🚑 Anaphylaxis / Anaphylactic Shock Management
UseEmergency management of anaphylaxis and anaphylactic shock.
SourceCardona V, et al. WAO Anaphylaxis Guidance 2020. doi:10.1016/j.waojou.2020.100472
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
IM epinephrine is the first-line and only life-saving drug — never delayed for antihistamines or steroids.
When to use
Emergency management of anaphylaxis and anaphylactic shock.
How it works
IM epinephrine 0.01 mg/kg (adult max 0.5 mg, child max 0.3 mg) into the mid-outer thigh, repeatable every 5–15 min. Hypotension → supine with legs up + oxygen + rapid crystalloid 1–2 L. Persisting after two IM doses → IV epinephrine infusion (monitored). On a beta-blocker and refractory → glucagon.
Key points
- IM epinephrine is the first-line and only life-saving drug — never delayed for antihistamines or steroids.
- Antihistamines (H1 ± H2) and corticosteroids are adjuncts only and do not replace epinephrine.
- Watch for biphasic reactions requiring observation; discharge with an epinephrine auto-injector and trigger-avoidance education.
- Glucagon is the option when a beta-blocked patient responds poorly to epinephrine.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Weight (to estimate epinephrine dose) | 60 kg |
|---|---|
| Age (<12 years = child, single-dose cap 0.3 mg) | 8 years |
| Hypotension/shock | Yes |
| Persists after two IM doses | Yes |
| On a beta-blocker | Yes |
→Primary actionImmediate IM epinephrine 0.3 mg = 0.3 mL (calculated 0.6 mg, cap 0.3 mg)
- First-line (immediate)：IM epinephrine 0.3 mg = 0.3 mL (calculated 0.6 mg, cap 0.3 mg) (1 mg/mL) into the mid-outer thigh (vastus lateralis), repeatable in 5–15 min; do not delay for antihistamines/steroids
- Note：Body size is close to adult; the clinician decides whether to use 0.5 mg
- Positioning：Supine with legs elevated (semi-recumbent if dyspneic); avoid sudden sitting up/standing
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Anaphylaxis / Anaphylactic Shock Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Anaphylaxis / Anaphylactic Shock Management upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Anaphylaxis / Anaphylactic Shock Management calculated in practice? Can you show a worked example?
- Inputs: Weight (to estimate epinephrine dose) 60 kg, Age (<12 years = child, single-dose cap 0.3 mg) 8 years, Hypotension/shock Yes, Persists after two IM doses Yes, On a beta-blocker Yes → Result: Primary action Immediate IM epinephrine 0.3 mg = 0.3 mL (calculated 0.6 mg, cap 0.3 mg)（First-line (immediate): IM epinephrine 0.3 mg = 0.3 mL (calculated 0.6 mg, cap 0.3 mg) (1 mg/mL) into the mid-outer thigh (vastus lateralis), repeatable in 5–15 min; do not delay for antihistamines/steroids, Note: Body size is close to adult; the clinician decides whether to use 0.5 mg, Positioning: Supine with legs elevated (semi-recumbent if dyspneic); avoid sudden sitting up/standing）