507.10 - Standing Orders Allergy/Anaphylaxis Treatment Protocol

Code No.  507.10

STANDING ORDERS

ALLERGY/ANAPHYLAXIS TREATMENT PROTOCOL

The following standing orders apply to persons who do not have individual orders provided by parents and/or private physicians.  The guidelines apply to persons with allergic symptoms triggered by touching, inhaling or ingesting allergens or by insect stings.  Before administering medications, attempt to obtain a history from the patient or bystanders, and check for Med-Alert bracelets, etc., to ascertain if patient has any underlying condition that could mimic allergies or anaphylaxis.

For MILD Allergic Reactions:  Patients may exhibit a few hives and itching or swelling at the site of the bite or sting.

1. Administer Benadryl (Liquid, dye-free is preferred.  Make sure patient is not allergic to Benadryl)

1. 5 to 12 years of age, give Benadryl 12.5 to 25 mg orally
2. 12 years of age or older, give Benadryl 25 to 50 mg orally.
3. If stinger is present, remove by scraping it off.  Do not squeeze or pinch stinger, as this may inject more venom.  Apply ice. 
4. Monitor to assess if symptoms improve or worsen.
5. Notify parent and advise parent to consult with physician for follow-up if needed.

For SEVERE Allergic Reactions (Anaphylaxis).  Patient may exhibit some or all of the following symptoms:

*Flushing, hives, swelling or itching, especially of face, lips, mouth, eyes, tongue or throat

*Difficulty breathing or swallowing, tightness in chest or mouth or throat, drooling

*Coughing, sneezing, wheezing

*Difficulty talking, change in voice, runny nose

*Fear or apprehension, feeling of impending doom

*Change in skin color, chills, rapid pulse

*Nausea, vomiting, abdominal pain, diarrhea

* Dizziness, fainting, collapse, convulsion

ADMINISTER EpiPen IMMEDIATELY  (If patient is an infant or toddler who weighs less than 22 pounds or if patient is 50 years or older or has a history of heart disease, it may be prudent to check with physician prior to epinephrine administration, if possible.  However, if there is reasonable evidence that the patient is having an allergic reaction and it appears that death is imminent, administer epinephrine regardless of age.)

1. 1. If under age 6 (estimated weight between 33-66 pounds) give EpiPen Jr. 0.15 mg
   2. If age 6 or above (estimated weight 66 pounds or above) give EpiPen 0.30 mg

TO ADMINISTER EpiPen:

1. Pull off gray safety release
2. Jab black tip firmly into outer thigh so it “clicks” AND HOLD on thigh for approximately 10 seconds
3. Seek medical attention (see below)
4. Enlist others to make phone calls as you provide care.
   
   1. Call 911
   2. Notify parent
   3. Monitor airway, breathing and pulse
   4. Provide CPR if necessary and/or other first aid measures if needed
5. May repeat EpiPen in 20 minutes if needed
6. A SECOND, DELAYED REACTION MAY OCCUR.  Obtain follow-up care in emergency room or as directed by physician.
7. OSHA compliance:  Dispose of EpiPen in red Sharps container or give to paramedics

Physician Signature:_______________________________________      Date_________

Adopted:         07/17/2006

Revised:          10/15/2007

Reviewed:       04/22/2024