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

S492 Lieberman et al
J ALLERGY CLIN IMMUNOL
MARCH 2005
FIG 4. Suggested anaphylaxis supply check sheet
successful. These include, for example, inhaled
epinephrine in the presence of laryngeal edema or
sublingual administration if an intravenous route
cannot be obtained. Endotracheally administered
dosages have also been proposed for use when intravenous
access is not available in intubated patients
experiencing cardiac arrest.
Annotation 6. Subsequent emergency care
that might be necessary depending on
response to epinephrine
1. Place patient in the recumbent position and elevate
the lower extremities, as tolerated symptomatically.
This slows progression of hemodynamic compromise,
if present, by preventing orthostatic hypotension
and helping to shunt effective circulation from
the periphery to the head and to the heart and kidneys.
2. Establish and maintain airway. Ventilatory assistance
through a 1-way valve facemask with an oxygen
inlet port (eg, Pocket-Mask [LaerdalÒ, Preparedness
Industries, Ukiah, Calif] or similar device) might be
necessary. Ambubags of less than 700 mL are
discouraged in adults in the absence of an endotracheal
tube because ventilated volume will not overcome
150 to 200 mL of anatomic dead space to
provide effective tidal volume. (Ambubags can be
used in children, provided the reservoir volume of
the device is sufficient.) Endotracheal intubation or
cricothyroidotomy might be considered where appropriate
and provided that clinicians are adequately
trained and proficient in this procedure.
3. Administer oxygen. Oxygen should be administered
to patients with anaphylaxis who have prolonged
reactions, have pre-existing hypoxemia or myocardial
dysfunction, receive inhaled b-agonists as part of