Anaphylaxis Protocols

[EpiEMS]

Do you have any relative or absolute contraindications (or mandatory medical control contact points) for epinephrine administration in your anaphylaxis protocols?

If so, what are they? Do you think they're sound?

Ours used to have mandatory medical control contact before EpiPen administration to anybody with a cardiac history, over 60, or pregnant, but they removed these with our new 2016 protocols (yay!). After all, there was no evidence that I am aware of suggesting that these were clinically valid reasons to delay administration.

I'm more afraid of undertreatment, frankly.

 

[DesertMedic66]

Nope

 

[NomadicMedic]

As seen above, We have to contact med control for Patients >50, hx of cardiac ischemia or rate >150.

I understand that's coming out, since we haven't updated protocols since 2013.

 

[EpiEMS]

We have to contact med control for Patients >50, hx of cardiac ischemia or rate >150.

Oof. Well, hopefully the doc comes to the phone fast?

 

[NomadicMedic]

Oof. Well, hopefully the doc comes to the phone fast?

I'm certainly not a cowboy, but I'd have no problem hitting anaphylaxis with Epi and not calling first. In extremis, we treat first and then call.

 

[DrParasite]

we give epi (I think at both the BLS and ALS level) at .3 mg for adults <50, and .15mg for adults >50 and kids. we don't have to call for it at all

I think the line of thinking is epi may cause a heart condition to get worse, which is not good. withholding epi can result in the patient quickly dying.

 

[StCEMT]

we give epi (I think at both the BLS and ALS level) at .3 mg for adults <50, and .15mg for adults >50 and kids. we don't have to call for it at all

.5 and .3 respectively here. Unless it's an older kid and then they get .5 too.

OP, no mandatory contact points unless I gave 2 doses and there is no improvement.

 

[Handsome Robb]

No mandatory contact for us. We also do epi drips on standing orders if we need to re-dose it rather than sending them on a catecholamine rollercoaster of IM shot after IM shot.


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[StCEMT]

No mandatory contact for us. We also do epi drips on standing orders if we need to re-dose it rather than sending them on a catecholamine rollercoaster of IM shot after IM shot.


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What dose do you use for that?

 

[Handsome Robb]

What dose do you use for that?

2mg in 100cc of NSS at 5mcg/min titrated to effect.




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[Eden]

No contraindications or contact needed..can do drips and iv push.

 

[NPO]

No contact for us, and BLS is just got it added to their scope as an EpiPen but will soon be allowed to draw up Epi as well.

We are supposed to contact for Benadryl though.

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[Handsome Robb]

We are supposed to contact for Benadryl though.

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What? [emoji848]


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[NPO]

What? [emoji848]


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Yeah. Idk. Probably because they don't want you giving it to people having an asthma attack lol.

We hardly give it.

Our medical director is investigating getting rid of all Level 2 (base order) meds and procedures and making everything standing order.

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[Handsome Robb]

Yeah. Idk. Probably because they don't want you giving it to people having an asthma attack lol.

We hardly give it.

Our medical director is investigating getting rid of all Level 2 (base order) meds and procedures and making everything standing order.

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Well yea...you shouldn't be giving it for an asthma attack...but still! Calling for benedryl...that's a new one.

Not hating on you, that's just *** backwards.


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[NPO]

Well yea...you shouldn't be giving it for an asthma attack...but still! Calling for benedryl...that's a new one.

Not hating on you, that's just *** backwards.


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Yeah, but how many times have you seen anaphylaxis treated with albutrol first lol.

It's in there from our old Medical Director. And we're allowed to give any med without contact if we think it's necessary and the time to call in would be detrimental to the patient.

Although, Benadryl never brought someone back from the brink of death in the last few minutes anyway. I think most people either don't give it, or give it and tell them later.

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[NysEms2117]

http://midstateems.org/docs/2016/2016 Collaborative Protocols Last Draft for Comments.pdf
You can try an interpret page 30- Paramedic up here has: albuterol, atrovent, decadron, and benadryl.
The other protocols for BLS basically say if they're dying use an epi pen, but don't use it to early so i won't link those. NYS also had a checklist(shocking i know) of things that needed to happen, if the kid was under 18 MC, over 60 MC, heart condition MC, all of which got removed as well in the same update that canned backboards and what not. How you'd find that out, not entirely sure, but okay NY .

 

[GMCmedic]

Nope. Strong emphasis on Epi and Epi drips.

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