Anaphylaxis is a common presentation to the emergency department requiring rapid treatment as death can occur within minutes. From 1986 – 2011, in Ontario, Canada alone there were 82 deaths from anaphylaxis (1). Epinephrine 0.5mg IM (1:1000) is the first line treatment for anaphylaxis and the only lifesaving treatment (2).
The other medications are for symptomatic control or can help prevent the biphasic reaction anywhere from 8-72 hours from the initial reaction. For the junior learner, remembering which medications to give and at what dose during an acute presentation can be daunting. Here are two rules to help remember the treatment of ADULT anaphylaxis easily:
ABCDsss – for the name of the intervention
Rule of 5s – each dose is in a multiple of 5
The Tiny Tip: Anaphylaxis Treatment
Adrenaline – Epinephrine 0.5mg IM for adults
Benadryl – Diphenhydramine 50mg IV for adults*
Corticosteroid – Methyprednisolone 125mg IV*
ranitiDine 50mg IV*
Supplemental O2 – 5L via NP →15L via NRB
Salbutamol – 5mg via nebulizer
Saline – 500 mL or more
The starred (*) treatments treatments are less useful during acute resuscitation and should be lowest on the priority list with a sick patient.
Don’t forget that the initial epinephrine administration for anaphylaxis is IM not IV!
These are the basics. Check out the awesome post on First 10 in EM for a much more comprehensive overview.
- Xu YS, Waserman S, Harada L, Kastner M. Anaphylaxis deaths in Ontario: a retrospective review of cases from 1986 to 2011. Allergy, Asthma, & Clinical Immunology 2012, 8(Suppl 1):A8
- Moore LE, Kemp AM, Kemp SF. Recognition, Treatment, and Prevention of Anaphylaxis. Immunol Allergy Clin N Am 35 (2015) 363-374
- Zilberstein J, McCurdy MT, Winters ME. Anaphylaxis. Journal of Emergency Medicine. Vol 47, No 2, pp. 182-287, 2014