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Table 6 Medications, Supplies, and Equipment for Anaphylaxis Treatment

From: World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

Medicationsa, b
   First line (priority medication)
Epinephrine (adrenaline) 1:1,000 (1 mg/mL)for intramuscular injection 0.01 mg/kg, to a maximum of 0.5 mg (adult), 0.3 mg (childc)
   Second line medications
H1-antihistamine for intravenous infusion eg. chlorpheniramine 10 mg (adult), 2.5-5 mg (child)c or diphenhydramine 25-50 mg (adult) (1 mg/kg, maximum 50 mg [childc])
ß2-adrenergic agonist, eg. salbutamol (albuterol) solution, 2.5 mg/3 mL or 5 mg/3 mL (adult), (2.5 mg/3 mL [childc]) given by nebulizer and face mask glucocorticoid for intravenous infusion, eg. hydrocortisone 200 mg (adult), maximum 100 mg (childc); or methylprednisolone 50-100 mg (adult); 1 mg/kg, maximum 50 mg (childc)
H2-antihistamine for intravenous infusion,d for example, ranitidine 50 mg (adult) or 1 mg/kg, maximum 50 mg (childc)
Supplies
   Management of the airway
Supplemental oxygen (oxygen tank,b valve with flow-meter, and extension tubing)
Ambu bag/valve/mask, self-inflating with reservoir (volume 700-1,000 mL [adult]; 100-700 mL [childc])
Disposable face masks (infant, toddler, child, adult)
Oropharyngeal airway: 6 cm, 7 cm, 8 cm, 9 cm, 10 cm
Pocket masks, nasal cannulae,e laryngeal mask airwayse
Supplies for suctioning
Supplies for intubation
   Management of hypotension and shock
Supplies for giving large volumes of intravenous fluids rapidly, eg. 0.9% (isotonic) saline, 1 L bags
Alcohol swabs
Tourniquet
Indwelling intravenous catheters (gauge 14, 16, 18, 20, 22)
Intravenous butterfly needles (gauge 19, 21, 23, 25)
Syringes with needles (1 mL, 10 mL, 20 mL)
Macro-drip administration sets
Extension tubing
T-connectors
3-way stopcock
Arm boards (4 sizes)
   Other supplies
Written emergency protocol for anaphylaxis treatmentf
Flow chart for recording times and events
Synthetic tape
Gloves, preferably latex-free
Equipment
   Essential
Stethoscope
Sphygmomanometer, blood pressure cuffs (infant, child, adult, obese adult) Watch or clock
Cardiac arrest backboard or any flat, hard surface for use in cardiopulmonary resuscitation
Equipment for suctioning
Equipment for intubation
Equipment for giving large volumes of intravenous fluids rapidly
   Desirable
Electrocardiogram machine and supplies
Equipment for continuous noninvasive blood pressure monitoringg
Equipment for continuous noninvasive cardiac monitoringg
Pulse oximeter
Defibrillator
  1. aSecond line medication, for example, H1-antihistamine or glucocorticoid should be given by slow intravenous infusion over 10-15 minutes. Do not delay the administration of epinephrine, supplemental oxygen, or IV fluid resuscitation by taking time to draw up and administer a second-line medication.
  2. bThe expiry dates of all medications should be reviewed regularly, for example, after use and at monthly intervals, followed by restocking as needed. Oxygen tanks should also be checked regularly.
  3. cChild is defined as a prepubertal patient weighing less than 35-40 kg (not defined by age).
  4. dH2-antihistamines are sometimes used for anaphylaxis treatment in the US and Canada.
  5. eNasal cannulae deliver oxygen at a flow rate of 2-6 L/m; laryngeal mask airways do not protect the airway against aspiration and present a hazard in patients who are vomiting or at risk of vomiting.
  6. fA written emergency protocol for anaphylaxis treatment should be posted in a prominent place and rehearsed regularly. It should include drug dosages for adults and children, as well as telephone numbers and contact details for resuscitation team, emergency medical services, emergency department, etc.
  7. gNeeded if administering intravenous epinephrine or another intravenous vasopressor.
  8. Adapted from references [3, 2125].