Start with 0.5 mg IM into the mid anterolateral thigh. (33895231) If symptoms are refractory to treatment, then one or two additional 0.5-mg doses may be given every five minutes. (33895231) If three doses fail to work, then consider initiation of an epinephrine infusion (as below).(33895231)
When to seek emergency medical treatment for a bee sting?
a white spot where the stinger punctured the skin. redness and slight swelling around the sting. Severe (allergic) systemic symptoms of a bee sting include: hives. flushed or pale skin. swelling ...
Do you need an epinephrine autoinjector for bee stings?
· Wrap a towel around an ice pack and apply it to the bee sting for 20 minutes at a time. This will reduce swelling. Use an antihistamine, such as Benadryl, to relieve itchiness and swelling. Apply calamine lotion or hydrocortisone cream to reduce pain and itching. If you use these, cover the sting with a bandage afterward.
Can bee stings cause anaphylaxis?
A bee sting may not seem like an emergency, but it very well could be! Each year, at least 60 deaths occur in the United States due to insect sting anaphylaxis. 2 So, it’s important to learn about different bee sting treatment options—from ice to epinephrine auto-injectors to venom immunotherapy. 16M.
What are the strengths of epinephrine syringes used in the treatment of anaphylaxis?
· Start with 0.5 mg IM into the mid anterolateral thigh. ( 33895231 ) If symptoms are refractory to treatment, then one or two additional 0.5-mg doses may be given every five minutes. ( 33895231 ) If three doses fail to work, then consider initiation of an epinephrine infusion (as below).( 33895231 )
How many doses of EPI can you give for anaphylaxis?
Administer epinephrine 1:1,000 (weight-based) (adults: 0.01 mL per kg, up to a maximum of 0.2 to 0.5 mL every 10 to 15 minutes as needed; children: 0.01 mL per kg, up to a maximum dose of 0.2 to 0.5 mL) by SC or IM route and, if necessary, repeat every 15 minutes, up to two doses).
How often can you repeat EPI for anaphylaxis?
You may repeat the injection every 5 to 10 minutes as needed. Children weighing less than 30 kg—Dose is based on body weight and must be determined by your doctor. The dose is 0.01 mg per kg of body weight injected under the skin or into the muscle of your thigh.
Can you give multiple doses of EPI?
According to the NIAID food allergy guidelines, there are two reasons that patients should carry two doses of their epinephrine auto-injector. “If a patient responds poorly to the initial dose or has ongoing or progressive symptoms despite initial dosing, repeated dosing may be required after 5 to 15 minutes.
How long should you wait between doses of epinephrine?
Dr. Brown generally recommends between 5 and 15 minutes as a reasonable timeframe between doses to determine if the epinephrine has taken effect.
How often can you give EPI in a code?
It is reasonable to administer 1 mg of epinephrine every 3 to 5 minutes.
How many EpiPens should you have?
The Joint Task Force on Practice Parameters guidelines recommend that patients at risk carry two epipens at all times (or any auto injector).
How much epinephrine can take?
Adults And Children 30 kg (66 lbs) Or More 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted Adrenalin administered intramuscularly or subcutaneously in the anterolateral aspect of the thigh, up to a maximum of 0.5 mg (0.5 mL) per injection, repeated every 5 to 10 minutes as necessary.
How is epinephrine administered in an emergency?
Slowly inject the syringe into the thigh while sitting down. Push the plunger all the way down until you hear a "clicking" sound. Hold it for 2 seconds. Remove the syringe and massage the area for 10 seconds.
Where should you inject a second EpiPen?
However, the reason the thigh is recommended for administering epinephrine is because this is a large muscle with a lot of blood flow. It is not likely that two injections would be so close as to significantly affect the circulation of the second dose.
What is the protocol for the treatment of anaphylaxis?
