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The Valley Hospital Mobile ICU
Standing Orders / Communications Failure Orders
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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.