Patient ID label

ALGORITHM FOR MANAGEMENT OF ALLERGIC REACTION in PEDIATRIC HEMATOLOGY / ONCOLOGY

For medications/products with a known risk for allergic reaction, ensure the following are available prior to administration: Oxygen/nonrebreather mask and suction available at bedside/available emergency basket/bagger IV set up with Normal Saline Baseline vital signs (BP, HR, RR, O2 Sats) Physician or Nurse Practitioner is notified / available EVALUATE A, B, Cs (Manage accordingly) REMOVE ALLERGEN (where possible) NOTIFY PHYSICIAN / NURSE PRACTITIONER CONSIDER TYPE OF REACTION Urticaria or soft tissue swelling: - Diphenhydramine (Benadryl) IV - Observe - Reassess, treating any further symptoms as appropriate Wheeze / Stridor: - High flow Oxygen (10-15 L/min) - Diphenhydramine (Benadryl) IV - Hydrocortisone IV - Consider Epinephrine IM - Consider Inhaled / Nebulized Salbutamol - Call Rapid ResponseTeam (RAP) Hypotension: - High flow Oxygen (10-15 L/min) - Normal Saline 20mL/kg IV bolus - Diphenhydramine (Benadryl) IV - Epinephrine IM - Hydrocortisone IV - Call RAP (if not already done)

If no response to above within 5 minutes: - Inhaled / Nebulized Salbutamol - Epinephrine IM - RAP should be in attendance - Consider move to PICU

If no response to above within 5 minutes: - RAP should be in attendance - Repeat 20 mL/kg normal saline bolus - Repeat Epinephrine IM or IV - Consider move to PICU

Initial Diphenhydramine dose may be given prior to physician/NP assessment. Ensure you have a physician/NP order before administering other reaction medications. Diphenhydramine (Benadryl) 1 mg/kg IV = ______ mg, up to a MAXimum of 50mg

Patient Wt: ___________ kg Date: _____________

Administer IV direct undiluted or further diluted in 10 mL normal saline over 1 5 minutes at a rate not exceeding 25 mg/minute.

Hydrocortisone 2 mg/kg IV = ______mg, up to a MAXimum of 100 mg.

Administer concentrations of 125 mg/ml or less IV direct over 30 seconds

Epinephrine 1 mg/mL (1:1000) IM/subcutaneously: 0.01 mg/kg (0.01 mL/kg)= _____ mL, up to MAXimum of 0.5 mg (0.5 mL)
IM route (anterolateral thigh) is recommended when the anaphylaxis is not life threatening. Do not give undiluted by direct IV push.

Direct IV Epinephrine (1:10 000) may be given by physician or under the direction of the rapid response/ medical emergency team ONLY Fluid Bolus: Normal saline (NaCl 0.9%) 20 mL/kg IV = _____ mL IV, up to a MAXimum of 1 L Salbutamol MDI: 4-8 puffs INH with spacer/aerochamber Nebulizer: Weight less than 20 kg = 2.5 mg/dose
Clinical Concerns Committee DRAFT , Updated Jan 2012

Weight 20 kg or more = 5 mg/dose

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