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

In the prehospital setting, anaphylaxis must be recognized and treated immediately to prevent airway compromise, shock, and death. The proper assessment and management of a patient experiencing anaphylaxis includes the following steps:

1. Recognize the Signs & Symptoms – Common indicators of anaphylaxis include:
2. Respiratory distress (wheezing, stridor, difficulty breathing)
3. Hypotension (low blood pressure)
4. Urticaria (hives), itching, and swelling (especially around the face, lips, and throat)
5. Gastrointestinal symptoms (nausea, vomiting, diarrhea)
6. Rapid, weak pulse or signs of shock
7. Perform Initial Assessment & Maintain Airway –
8. Check the airway for swelling or obstruction. If swelling is present, be prepared to manage the airway aggressively.
9. Administer high-flow oxygen via a non-rebreather mask or assist ventilations with a BVM if necessary.
10. Position the patient in a supine position unless respiratory distress worsens in this position.
11. Administer Epinephrine –
12. First-line treatment for anaphylaxis is intramuscular (IM) epinephrine 1:1000 at a dose of 0.3 mg for adults or 0.15 mg for children (typically via an auto-injector in the lateral thigh).
13. If there is no improvement after 5-15 minutes, a second dose may be necessary per protocol.
14. Monitor Circulation & Manage Shock –
15. Administer normal saline (if within your scope of practice) to support blood pressure if signs of hypotension are present.
16. Monitor for signs of hypotension and prepare for advanced interventions if needed.
17. Consider Adjunct Medications –
18. Albuterol nebulizer may be indicated if bronchospasm is present.
19. Rapid Transport to the Nearest Emergency Department –
20. Even if symptoms improve, all patients experiencing anaphylaxis require transport for further evaluation, as biphasic reactions can occur hours later.
21. Continuous Monitoring & Reassessment –
22. Monitor airway, breathing, circulation (ABCs), and vitals frequently.
23. Be prepared to escalate care if the patient deteriorates.

Early recognition and immediate administration of epinephrine are the most crucial steps in treating anaphylaxis. Delaying treatment can result in rapid deterioration, making swift assessment and intervention essential in the prehospital setting.