diphenhydramine 1 mg/kg, Monitoring: Continuous hemodynamic monitoring, pulse ox; Urine

max 40 mg IV, over 5 min output in pts receiving IVF for severe hypotension or shock.
Cetirizine 10 mg in
children >12 yrs H1 antihistamine
Immediate intubation of
impending airway obstruction
Albuterol 0.15 mg/kg for epi-resistant #3: Additional supportive care Cricothyrotomy may be necessary if
bronchospasm delay/complete obstruction
#2: Airway Management
and Volume Resuscitaiton Oxygen (8-10 L/min facemark or up to
100% NC), as needed
Commonly given; no Normal saline rapid bolus 20 mL/kg
Glucocorticoid: methylprednisolone
evidence of immediate Reevaluate and repeat as needed.
1 mg/kg (max 125 mg) IV. #1: Epinephrine
benefit; may prevent relapse
(IM preferred; 1 mg/mL)
Mainstay of therapy, delay
leads to increased fatality
IgE-mediated mast cell
degranulation Type 1 Hypersensitivity rxn
Etiology
Bumblebees, honeybees Treatment
Systemic - multiple organ systems
Anaphylaxis highly
Yellow jackets, wasps, hornets
Insects likely when any one of
Stinging black and red fire ants Diagnostic the following is fulfilled
Criteria
Big six: milk, egg, soy,
wheat, peanut and fish
Food Pediatric
#1: Penicillin - beta lactam abx Drugs Latex Common
Triggers
Anaphylaxis
Non β lactams, ASA, NSAIDS, Exercise
chemotherapy agents Perioperative
Immunotherapy Other
Vaccine Allergic urticaria may progress to
anaphylaxis LOCALIZED; No respiratory or other systemic signs
Idiopathic
Features present to indicate concern for anaphylaxis
Leaky vessels, edema of skin/mucosal C1 inhibitor deficiency --> Presents as raised, erythematous, and generally
tissues (bowels, upper airways) excess bradykinin Etiology intensely pruritic wheals
Urticaria
Cutanous swelling of face, Etiology: caused by activated dermal mast cells, histamine +
Hereditary
extremity, genitalia cytokine release --> inflammation
Angioedema
No urticaria, pruritus (which are Features
often seen in anaphylaxis)
DDx 1st line is 2nd-gen antihistamines
Abd pain (colicky, V/D)
Severe asthma Treatment +/- “rescue” 1st gens (diphenhydramine,
Airway obstruction/ Less likely ddx hydroxyzine) for “breakthrough” symptoms
larygnospasm
Upper airway infections (croup,
Low C4 and C1 inhibitor protein epiglottiis)
C1 inhibitor concentrate
Treatment Acute heart failure
Bradykinin antagonist (icatibant)
Kallikrein inhibitor (ecallantide) Foreign body aspiration