Adult Medical Protocol Section IM mg IO IO / IO / mg ) IM Procedure – 5 / mg hypotension mg mg IM + minutes if no minutes if P – 5 5 – 0.5 Nebulizer 2.5 if available if if indicated if indicated if improvement Airway Airway obstruction SEVERE 25- 50 mg PO / 0.3 if indicatedif if not already given if already not Diphenhydramine Diphenhydramine IV Epinephrine1:1000 NebulizerAlbuterol Albuterol Albuterol 2.5 Repeat as needed as Repeat x 3 x needed 3 as Repeat 25 - 50 mg IV 25mg- 50 IV Airway Airway Protocol(s +/- Ipratropium 0.5 Epinephrine 1:1000 Epinephrine1:1000 Repeat inRepeat Procedure Or Isolated Isolated Hypotension Or Body Systems Systems Body + I Urticarial (rash only)Urticarial(rash Anaphylaxis (systemic effect) effect)Shock(vascular Angioedema(drug induced) Aspiration event Vasovagal COPD or Asthma CHF 2 P B       Differential   Anaphylaxis IM mg / 24 / IO / IM / mg mg mg IM 5 5 minutes if no minutes if – – 5 0.5 5 5 wheezing or respiratory respiratory or wheezing – / 2. 2. if available if if indicated if indicated if 3 improvement IV ProcedureIV Protocol 25- 50 mg PO Body Systems Body 0. MODERATE + Diphenhydramine Diphenhydramine - Ipratropium - Ipratropium 5 0. Albuterol Albuterol Nebulizer 1:1000 Epinephrine Albuterol Nebulizer Repeat as needed as Repeat x 3 needed as Repeat x 3 25 - 50 mg IV 25- 50 mg IV 2 +/ Epinephrine 1:1000 Epinephrine1:1000 if not already given PO already notgivenif Repeat inRepeat Notify Destination or or Destination Notify Itching or hives orItching Coughing distress constriction throatorChest swallowing Difficulty shockor Hypotension Edema N/V Assess Symptom Severity Contact Medical Control Medical Contact Suspected Exposure to Exposure Suspected Allergen I P B Signs and Symptoms and Signs        detergent exposure , / / IO / Allergic Reaction mg IM exposure soap / / , IV Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and bebyPolicyOEMS Changetheapproved OEMSand ProtocoldocumentNC this toEMS localmust follow changes Any System / MILD 25- 50 if indicated if IV Procedure IV Skin Only Skin 25 - 50 mg - mg 2550PO PO Diphenhydramine Diphenhydramine Signs and Symptoms Signs and Monitor for Worsening Monitor for Monitor and Reassess Monitor and if if available Insect sting or bite or Insect sting allergy Food Onset and location Onset and Medication allergy Medication allergy New clothing of reactions Past history history Past medical Medication history 2016 / I 21 Cardiac Monitoring Monitoring Cardiac B B Revised 2/ and Severe Reactions and Severe Indicated for Indicated Moderate   History       Adult Medical Protocol Section Severe / . This can also also becanThis . skin skin involvement. / Agency DirectorMedical . or gastrointestinal or gastrointestinal or gastrointestinal ) ) . -P may assist EMT-P or may il. -il. hypoxia hypoxia and may cause moderate tomoderate severe and cause may , , , . lips or airway lips structures airway or , per Agency Medical Director Agency Medical per up dyspnea dyspnea , , extremities , Anaphylaxis / 24 . Zestril Zestril (lisinopril)-typically end in MR administering any MR administeringmedication with normal blood pressure andpressureblood perfusion. with normal hypotension. or with perfusion isolated hypotension/poor / / ) ) airway airway structures , MR administering any MR administeringmedication lips , Lungs Protocol , the more severe the reaction.severe the more the , Heart abdominal abdominal pain abdominal pain , , , -B administering any medication. any-B administering package package instructions / Skin should NOT delay administration of epinephrine. of NOT administration delay should erythema plus respiratorypluserythema (wheezing erythema with normal blood pressure and perfusion. with normal and erythemapressure blood respiratorypluserythema (wheezing , EMT , , , , / vomiting vomiting , , itching itching itching , , , : involves swellinginvolvesof the face hives hives hives Contact Medical Control for appropriate appropriate dosing. Medical Contact for Control , , , . : Allergic Reaction Some patients are prescribed specific medications to aid in reversal of of reversal aid prescribedswelling. patients inspecific are medications Some to . is seen in moderate to severe reactions and is swelling involving the face the involvingswelling is to moderate seen is severe in and reactions Flushing symptoms (nausea symptoms (nausea Flushing Flushing Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and bebyPolicyOEMS Changetheapproved OEMSand ProtocoldocumentNC this toEMS localmust follow changes Any System -B may administer Epinephrine IM and may administer fromEMSadminister and supply.IM -B may may Epinephrine Director administer Agency require may Medical or manual draw-AutoInjectorvia IM Epinephrine may -B administer EMT EMT -B may administer diphenhydramine by oral route only andsupply only by oral may EMS from route administer may -B diphenhydramine administer supply. already prescribed may patient EMS from administer and may -B if Albuterol administer Agency Medical Moderate symptoms Moderate Mild Mild symptoms symptoms: Severe / / Anaphylaxis unresponsive to repeat doses of IM epinephrine may require IV epinephrine administration by IV push or push by epinephrine epinephrine administration may IV IVIM require repeat of unresponsive doses to Anaphylaxis epinephrine infusion Classification:Severity Symptom Symptoms.) IM Epinephrine should be administered in priority before or during attempts at IV or attempts access. or IO before IV at during Epinephrine be priority in Symptoms.)administered IMshould Prinivilblood medications patients pressure seen like taking in Anaphylaxis is an acute and potentially lethal multisystem acute allergic potentially reaction.lethal is Anaphylaxis and an acutein administered shouldanaphylaxis the be is choice that drug first the and Epinephrineof drug (Moderate have symptoms respiratory only andrash no gastrointestinal may with and Allergic occur reactions Angioedema Angioedema Hereditary abdominal pain abdominal medication thispatient per administer control of contactprior medical to requiremay EMT- B / Recommended Recommended Mental Exam: Status contact of medical control prior to to MR control of contact prior medical EMT- control of contact prior Director medical to require may B 12 lead ECG and cardiac monitoring and cardiac lead ECG 12 MR MR EMT EMT to contact symptoms onset the from shorter The 2016 / 21 Revised 2/        Pearls       