Anaphylaxis%20(pediatric) Treatment

• Establish and maintain airway
  • Endotracheal tube, cricothyrotomy or needle cricothyrotomy may be performed if indicated

Oxygen

• High flow O₂ (6-8 L/min) via non-rebreathing mask or endotracheal tube in patients experiencing respiratory symptoms, hypoxemia, or hypotension related to anaphylaxis
• Continuous pulse oximetry and arterial blood gas determination should guide oxygen therapy

Fluid Support

• Maintain an IV access using wide bore needles or cannulas (14-16 gauge)
• Rapid administration of 1-2 liters of isotonic (0.9%) saline solution may be indicated
  • Children: 10 mL/kg for the first 5-10 minutes

• For hypotensive patients or those with cardiovascular collapse, IV administration of normal saline at 20 mL/kg is recommended
  • If IV access is delayed or impossible, intraosseous route can be used
• Inotropic support with Dopamine or Epinephrine infusion should be started if >40 mL/kg is needed
  • Invasive BP monitoring may be required
• Monitor patient for signs of overtreatment eg hypertension or pulmonary edema

Additional Intervention for Cardiopulmonary Arrest Occurring During Anaphylaxis

• Cardiopulmonary resuscitation and advanced cardiac life support measures
  • Prolonged resuscitation efforts are encouraged
• High dose Epinephrine (IV)
• Rapid volume expansion
• Consider extracorporeal membrane oxygenation (ECMO) if available
• Transport to ICU, as setting dictates