e. Transport. Unless contradictory to local policy, start supportive treatment
and transport as soon as possible.
(1) Administer epinephrine (if available) only under the supervision of the
physician, physician assistant, nurse practitioner, or by local protocol. A 1:1,000
solution is given intramuscularly or subcutaneously; the usual dosage for an adult is 0.4
to 0.5 milliliters. A pediatric dose is determined by weight and should be ordered by a
physician, physician assistant, or nurse practitioner.
(2) If signs and symptoms worsen or recur, the administration of up to four
additional injections of epinephrine may be necessary. These injections may be
administered every 15 minutes.
(3) Epinephrine is the drug of choice to relieve the symptoms of acute
hypersensitivity reaction to drugs and of other acute allergic reactions. However, in
patients suffering from shock from other causes, epinephrine may accentuate the
underlying disorder. Therefore, care must be taken to perform an accurate assessment
of the patient before administering epinephrine.
f. Record Treatment. Record the treatment administered in the patient's health
record. If you can determine what drug or food caused the anaphylactic shock, enter
that into the record and flag the record appropriately.
g. Evacuate Casualty. If you did not evacuate the patient earlier to a
comprehensive medical treatment facility, do so at this time. Since symptoms will return
in about 20 percent of patients experiencing an anaphylactic reaction, the doctor may
require admission for observation and further treatment.