Adult Medical Protocol Section 4

- mg

– mg

– Nebulizer if if available if if indicated

SEVERE if if indicated if indicated Protocol AM AM Protocol 5 Albuterol 2.5Albuterol Repeat as needed x needed asRepeat3 Epinephrine Epinephrine IM 1:1000 Hypotension / / HypotensionShock Or Or Hypotension Isolated Airway Protocol(s) AR 1 Protocol(s) Airway 1 AR Urticaria (rash (rash Urticariaonly) effect) (systemicAnaphylaxis Shock effect) (vascular induced) Angioedema (drug Airway obstruction Aspiration / event Vasovagal COPD orAsthma CHF 2 + Body Systems + Body Systems + 2hypotension B

Differential • • • • • • • • mg mg mg mg IM mg

– – AM1

–

50 PO 50 mg

– -

See See Pearls if if available if if indicated if indicated

50 IM 50 IV / mgIO /

25 25

- Ipratropium 0.5 mg0.5Ipratropium MODERATE IV IOProcedureIV / if noif improvement

Diphenhydramine Diphenhydramine - Albuterol Nebulizer Albuterol Nebulizer Albuterol Epinephrine Epinephrine 1:1000 Repeat as needed x needed asRepeat3 x Repeatasneeded 3 25 25 2 + BodySystems + 2 +/ Epinephrine 1:1000 IM Epinephrine 1:1000 Repeat every Repeat every 5 minutes NotifyDestination or if not given PO (See PO (See if Pearls) given not Itching or Itching hives or respiratoryorwheezing Coughing / distress Chest constriction throat or Difficulty swallowing shock orHypotension Edema N/V ContactMedical Control

• • • • • • • Signs andSymptoms A B P A Assess Symptom Severity / Suspected Exposure to AssessSymptomSeverity / Allergen Allergic Reaction / Anaphylaxis Reaction Allergic 50 50 mg

- 50 PO 50 mg Any local EMS System changes to this document must follow the NC OEMS mustbe Policy the documentProtocolNC this EMS local by followchanges OEMS Any Changeapproved System OEMS and to

- MILD 25 25 if if indicated IV IV Procedure Skin Skin Only 25 25 PO / IV / IM / IV IO / PO IM / Diphenhydramine Diphenhydramine Signs and and Signs Symptoms Monitor for for Monitor Worsening Monitor and and Monitor Reassess Revised Past medicalhistory Past history Medication Food allergy / exposure Food allergy allergy/ exposure Medication soap,detergent clothing, New reactions history of Past Onset and and Onset location stingbiteor Insect 12/16/2017

• • • • • • History • • B A Adult Medical Protocol Section Agency Medical Director Agency

. . Medical Agency Director il. il. Paramedic may assist assist may Paramedic or -

Agency Medical Director may requiremayMedical Director Agency

per Agency Medical Medical Director. per Agency

up typically end in end typically - - AM1 should NOT delay administration ofadministration delayepinephrine. should NOT involves involves lips,theextremities,face, airwaymaystructures,swelling causeof and severe moderateto a patient andpatient may patient adecreased hypotensivea/ nauseaas withmental status or this cause Allergic Reaction / Anaphylaxis Reaction Allergic is seen in moderate to severe reactions and is swelling involving the face, lips or airway structures. This can also becanThis also structures. face, airwayorthe involving swellinglips is severe and in to reactions moderate seen is Flushing, hives, itching, erythema plus respiratory (wheezing, dyspnea, hypoxia) or or dyspnea, gastrointestinal hypoxia) erythema itching,(wheezing, respiratory Flushing, plus hives, and pressureperfusion. with blood pain) vomiting,normal abdominal (nausea, symptoms or dyspnea, gastrointestinal hypoxia) erythema itching,(wheezing, respiratory Flushing, plus hives, hypotension. or perfusion with pain) vomiting, (nausea, abdominal isolated hypotension/poor symptoms Flushing, hives, itching, erythema with normal blood pressure andpressureblood perfusion. normal erythema itching,Flushing, with hives, e infusion. ContactMedicale infusion. dosing. appropriate Control for Any local EMS System changes to this document must follow the NC OEMS mustbe Policy the documentProtocolNC this EMS local by followchanges OEMS Any Changeapproved System OEMS and to in patients taking blood pressure medications like Prinivil / like (lisinopril) bloodZestril medications pressure taking Prinivil in patients Moderate Moderate symptoms: Severe symptoms: NOT be given given NOT to be or and vomiting. / symptoms: Mild Drug of choice and the FIRST drug that should be administered in acute anaphylaxis (Moderate / Severe Symptoms.) (Moderate anaphylaxis / be that drugFIRST andSevere of the acute in choice Drug administered should access. IOIVatduringpriorityin or administered attempts should or before be IM Epinephrine may /given utility After haveonlySevere steroids be and proven noanaphylaxis Moderate in Diphenhydramine and Epinephrine administration. should NOT steroidsrepeated delay and Diphenhydramine Epinephrine. mental decrease Diphenhydramine Severe Diphenhydramine should anaphylaxis may Oral Moderate status. In and The shorter the onset from exposure to symptoms the more severe severe reaction. to the more from the symptoms exposure shorter onset Thethe EMR may administer diphenhydramine by oral route only and may administer from supply may EMS from route administer oral and diphenhydramine only administerby may EMR medication. / to administering any EMR prior EMT medical control of require maycontact EMS fromadministerand already may supply. if Albuteroladministerprescribed EMT patient may medication. / to administering EMR prior any medical EMT require may control of contact EMR / EMT may administer Epinephrine IM and may administer from EMS supply. IM EMS from may administer and / EMRmay Epinephrine administer EMT administering prior any medical / EMR medication. control of contactEMT to manual or IMdraw AutoInjector via may Epinephrine / administer EMREMT Hereditary Hereditary Angioedema medications of reversal aid specific are to Some swelling. prescribed abdominal in patients pain. patientper instructions. / this administerpackage medication monitoringand cardiac ECG 12 lead Allergic reactions may occur with only respiratory and gastrointestinal symptoms and have no rash / skin andhave rash involvement. no symptoms gastrointestinal with occurand respiratory reactions only may Allergic Angioedema seen Anaphylaxis unresponsive to repeat doses of IM epinephrine may require IV epinephrine administration by IV push or or push by administration IV IV requireepinephrine may ofdosesIM to epinephrine repeat unresponsive Anaphylaxis epinephrin Classification: SeveritySymptom Recommended Exam: Mental Status, Skin, Heart, Lungs, Status, Exam: Lungs, Mental Abdominal Recommended Heart, Skin, allergic lethalreaction. multisystem and an potentially is acute Anaphylaxis Epinephrine administration: Revised 12/16/2017

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