Anaphylaxis Recognition

Why This Is Hard

Anaphylaxis kills by airway swelling and distributive shock. Crews delay epinephrine waiting for hives or “more symptoms.” Some patients present with GI symptoms and hypotension after a known allergen — still anaphylaxis thinking.

Working Field Picture

• Acute onset after exposure (food, sting, drug, latex) — exposure may be unknown.
• Skin/mucosal: hives, flushing, angioedema — helpful but not required in every definition pathway.
• Respiratory: wheeze, stridor, dyspnea, hypoxia.
• Cardiovascular: hypotension, syncope, collapse.
• GI: crampy pain, vomiting, diarrhea in some cases.

EMS Priorities (Education)

1. Epinephrine IM early when criteria met — per protocol dose/site; do not wait for IV access.
2. High-flow O₂, position of comfort; prepare for airway difficulty.
3. Remove ongoing exposure if safe (stinger, etc.).
4. IV fluids for hypotension per protocol; second-line agents only as authorized.
5. Antihistamines/steroids may be adjuncts in protocols — they do not replace epi for true anaphylaxis.
6. Reassess; biphasic reactions exist — transport and monitoring matter.

Key Points for Paramedics

• Epi is the priority drug class for anaphylaxis education frameworks.
• No rash ≠ no anaphylaxis.
• Patients on beta-blockers may be harder to resuscitate — still follow protocol.
• Document exposure, times of epi, response, and airway status.

Field Pitfalls

• Giving only diphenhydramine for multi-system involvement with shock.
• Delaying IM epi to start an IV.
• Assuming “anxiety” when the patient is hypoxic and hypotensive after peanuts.

Practice

State your system’s IM epi pathway from memory (site, concentration awareness, redosing rules). Related: Epinephrine lesson, Shock categories.

Sources & Further Study

• NIAID/FARE-style anaphylaxis education concepts; your allergic reaction protocol.