ValleyProtocolBook

The Valley Hospital Mobile ICU

23

Standing Orders / Communications Failure Orders

Communications Failure Orders for allergic/reaction/anaphylaxis

(a) The following Communications Failure Orders are authorized in the event that an adult patient presents with signs of generalized allergic findings such as urticaria without signs of acute significant respiratory distress and/or profound hypotension (systolic blood pressure less than or equal to 90 mmHg)

1. Administer Methylprednisolone Sodium Succinate 125 mg or Dexamethasone Sodium Phosphate 10 mg IV/IO over one to two minutes.

2. If at any point the patient develops signs or symptoms of acute significant respiratory distress and /or profound hypotension (systolic blood pressure less than or equal to 90mmHg) with clinical evidence of shock, (altered mental status; cool clammy or mottled skin; and /or delayed capillary refill), refer to part (b) of 8.41-7.16 Standing orders for allergic reaction/anaphylactic shock and part (b) below. (b) The following Communications Failure Orders are authorized in the event that an adult patient presents with signs of generalized allergic findings such as urticaria with signs of acute significant respiratory distress and /or profound hypotension, (systolic blood pressure less than or equal to 90mmHg) with clinical evidence of shock, (altered mental status; cool clammy or mottled skin; and /or delayed capillary refill).

1. If the patient continues to have serious signs and symptoms that are not resolving, repeat administration of Epinephrine 0.3 mg IM in lateral thigh or deltoid.

2. Consider intubation for patients who fail to respond to initial therapy. Refer to the Standing Orders and Communications Failure Orders for Advanced Airway Management.

3. Administer additional Normal Saline 1 liter IV/IO.

4. If patient is severely hypotensive (systolic blood pressure less than or equal to 70 mmHg), administer Epinephrine 1:10,000 0.25 mg IV/IO slow push.

5. If patient still does not respond to treatment, administer Epinephrine 1:1000 1-10 mcg/min IV/IO drip.