Epinephrine (1 mg/ml aqueous solution [1:1000 dilution]) is the first-line treatment for anaphylaxis and should be administered immediately. In adults, administer a 0.3 mg intramuscular dose using a premeasured or prefilled syringe, or an autoinjector, in the mid-outer thigh (through clothing if necessary).
How long does an EpiPen last after injection?
EpiPen Auto-Injectors are used to treat severe allergic reactions (anaphylaxis). Seek emergency medical attention even after you use EpiPen to treat a severe allergic reaction. The effects may wear off after 10 or 20 minutes.
How do you give epinephrine for anaphylaxis?
This is best administered by slow push of 0.5 to 1 mL of 0.1 mg/mL epinephrine solution ("cardiac" epinephrine, available in 10 mL prefilled syringes, containing 1 mg of epinephrine, and stocked on resuscitation carts).
What Are The Symptoms of Bee Poisoning?
Mild symptoms of a bee sting include: 1. pain or itching at the site of the sting 2. a white spot where the stinger punctured the skin 3. redness a...
Who Is at Risk For Bee Poisoning?
Certain individuals are at a higher risk for bee poisoning than others. Risk factors for bee poisoning include: 1. living in an area near active be...
When to Seek Medical Attention
Most people who’ve been stung by a bee don’t require medical attention. You should monitor any minor symptoms, such as mild swelling and itching. I...
First Aid: Treating Bee Stings at Home
Treatment for a bee sting involves removing the stinger and caring for any symptoms. Treatment techniques include: 1. removing the stinger using a...
What is the best medicine for a bee sting?
If you’ve had an allergic reaction to a bee sting, your doctor will prescribe you an epinephrine auto-injector such as EpiPen. This should be carried with you at all times and is used to treat anaphylactic reactions. Your doctor may also refer you to an allergist.
What to do if you have a bee sting?
If you’re experiencing symptoms of anaphylaxis, such as trouble breathing or difficulty swallowing, call 911. You should also seek medical help if you have a known allergy to bee stings or if you have had multiple bee stings. When you call 911, the operator will ask for your age, weight, and symptoms. It’s also helpful to know the type of insect ...
What to take with you when you are allergic to bees?
If you have a known allergy to bee, wasp, or yellow jacket venom, you should carry a bee sting kit with you when you’re spending time outdoors. This contains a medication called epinephrine, which treats anaphylaxis — a severe allergic reaction that could make breathing difficult.
What are the risk factors for bee stings?
Risk factors include: living in an area near active beehives. living in an area where bees are actively pollinating plants. spending lots of time outside. having had a previous allergic reaction to a bee sting. taking certain medications, such as beta-blockers.
How to help a bee stinger?
Remove constricting clothing and any jewelry in case of swelling. Administer epinephrine if the person has a bee sting emergency kit. Roll the person into the shock position if symptoms of shock are. present. This involves rolling the person onto their back and raising their. legs 12 inches above their body.
What are the symptoms of a bee sting?
redness and slight swelling around the sting. Severe (allergic) systemic symptoms of a bee sting include: hives. flushed or pale skin. swelling of the throat, face, and lips. headache. dizziness or fainting. nausea and vomiting. abdominal cramping and diarrhea.
How do you know if you have been stung by a bee?
Most people who’ve been stung by a bee don’t require medical attention. You should monitor any minor symptoms, such as mild swelling and itching. If those symptoms don’t go away in a few days or if you begin to experience more severe symptoms, call your doctor.
What to do if you have multiple bee stings?
What to Do About Multiple Bee Stings. Anyone who has been stung multiple times (10 or more) needs to go to the emergency room. Multiple local reactions, even without an allergy, can cause a lot of pain. Also, the more venom in your body, the more likely it is you'll have an allergic reaction.
How to stop bee stings from hurting?
Once you're in a safe place and have removed the stinger (if necessary), clean the area with soap and water. It'll hurt, but this is important for preventing infection. Bee stings almost always cause a local reaction (at the site of the sting), even in people who aren't allergic to them.
