Anaphylaxis_Immediate_Action_Checklist

Anaphylaxis Immediate Action Checklist (When Injecting Now)

Use when you are sure or sufficiently sure to treat for anaphylaxis. Work the list in order; do not delay IM adrenaline.

Immediate (0–10 minutes)

• Shout for help and call 999/112; state “suspected anaphylaxis”.
• Do not allow standing/walking/sitting up suddenly.
• Position now (tick one):
  • Lay flat with legs raised (hypotension/shock).
  • Semi‑recumbent with legs raised (breathing difficulty).
  • Recovery position if unconscious with normal breathing.
  • Left lateral if pregnant.
• Remove visible trigger if safe (stop infusion/remove stinger). Do not induce vomiting.
• Administer IM adrenaline now (1 mg/ml, 1:1000) into anterolateral mid‑thigh (through clothing if needed):
  • Adult/adolescent (>12 y): 0.5 mg IM via syringe/needle (preferred in healthcare setting).
  • If using AAI in adults: 0.3 mg (device standard dose).
  • Child dosing:
    • <6 months: 0.1 mg (0.1–0.15 ml).
    • 7.5–26 kg (≈6 m–6 y): 0.15 mg.
    • >26 kg (≈6–12 y): 0.3 mg.
• Start high‑flow oxygen (aim SpO₂ ≥ 94%).
• Attach monitoring: SpO₂, BP, ECG; record time and dose of adrenaline.
• Establish IV access.
• If wheeze: salbutamol via MDI + spacer or oxygen nebuliser ± ipratropium.
• Consider nebulised adrenaline for laryngeal oedema/stridor (adjunct only).
• If hypotensive: crystalloid bolus (not dextrose): adult 500 ml; child 10 ml/kg.
• Reassess at 5 minutes; repeat IM adrenaline if no improvement (repeat q5 min as needed).

Ongoing (next 10–60 minutes)

• Continue A/B/C reassessment; document vitals and responses.
• Arrange urgent transfer to hospital; continuous monitoring during transfer.
• If on β‑blocker and poor response, consider IM/IV glucagon (usually hospital protocol).
• Treat refractoriness (no improvement after ≥2 IM doses 5 min apart) with hospital IV adrenaline infusion pathway.
• Cardiorespiratory arrest: start high‑quality CPR; do not interrupt CPR to give IM adrenaline (IM absorption unreliable in arrest).

Avoid / Do Not

• Do not give IV adrenaline in primary care.
• Do not give chlorphenamine acutely (sedation confounds assessment); antihistamines only for skin itch once stable.
• Do not give routine oral prednisolone to prevent biphasic reactions (no benefit; potential harms in children).
• Do not allow the patient to stand or walk during an acute reaction.

Handover & Early Post‑Stabilisation Tasks

• Handover times/doses of adrenaline, response, triggers, co‑factors, vitals, treatments given, devices used (give used AAI to crew).
• Observe in hospital 6–12 h (12–24 h if circulatory collapse/severe features); warn about biphasic reactions (~5%).
• ED tryptase sampling requested if feasible: 30 min–2 h after onset, plus baseline at ~24 h.
• On discharge (hospital): supply two AAIs, written plan, and training; advise always carrying both; storage 20–25°C; avoid refrigeration.

Quick Device Notes (UK)

• EpiPen: 150 mcg (<15 kg); 300 mcg (≥15 kg; standard for >26 kg). Shelf ≈ 18 months; can use just‑expired in emergency.
• Jext: 150 mcg (<15 kg); 300 mcg (>31 kg; may be appropriate at 15–30 kg). Shelf ≈ 22 months; can use just‑expired in emergency.
• Emerade: 150/300/500 mcg — withdrawn 2023 (misfiring/faulty needles).
• Neffy (nasal adrenaline): approved EU/US; not yet available in UK; ≥30 kg.