Anaphylaxis, part 2: Management strategies

The management goals for patients with anaphylaxis are the same as those in any other cardiac life support situation. Oxygen, adequate venous access, and volume resuscitation should be provided (when clinically indicated), and the patient's vital signs, telemetry, and oxygenation should be closely monitored. The treatment of choice is epinephrine administered intramuscularly into the outer thigh. Repeated injections or intravenous infusion of epinephrine may be necessary for those who do not respond. Adjunct therapies include antihistamines, H₂ antagonists, crystalloids, and corticosteroids. Because of the risk of biphasic reactions, patients should be observed for at least 6 hours after initial symptoms. After experiencing anaphylaxis, patients should be counseled on prevention of future reactions and may be given a prescription for self-injectable epinephrine and instructions on how to use it.