CodeBlue
Algorithms

Emergencies

Anaphylaxis

Epinephrine IM into the thigh is first-line and time-critical. Antihistamines and steroids are adjuncts only.

Interactive pathway
  1. Assess

    Recognize anaphylaxis

    • Acute skin/mucosal signs + respiratory compromise or hypotension
    • OR ≥ 2 systems after a likely allergen (skin, respiratory, circulation, GI)
    • OR hypotension after a known allergen
    • Up to 20% have no skin findings
  2. Medication

    Epinephrine IM, immediately

    • Remove the trigger; call for help
    • Supine with legs raised (sit up if breathing is hard; left side if pregnant)
    • High-flow O₂, IV access, cardiac monitor
    Epinephrine
    0.01 mg/kg IM of 1 mg/mL
    max 0.5 mg adult / 0.3 mg child; anterolateral thigh; repeat every 5–15 min
    Normal saline
    1–2 L IV bolus
    20 mL/kg in children
  3. Decision

    Improving after 2 IM doses?