What is the correct procedure for assessing and treating a patient with suspected anaphylaxis in the prehospital setting?

Question

Anaphylaxis is a life-threatening emergency that requires immediate intervention. As an EMT, what steps should you take to recognize, assess, and manage a patient experiencing anaphylaxis in the field? Include considerations for airway management, medication administration, and transport decisions.

Answer 1

To medically assist prehospital patients who display signs of anaphylaxis clinicians must perform these assessment and treatment steps.

1. Assessment: Safety should be guaranteed to protect patients as well as emergency responders during the assessment period. Fast assessment of the patient's airway breathing and circulation stands as the main priority at the beginning of care. Inspection should include detection of airway obstructions which include tongue or throat swelling or difficulty breathing or wheezing sounds. Medical personnel must look for three main shock indicators consisting of hypotension, tachycardia and pale skin condition. Ensure careful assessment of hives together with swelling and redness especially around the face lips or neck because these are typical signs of anaphylaxis. If possible the medical professional should quickly get historical information regarding known allergies together with recent exposures and sign, symptom onset.

2. Immediate Treatment:

Administer Epinephrine (adrenaline): The first response to treat anaphylaxis requires intramuscular (IM) injection of epinephrine into the vastus lateralis of the outer thigh. - Adult dose: 0.3–0.5 mg of 1:1000 epinephrine. - Pediatric dose: 0.01 mg/kg of 1:1000 epinephrine (up to 0.3 mg for children). The treatment should start immediately with the recommended dose because mild symptoms already indicate a potential emergency.

Oxygen: The patient requires oxygen therapy at 100% concentration through a non-rebreather mask in case their respiratory or hypoxia symptoms are present.

IV Access: The healthcare provider should establish intravenous access to provide normal saline fluids because this helps support circulation specifically when hypotension develops.

Monitor the patient closely: Medical personnel must keep an active check of vital signs which include measuring pulse and blood pressure and exploring respiratory rate and oxygen saturation levels.

Another dose of epinephrine should be administered through an intravenous needle in case symptoms get worse after a period of five to ten minutes.

3. Additional Treatments (if needed):

The healthcare provider will consider giving antihistamines (such as diphenhydramine) and steroids (such as hydrocortisone) for supplementing care but these drugs remain secondary to other interventions.

Administering albuterol acts as a suitable treatment option when wheezing and bronchoconstriction become problematic.

4. Transport:

Medical facilities should receive the victim immediately because anaphylaxis evolves quickly enough to cause fatal harm including breathing obstruction and cardiovascular failure and death.

Make an urgent call to the destination medical facility to report patient status together with all applied medical interventions.

5. Reassess:

Routine checks should monitor the patient's health status throughout transportation for signs or symptoms that worsen.

When treating patients in the prehospital setting the immediate administration of epinephrine stands as the most essential medication. The administration of antihistamines or steroids cannot replace epinephrine therapy because patients should receive epinephrine first.