 ugfkg/minute (0.05 mI/kg/min)
• Prompt recognition and treatment is critical -- early use is the key. The longer initial
therapy is delayed, the greater the incidence of fatality.
Expansion of Intravascular Volume
• Trendelenburg position
• Normal saline or Plasmanate can be administered (Child: 10-30 ml/kg)
Vasopressor infusion
• Norepinephrine (Levophed) appears to be the most consistently effective pressor in
anaphylaxis
• Dopamine hydrochloride (Intropin):
• Primarily a beta-adrenergic stimulant.
• May be useful in the presence of cardiac failure.
• Glucagon: IV glucagon has been effective in patient on beta-blockers who are in shock
and unresponsive to beta-agonists. This may reflect a direct action of glucagon on
cardiac that is independent of the beta-receptor.
(It is probably not indicated for bronchospasm).
• Initial dose of 1-5 mg, followed by infusion of 5-15 mg/minute titrated against
blood pressure.