What do bees do when they sting you?
When females of certain bee species sting you, they leave behind a barbed stinger attached to a venom sac. The stinger can continue injecting venom into your body until it's removed, so it's important to remove the stinger right away. (Males, females from other species, yellowjackets, hornets, and wasps do not leave stingers behind, so if you don't see a stinger, you were likely stung by one of them.)
How to get a stinger out of a stinger?
Then pinch or scrape the stinger to pull it out. Act quickly, because the longer it pumps in venom, the more the sting will hurt. It also increases the risk of an allergic reaction.
What to do if you have been stung by a bee?
If you've previously had anaphylaxis after a bee sting, you should always carry an epinephrine auto-injector (EpiPen) with you in case you're stung again. This can stop the reaction and keep you alive. If you witness anaphylaxis in someone else, use any EpiPen that's available along with calling 9-1-1. 2.
Why do you scrape bee stingers off?
You may have heard that you should always scrape bee stingers off because pinching the venom sac could push in extra venom, but that's one of the biggest myths of first aid. Research shows that pinching the stinger doesn't seem to inject more venom, but being slow to remove it does. So how fast you get the stinger out is much more important than how you do it. 3
How long does it take for anaphylaxis to develop?
An allergy can develop after any sting. Symptoms of anaphylaxis typically develop within two hours of the sting, but it may be a longer or shorter amount of time. Any symptoms of anaphylaxis should be treated as an emergency.
How long does it take for anaphylaxis to start?
Anaphylaxis due to food or oral medication usually begins within a few hours.
What is the RCUK number for anaphylaxis?
Update on anaphylaxis based on this fresh guideline from the the Anaphylaxis Working Group of the Resuscitation Council UK (RCUK) (#1/7). https://t.co/k8nJPt3IvV pic.twitter.com/IykmyGSwI5
Why is it important to differentiate the cause of angioedema?
Clearly differentiating the cause of angioedema is important (because the treatments are entirely different). Anaphylaxis is histamine-mediated, so it will almost always respond rapidly to aggressive treatment (with epinephrine, antihistamine, and steroid, as discussed below).
Is epinephrine IV or IV?
Intravenous epinephrine may be useful for anaphylaxis which occurs in a context where providers are well versed in the use of IV epinephrine (especially the ICU or OR, where epinephrine is most commonly given via an IV route).
What is the infectious workup?
Infectious workup is pursued with chest X-ray, procalcitonin, and blood cultures. The infectious evaluation is negative, so antibiotics are stopped – leaving the patient with a clinical diagnosis of anaphylaxis.
Can antihistamines delay anaphylaxis?
Administration of antihistamines should never delay key interventions (e.g., epinephrine administration and volume resuscitation). Furthermore, administration of antihistamines alone should not be misconstrued as representing adequate therapy for anaphylaxis.
Is anaphylaxis histamine mediated?
Anaphylaxis is histamine-mediated, so it will almost always respond rapidly to aggressive treatment (with epinephrine, antihistamine, and steroid, as discussed below). In contrast, bradykinin-mediated angioedema won't respond to these treatments (and tends to progress slowly, over a period of hours). Therefore, an immediate therapeutic trial of therapies for anaphylaxis can be used as a diagnostic/therapeutic approach to differentiating anaphylaxis versus bradykinin-mediated angioedema. ( 29721614)
When should anaphylaxis be observed?
All patients with anaphylaxis should be observed until symptoms have completely resolved. There is no consensus regarding the optimal observation period for a patient who has been successfully treated for anaphylaxis in a health care facility [ 47,80,89-96 ].
Is anaphylaxis unpredictable?
Each pharmacologic therapy is discussed further below. Anaphylaxis is variable and unpredictable. It may be mild and resolve spontaneously due to endogenous production of compensatory mediators or it may be severe and progress within minutes to respiratory or cardiovascular compromise and death [ 34 ].
