FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- The IM and IV/IO epinephrine solutions have different concentrations and maximum doses.
- Document prearrival epinephrine and diphenhydramine to avoid treating those doses as if they never occurred.
Classify the reaction
- Stable rash/urticaria alone has a different branch from angioedema or systemic anaphylaxis; SpO₂ below 95% moves the patient to the anaphylaxis branch.
- Anaphylaxis findings include hypotension, wheeze, hypoxia, stridor, intraoral swelling, GI symptoms, or impending obstruction.
- For isolated facial or cervical angioedema, give one 0.01 mg/kg IM epinephrine dose (maximum 0.5 mg), holding it if an auto-injector was already given. Add oxygen and diphenhydramine as indicated.
First-line anaphylaxis care
- Give epinephrine 0.01 mg/kg IM of 1 mg/mL into the lateral thigh; maximum 0.5 mg. Count prior auto-injector treatment as the first dose.
- Provide oxygen as tolerated. For hypotension, give normal saline 20 mL/kg IV/IO, maximum 250 mL per bolus, and contact base; may repeat twice for 3 total boluses.
- For wheeze or room-air hypoxia below 95%, give continuous albuterol 5 mg/6 mL as tolerated.
Persistent symptoms after about 5 minutes
- With continued hypotension, respiratory distress, or impending obstruction, a second dose may be 0.01 mg/kg IM of 1 mg/mL, maximum 0.5 mg; OR 0.01 mg/kg IV/IO of 0.1 mg/mL, maximum 0.3 mg.
- After initial epinephrine, give diphenhydramine 1 mg/kg IM/IV/IO once, maximum 50 mg, unless already taken before EMS arrival.
Contact & transport
- Contact base (pediatric-capable preferred) and provide ALS escort to the designated pediatric-capable or other ERC.
- Reassess airway, respiratory effort, perfusion, and response repeatedly. Even a resolving reaction after self-administered epinephrine needs ALS evaluation and transport.
VISUAL FIELD REFERENCE
Pediatric anaphylaxis: route and maximum matter
Pediatric · ALS
Anaphylaxis branch only. Continue airway, oxygen, perfusion, and other indicated care alongside these checkpoints.
First-line IM epinephrine
Give epinephrine 0.01 mg/kg IM of 1 mg/mL into the lateral thigh; maximum 0.5 mg. Count prior auto-injector treatment as the first dose.
Persistent severe symptoms after about 5 minutes
With continued hypotension, respiratory distress, or impending obstruction, a second dose may be 0.01 mg/kg IM of 1 mg/mL, maximum 0.5 mg; OR 0.01 mg/kg IV/IO of 0.1 mg/mL, maximum 0.3 mg.
Diphenhydramine after initial epinephrine
After initial epinephrine, give diphenhydramine 1 mg/kg IM/IV/IO once, maximum 50 mg, unless already taken before EMS arrival.
- Contact base (pediatric-capable preferred) and provide ALS escort to the designated pediatric-capable or other ERC.
- The IM and IV/IO epinephrine solutions have different concentrations and maximum doses.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-P-060
UNDERSTAND THE CARE
How to prevent route and concentration errors
Classify the presentation before selecting a medication branch. Stable rash-only illness, isolated angioedema and systemic anaphylaxis are described separately in the local order. Obtain the child’s weight and the history of any auto-injector or antihistamine used before arrival so treatment already delivered is counted.
Applying the guidance
The calculation must include the indication, route, concentration and maximum dose. Two preparations bearing the same drug name can require different volumes, and the allowed maximum differs between the IM and IV/IO repeat options. Read the selected pathway aloud during preparation and then reassess the airway, respiratory effort and circulation after administration.
Putting it together
Teaching example: a caregiver reports giving epinephrine just before the crew arrived. Clarify the product and time, include it in the sequence and select any further treatment from the persistent-symptom criteria rather than restarting the count.
Diagram text & teaching checkpoints
- Branch
- Rash only, angioedema or anaphylaxis.
- Weight and prior care
- Include caregiver-administered doses.
- Route and concentration
- Verify solution and indication-specific cap.
- Response
- Airway, breathing, perfusion and base contact.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.