1. Severe Allergic Reaction Protocol & Epinephrine Administration Bill Hall, MD Mesa County EMS System West End EMS System

2. Severe Allergic Reaction Known or suspected allergen exposure Known or suspected allergen exposure Severe Reactions: (ANY OF THE FOLLOWING) Severe Reactions: (ANY OF THE FOLLOWING) Wheezing Wheezing Difficulty Breathing Difficulty Breathing Oral Swelling Oral Swelling Altered Level of Consciousness Altered Level of Consciousness Chest Tightness Chest Tightness Hypotension Hypotension

3. Treating Reactions Contact Dispatch, request ALS backup Contact Dispatch, request ALS backup Assess reaction Assess reaction If SEVERE, If SEVERE, Contact Base for IM Epinephrine authorization Contact Base for IM Epinephrine authorization Oxygen Oxygen Remove Allergen Remove Allergen

4. Epinephrine Dose: Dose: All ages: 0.3 mg IM 1:1000 concentration All ages: 0.3 mg IM 1:1000 concentration Frequency: Frequency: Repeat every 10 min until SEVERE symptoms resolve Repeat every 10 min until SEVERE symptoms resolve Increase to every 5 min if symptoms worsening Increase to every 5 min if symptoms worsening

5. Ampules

6. Procedure Confirm medications are correct and not expired Confirm medications are correct and not expired

7. Procedure Clear the ampule neck of medicine Clear the ampule neck of medicine

9. Procedure Confirm medications are correct and not expired Confirm medications are correct and not expired Clear the ampule neck of medicine Clear the ampule neck of medicine Break neck using alcohol wipe Break neck using alcohol wipe

11. Procedure Confirm medications are correct and not expired Confirm medications are correct and not expired Clear the ampule neck of medicine Clear the ampule neck of medicine Break neck using alcohol wipe Break neck using alcohol wipe Hold ampule upside down and draw up dose Hold ampule upside down and draw up dose

13. Procedure Confirm medications are correct and not expired Confirm medications are correct and not expired Clear the ampule neck of medicine Clear the ampule neck of medicine Break neck using alcohol wipe Break neck using alcohol wipe Hold ampule upside down and draw up dose Hold ampule upside down and draw up dose Clean site with alcohol wipe Clean site with alcohol wipe Insert needle at 90˚ Insert needle at 90˚ Pull back to check for blood Pull back to check for blood Inject Epinephrine Inject Epinephrine

14. IM Injection Sites The posterior gluteal site shall not be used for any IM injections! The deltoid of the upper arm is the preferred site for IM injections.

15. Questions/Practice Ampules Ampules Needles/syringes Needles/syringes Alcohol swabs Alcohol swabs Oranges Oranges