Can beta-2 agonists be used for asthma?
The evidence for the use of beta-2-adrenergic agonists in anaphylaxis is extrapolated from their use in acute asthma. Glucocorticoids — Glucocorticoids are commonly given in the treatment of anaphylaxis; however, there is little evidence of benefit. The onset of action of glucocorticoids takes several hours.
Is IM injection better than IV?
IM injection is also preferred over intravenous (IV) bolus because it is faster in many situations and safer (ie, lower risk of cardiovascular complications, such as severe hypertension and ventricular arrhythmias). The epinephrine dilution for IM injection contains 1 mg/mL.
Can anaphylaxis be treated quickly?
● Patients with anaphylaxis should be assessed and treated as rapidly as possible, as respiratory or cardiac arrest and death can occur within minutes. Anaphylaxis appears to be most responsive to treatment in its early phases, before shock has developed, based on the observation that delayed epinephrine injection is associated with fatalities. (See 'Immediate management' above.)
What is the initial management of anaphylaxis?
The initial management of anaphylaxis includes a focused examination, procurement of a stable airway and intravenous access, and administration of epinephrine. 2, 10 [Evidence level C, consensus and expert opinion] Vital signs and level of consciousness should be documented. Examination may reveal urticaria, angioedema, wheezing, or laryngeal edema. If the antigen was injected (e.g., insect sting), the portal of entry may be noted.
How long does anaphylaxis last?
Rarely, anaphylaxis may be delayed for several hours. Anaphylaxis can be protracted, lasting for more than 24 hours, or recur after initial resolution. 5, 6
How many people die from anaphylaxis in the US?
It causes approximately 1,500 deaths in the United States annually.
How long does it take for histamine to rise?
If the diagnosis of anaphylaxis is not clear, laboratory evaluation can include plasma histamine levels, which rise as soon as five to 10 minutes after onset but remain elevated for only 30 to 60 minutes. Urinary histamine levels remain elevated somewhat longer. Alternatively, serum tryptase levels peak 60 to 90 minutes after onset of anaphylaxis and remain elevated for up to five hours. Some patients have isolated abnormal tryptase or histamine levels without the other.
What are the symptoms of anaphylaxis?
3, 4 The respiratory system is commonly involved, producing symptoms such as dyspnea, wheezing, and upper airway obstruction from edema. Gastrointestinal manifestations (e.g., nausea, vomiting, diarrhea, abdominal pain) and cardiovascular manifestations (e.g., dizziness, syncope, hypotension) affect about one third of patients. Headache, rhinitis, substernal pain, pruritus, and seizure occur less frequently.
What is the cause of anaphylaxis?
Another common cause of anaphylaxis is a sting from a fire ant or Hymenoptera (bee, wasp, hornet, yellow jacket, and sawfly). Approximately 40 to 100 deaths per year in the United States result from insect stings, and up to 3 percent of the U.S. population may be sensitized. 1, 2 A history of systemic reaction to an insect sting and positive venom skin test confers a 50 to 60 percent risk of reaction to future stings. 7
What are the common etiologies of anaphylaxis?
The common etiologies of anaphylaxis include drugs, foods, insect stings, and physical factors/exercise ( Table 3) . 2 Idiopathic anaphylaxis (or reacting where no cause is identified) accounts for up to two thirds of persons who present to an allergist/immunologist.
When to administer epinephrine after allergic reaction?
It’s the treatment of choice for anyone experiencing anaphylaxis. But you need to administer epinephrine in the first few minutes after the allergic reaction starts for it to be most effective.
What to do if you witness an anaphylactic reaction?
The symptoms can go from bad to worse very quickly, and may include: If you witness someone having anaphylactic symptoms, or you’re having symptoms yourself, call emergency services immediately.
Why give epinephrine injections?
