Benadryl 50mg IV (up to 100mg for severe reactions) (peds 1mg/kg) is H1 blocker
Pepcid 20mg IV (peds 0.5 mg/kg) is H2 blocker
Epinephrine 1:1000 0.01ml/kg to max 0.5ml (0.3ml peds) IM (normotensive)
-Usual initial dose is 0.3ml IM
-Give 0.1 to 0.2ml of total dose at site of antigenic exposure
-Recall that 1cc of 1:1000 epinephrine is 1mg
Epinephrine IV if hypotensive or respiratory failure
- 0.3mg & if no improvementà
-Continuous gtt at 1mcg/min to 4mcg/min (peds 0.1mcg/kg/min to 1.5mcg/kg/min)
Racemic epinephrine neb 0.5cc in 2.5ml NS to temporize airway management
Albuterol and atrovent (continuous neb may be necessary) if pt wheezing
Solu-medrol 125mg to 250mg (peds 1-2mg/kg IV) or Prednisone 60mg PO (peds 1mg/kg)
-IV corticosteroids confer no greater benefit than PO
-Often ordered incorrectly: Solu-medrol is IM/IV. Prednisone is PO tablets. Prednisilone (Orapred, Pediapred, Prelone) is PO syrup for pediatric dosing
Glucagon 1mg adults and 0.5mg peds w/ prn infusion 1 to 5 mg/hr
-useful in refractory cases, especially in pts on beta-blockers