From: World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis
Preliminary Steps |
   1) Have a posted, written emergency protocol for recognition and treatment of anaphylaxis and rehearse the protocol regularlyb |
   2) Remove exposure to the trigger if possible, eg. discontinue an intravenous diagnostic or therapeutic agent that seems to be triggering symptoms |
   3) Assess circulation, airway, breathing, mental status, skin, and body weight (mass)c |
Promptly and simultaneouslyd |
   4) Call for help (resuscitation team in hospital or other healthcare setting, or emergency medical services in community setting), if available |
   5) Inject epinephrine (adrenaline) intramuscularly in the mid-anterolateral aspect of the thigh, 0.01 mg/kg of a 1:1,000 (1 mg/mL) solution, to a maximum of 0.5 mg (adult) or 0.3 mg (childe); record the time of the dose and repeat it in 5-15 minutes, if needed; most patients respond to 1 or 2 doses |
   6) Place patient on the back, or in a position of comfort if there is respiratory distress and/or vomiting; elevate the lower extremities; fatality can occur within seconds if a patient stands or sits suddenly |
When indicated at any time during the episode |
   7) Give high flow supplemental oxygen (6-8 L/min) by face mask or oropharyngeal airwayf |
   8) Establish intravenous access using needles or catheters with wide-bore cannulae (14 or 16 gauge for adults). When indicated, give 1-2 litres of 0.9% (isotonic) saline rapidly. (eg. 5-10 mL/kg in the first 5-10 minutes to an adult; or 10 mL/kg to a child) |
   9) When indicated at any time, prepare to initiate cardiopulmonary resuscitation with continuous chest compressionsg. |
In addition |
   10) At frequent and regular intervals, monitor patient's blood pressure, cardiac rate and function, respiratory status and oxygenation and obtain electrocardiograms; start continuous non-invasive monitoring, if possibleh |