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Anaphylaxis?

North District Hospital

Flow Chart for Initial Management of

Suspected Anaphylaxis

Give Intramuscular (IM) Adrenaline*

Use adrenaline 1mg/ml (1:1000) preparation and 23G needle

Adult and child >12 years Child 6-12 years

Child 6 months to ‹6 years

Child <6 months

0.5ml IM (500microgram) 0.3ml IM (300microgram) 0.15ml IM (150microgram)

0.1-0.15ml IM (100-150microgram)

Version 12/2024

Assess ABC and skin condition

  • Airway: Hoarseness, stridor
  • Breathing: ⇧ Shortness of breath, wheeze, SpO2 <94%
  • Circulation: Low blood pressure, signs of shock
  • Skin condition: Itchy skin rash, urticaria, flushing, angioedema

Call for HELP

Stop the drug/blood product if suspected to be the trigger

Correct Posture

Lie patient flat (or sit up)

If pregnant, lie on left side

ABC Support

  • Airway & breathing: Give O2
  • Circulation: IV fluid challenge* with crystalloid e.g. NaCl 0.9%

*Adults: 500-1000ml Children: 10-20ml/kg

If no clinical improvement:

  • Repeat IM adrenaline after 5 min
  • Seek ICU support early for refractory anaphylaxis

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*For patients on anticoagulants or with coagulopathy,

observe for any haematoma and apply firm pressure for at least 2 to 5 minutes.