› ! Angioedema → › ! Anaphylaxis → › Immediate stabilization workflow
› Airway positioning and suction readiness
› Continuous pulse oximetry
› Cardiac monitor
› Two IV lines if airway risk or anaphylaxis concern
› Oxygen if SpO2 less than 94 percent
› Early airway team activation triggers
› Voice change
› Stridor
› Drooling
› Rapid tongue progression
› Airway management principles
› Early decision making before progression
› Awake fiberoptic intubation consideration with anticipated difficult airway
› Surgical airway equipment readiness
› Avoid repeated traumatic attempts
Histamine mediated treatment
› Allergic pathway treatment
› Epinephrine IM 0.3 mg of 1 mg per mL for anaphylaxis concern
› Repeat IM every 5 to 15 minutes if ongoing anaphylaxis physiology
› Cetirizine PO 10 mg if able to swallow and non severe
› Diphenhydramine IV 25 mg to 50 mg as adjunct if severe symptoms
› Famotidine IV 20 mg as adjunct
› Dexamethasone IV 10 mg or methylprednisolone IV 125 mg adjunct
› Nebulized epinephrine as bridge for upper airway symptoms local protocol dependent
Bradykinin mediated treatment
› Bradykinin pathway treatment
› Immediate discontinuation of ACE inhibitor
› C1 inhibitor concentrate dosing per product and protocol
› Icatibant dosing per product and protocol
› Fresh frozen plasma 2 units if specific agents unavailable local protocol dependent
› Tranexamic acid dosing local protocol dependent
› Team involvement
› Anesthesia for anticipated difficult airway
› ENT for laryngoscopy and airway planning
› ICU for high risk airway or hemodynamic instability
› Allergy immunology follow up for recurrent or unclear mechanism
Monitoring and reassessment loop
› Reassessment cadence
› Airway symptom check every 15 to 30 minutes early course
› Repeat focused oral exam for tongue and floor of mouth progression
› Repeat vitals after epinephrine administration
› Escalate level of care if any progression
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