This is because it speeds up the heart rate and raises blood pressure. Give an epinephrine injection if someone has been exposed to an allergic trigger and: has trouble breathing. has swelling or tightness in the throat. feels dizzy. Also give an injection to children who has been exposed to allergic trigger and:
What to do if you witness someone having anaphylactic symptoms?
If you witness someone having anaphylactic symptoms, or you’re having symptoms yourself, call emergency services immediately .
What is the aftercare for rebound anaphylaxis?
The risk of a rebound anaphylactic reaction makes proper medical evaluation and aftercare crucial, even for people who feel fine after treatment with epinephrine. When you go to the emergency department to be treated for anaphylaxis, the doctor will do a full examination.
What to do if you are allergic to a drug?
If you’re allergic to medication, tell every doctor that you visit about your allergy, so they don’t prescribe that drug for you. Also let your pharmacist know. Consider wearing a medical alert bracelet to let emergency responders know that you have a drug allergy.
Can you get anaphylaxis after epinephrine?
Risk of rebound anaphylaxis after emergency epinephrine. An injection of emergency epinephrine could save a person’s life after an anaphylactic reaction. However, the injection is only one part of the treatment. Everyone who’s had an anaphylactic reaction needs to be examined and monitored in an emergency room.
Usual Adult Dose for Asystole
Injectable Solution of 0.1 mg/mL (1:10,000): -IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes -Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once -Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once Comments: -Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route. Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome) The American Heart Association (AHA) recommends: -IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest -Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established Use: For administration during cardiac arrest.
Usual Adult Dose for Ventricular Fibrillation
Injectable Solution of 0.1 mg/mL (1:10,000): -IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes -Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once -Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once Comments: -Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route. Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome) The American Heart Association (AHA) recommends: -IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest -Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established Use: For administration during cardiac arrest.
Usual Adult Dose for Ventricular Tachycardia
Injectable Solution of 0.1 mg/mL (1:10,000): -IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes -Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once -Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once Comments: -Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route. Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome) The American Heart Association (AHA) recommends: -IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest -Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established Use: For administration during cardiac arrest.
Usual Adult Dose for Cardiac Arrest
Injectable Solution of 0.1 mg/mL (1:10,000): -IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes -Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once -Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once Comments: -Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route. Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome) The American Heart Association (AHA) recommends: -IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest -Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established Use: For administration during cardiac arrest.
Usual Adult Dose for Asthma - Acute
Injectable Solution of 0.1 mg/mL (1:10,000): 0.1 to 0.25 mg (1 to 2.5 mL) IV slowly once Use: For the treatment of acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or subcutaneous administration of other solutions of the drug
Usual Adult Dose for Allergic Reaction
Auto-Injector: 30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed Comments: -The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions. -More than 2 sequential doses should only be administered under direct medical supervision. -The auto-injectors are intended for immediate administration as emergency supportive therapy only and not as a replacement or substitute for immediate medical care. Injectable Solution of 1 mg/mL (1:1000): 30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed -Maximum dose per injection: 0.5 mg (0.5 mL) Comments: -For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle. -Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis. -The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect. Injectable Solution of 0.1 mg/mL (1:10,000): 0.1 to 0.25 mg (1 to 2.5 mL) IV slowly once Convenience Kit 1 mg/mL (1:1000): 0.2 to 1 mg IM or subcutaneous Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions.
Usual Adult Dose for Anaphylaxis
Auto-Injector: 30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed Comments: -The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions. -More than 2 sequential doses should only be administered under direct medical supervision. -The auto-injectors are intended for immediate administration as emergency supportive therapy only and not as a replacement or substitute for immediate medical care. Injectable Solution of 1 mg/mL (1:1000): 30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed -Maximum dose per injection: 0.5 mg (0.5 mL) Comments: -For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle. -Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis. -The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect. Injectable Solution of 0.1 mg/mL (1:10,000): 0.1 to 0.25 mg (1 to 2.5 mL) IV slowly once Convenience Kit 1 mg/mL (1:1000): 0.2 to 1 mg IM or subcutaneous Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions.