First 5 minutes critical patient workflow
›Immediate stabilization
›Airway compromise signs
›Oxygen for hypoxia
›Cardiac monitoring for hypotension or tachyarrhythmia
›IV access for unstable vitals
›Immediate treatment triggers
›If anaphylaxis features then IM epinephrine per local protocol dependent
›If hypotension then IV fluids per shock pathway
›Time targets
›If systemic allergic reaction concern then epinephrine within minutes
›If sepsis concern then lactate and cultures within 1 hour per local protocol dependent
›Skin care and barrier support
›Thick emollient multiple times daily
›Lukewarm showers
›Avoid fragranced products
›Antihistamine strategy
›Non sedating daytime option
›Cetirizine PO 10 mg daily adult example
›Sedating nighttime option when sleep disruption
›Hydroxyzine PO 25 mg at bedtime adult example
›Topical antipruritic options
›Pramoxine topical as needed
›Menthol camphor lotion as needed
›Neuropathic itch options
›Consider gabapentin when neuropathic pattern and no contraindications
›Renal dosing adjustment required
Etiology directed management
›Cholestasis pathway
›RUQ ultrasound if cholestatic labs or jaundice
›Early GI or surgery discussion if obstruction suspected
›Uremic pruritus pathway
›Renal function optimization
›Dialysis adequacy review via nephrology for dialysis patients
›Infestation pathway
›Permethrin 5 percent topical for scabies suspected
›Treat close contacts and bedding
›Medication induced pruritus pathway
›Stop suspected offending agent when safe
›Alternative medication plan via prescriber
›Recheck interval
›30 to 60 minutes after initial symptom therapy
›Earlier if unstable vitals
›Recheck elements
›Vitals
›Airway symptoms
›Pruritus severity score
›New rash or hives emergence