Urgent Care

Question 0

What are the most important sequential steps for management of anaphylaxis in infants and children?

Answer 0

1) Airway: If evidence of impending angioedema immediate intubation indicated, maybe difficult. Cricothyroidotomy may be necessary.
2) Epinephrine IM
3) reverse Trendelenburg
4) Oxygen: 8-10 liters/min by face mask> up to 100% oxygen if needed.
5) Normal saline rapid fluid bolus: 20 ml/kilogram and repeat as needed
6) Albuterol: For resistant bronchospasm: 0.15 mg/kg in 3 ml NSS by
Nebulizer.(Minimum dose is 2.5 mg)
7) H1 antihistamine: consider giving diphenhydramine 1 mg per kilogram(maximum 40 mg) IV.
8) H2 antihistamine: consider giving ranitidine 1 mg per kilogram(max 40 mg) IV
9) Glucocorticoid: consider giving methylprednisolone 1 mg per kilogram(max 125 mg) IV
10)* Epinephrine infusion: for patients with an inadequate response to IM epinephrine and fluids: 0.1 to 1 mcg/kilogram > titrate

Question 1

For anaphylaxis what is the dose of epinephrine?

Answer 1

The dose of epinephrine is .01 mg/kg with a maximum dose for child of .5 mg given IM in the outer mid thigh. May repeat every 5 to 15 minutes for three doses if needed.

Question 2

For acute asthma in children how is dose of inhaler calculated(Albuterol MDI)?

Answer 2

0.25 to 0.33 inhalations/ kg Q 20-30 Min

Maximum dose = 8 inhalations