0071643192.pdf

■ Less severe symptoms
■ Adults: 0.3–0.5 mg of 1:1000 solution IMq 5–10 minutes
■ Pediatrics: .01 mg/kg, max 0.3 mg of 1:1000 solution IMq 5–10
minutes
■ Severe symptoms
■ Adults: 1 mL of 1:10,000 solution (0.1 mg) IVover 5 minutes (may
dilute in 10 mL to 1:100,000 solution); repeat PRN
■ Pediatrics: .01 mg/kg of 1:10,000 solution IV over 1–2 minutes;
repeat PRN
■ Crystalloid boluses via large-bore IVs
■ 1–2 liters in an adult
■ 20 cc/kg in children and infants
■ Histamine blockade
■ Diphenhydramine (H 1 blocker)
■ Cimetidine (H 2 blocker)
■ Other H 2 blockers are not as efficacious in anaphylaxis as cimetidine.
■ β 2 -Receptor agonistsfor bronchospasm
■ Aerosolized albuterol
■ Ipratropium and magnesium may be used as well.
■ Corticosteroidsto reduce inflammation, stabilize mast cells and basophils,
and prevent rebound phenomenon
■ Methylprednisolone
■ Glucagon
■ For refractory hypotension in patients on β-blockers
■ 1 mg IV every 5 minutes until hypotension resolved
■ Admission, if hypotension present

REWARMINGSHOCK

When a profoundly hypothermic patient is externally rewarmed, vasodilation
in the skin occurs. With the distribution of a large portion of plasma volume to
the skin there may be ensuing hypotension. In addition to causing vasodilation,
external rewarming may result in further cooling of the core (“afterdrop”),
which may worsen the patient’s cardiac output.

TREATMENT

■ Administration of crystalloid boluses (warmed)
■ Use core rewarming techniques in patients with severe hypothermia.
■ Use of vasoactive pressor agents: Rarely needed.
■ Phenylephrine
■ Norepinephrine
■ Dopamine

NEUROGENICSHOCK

Neurogenic shock occurs when an acute spinal cord injury above the level of
T6 disrupts the autonomic system, preventing tachycardia and peripheral
vasoconstriction.

SYMPTOMS/EXAM

■ Acute traumatic injury
■ Neurological deficits correlating to a spinal cord level above T6
■ No evidence of hemorrhage
■ Hypotension with relative bradycardia

RESUSCITATION

IM administration of

epinephrine has shown more

consistent absorption over

subcutaneous dosing in the

treatment of anaphylaxis.

Refractory hypotension from

anaphylaxis in patient on

β-blockers?

Administer glucagon.

Neurogenic shock is seen with

spinal cord injury above T6.