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Recognition and immediate priorities
Time-critical framework
Suspected anaphylaxis
Acute illness with airway compromise
Acute illness with breathing compromise
Acute illness with circulation compromise
Acute illness with skin mucosal involvement plus respiratory compromise
Acute illness with skin mucosal involvement plus hypotension or end-organ hypoperfusion
After likely allergen exposure with two or more systems involved
Skin mucosal
Respiratory
Cardiovascular
Gastrointestinal
If any airway or hemodynamic compromise then treat as anaphylaxis
Early epinephrine
Do not delay for tests
Remove trigger if possible
Stop infusion or medication
Remove stinger
Discontinue latex exposure
Resuscitation and monitoring
Initial stabilization bundle
Escalate to resuscitation bay for any hypotension or airway symptoms
Team activation
Respiratory therapy and airway support
Pharmacy for epinephrine infusion setup
Monitoring
Continuous cardiac monitoring
Dysrhythmia detection during epinephrine therapy
Continuous pulse oximetry
Trending response to therapy
Noninvasive blood pressure cycling every 1-2 minutes
If shock then arterial line when feasible
Access
Two large-bore IV lines
If difficult then IO access
Airway and breathing escalation triggers
Airway risk stratification
High-risk airway features
Voice change or hoarseness
Laryngeal edema concern
Stridor
Upper airway narrowing
Tongue or floor-of-mouth swelling
Rapid progression risk
Drooling or inability to handle secretions
Impending obstruction
Severe agitation or fatigue
Ventilatory failure risk
If progressive airway symptoms then early definitive airway
Most experienced laryngoscopist
Video laryngoscopy preferred when feasible
Prepare for front-of-neck access
Cricothyrotomy kit at bedside
Hemodynamic targets and shock approach
Perfusion goals
Mean arterial pressure at least 65 mmHg in adults
Adjust for baseline chronic hypertension
Normal mental status or improving
Surrogate of cerebral perfusion
Urine output at least 0.5 ml/kg/hour
For prolonged resuscitation
Shock pattern recognition
Distributive shock physiology
Warm extremities possible early
Wide pulse pressure possible
If hypotension then immediate IM epinephrine and fluid bolus
Epinephrine first-line vasopressor in anaphylaxis
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.