Environmental

Administer Diphenhydramine 1 mg/kg PO/IV/IM

1) Administer O2

2) Administer Epinephrine (1:1,000) 0.01 mg/kg IM, maximum dose 0.3 mg / 0.3 ml

3) Establish IV NS and give 20 ml/kg fluid bolus

4) Administer Diphenhydramine 1 mg/kg PO/IM/IV

5) In case of wheezing or respiratory distress administer aerosolized Albuterol 5 mg (2 vials) with Ipratroprium 0.5 mg (1 vial)

6) If hypotensive, continue IV NS bolus 20 ml/kg

7) If unable to establish IV then establish IO access.

8) If patient remains in critical condition:

a. Administer Epinephrine 0.01 mg/kg IV or IO

b. For more accurate dosing, use the dilute form 1:10,000 which is 0.1 mg/ml

c. Infuse briskly and administer the IV Epinephrine dose slowly, over 1- 2 minutes

d. Monitor cardiac monitor and VS

9) If no IV or IO access available and patient is still in shock, repeat Epinephrine 0.01 mg/kg IM 5 minutes after first dose

1) Administer O2

2) Consider CPAP if respiratory distress persists. Apply CPAP if:

a) BP > 90 mmHg systolic

b) The patient is awake and able to tolerate the CPAP

c) The patient can fit the mask

d) The patient if able to maintain an open airway

3) Establish an IV NS at TKO

4) Be aware of possible hypothermia

5) Prevent further heat loss

6) Patient should be dry

7) Cover the patient with blankets and turn off the air conditioner

8) Advise receiving facility/physician of CPAP use

9) If respiratory status deteriorates, remove the device and assist ventilations with BVM

Central Nervous System