xử trí phản vệ
Situation | Intervention | Comments |
Systemic anaphylaxis | Epinephrine 1:1,000, 0.3 cc SC, repeat
at 5-10 min intervals Diphenhydramine 25-100 mg IV |
Repeat doses of
diphenhydramine may be required for |
Special Problems | H2-blocker^
Hydrocortisone 100-250 mg IV q6h |
symptom relief |
Upper airway | Nebulized racemic epinephrine, 0.3 ml | Administer oxygen; |
obstruction | diluted in 3 ml 0.9% NaCl | consider tracheal intubation and mechanical ventilation |
Bronchospasm | Epinephrine 1:1,000, 0.3-0.5 ml SC,
may repeat at 5-10 min intervals, or Albuterol, 1-2 puffs metered dose inhaler or 2.5-5 mg nebulized in 2-3 ml 0.9% NaCl, or Aminophylline, 6 mg/kg IV initially (see Table 4.4) |
With severe
bronchospasm or hypotension, consider epinephrine, 1:10,000, 0.5-1.0 ml IV (rather than SC) |
Shock | Volume resuscitation with 0.9% NaCl >500 ml rapidly, with or without vasopressors
Dopamine 5-20 ^g/kg/min, titrated to blood pressure, or Norepinephrine, 2 ^g/min, titrated to blood pressure Patients on ^-blockers who are hypotensive may also be treated with glucagon, 1 mg IV |
|
IV, intravenous; SC, subcutaneous ^Ranitidine: 50 mg IV Famotidine: 20 mg IV Cimetidine: 300 mg IV |
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