1. For severe pain give meperidine hydrochloride (Demerol, 50-100 mg PO or IM), morphine sulfate (0.25 subcutaneous), codeine phosphate (0.5 g PO) NOTE: Aspirin is generally not effective 2. Shock ([Chart 2])

CHART 1
ANTIHISTAMINES

GROUP TRADE NAME AVERAGE ORAL BASE SEDATION
GENERIC NAMES ADULT CHILD
Ethanolamines
diphenhydramine•HCl Benadryl 50 mg q 4-6h 25 mg q 4-6h ++++
diphenhydramine theophyllinate Dramamine 50 mg q 4h 25 mg q 4h ++++
Ethylenediamine
tripelennamine Pyribenzamine 50 mg q 4-6h 25 mg q 4-6h +++
Alkylamines
chlorpheniramine maleate Chlor-Trimeton 4 mg q 6h 2 mg q 6h ++
brompheniramine maleate Dimetane 8 mg q 6h 4 mg q 6h +
triprolidine•HCl Actidil 2.5 mg q 8h 1.25 mg q 8h ++
Cyclizines
hydroxyzine•HCl Atarax 25-100 mg q 6h 10-25 mg q 6h +
Miscellaneous
cyproheptadine•HCl Periactin 4 mg q 6h 2 mg q 6h +++
promethazine Phenergan 25-50 mg q 6-8h 12.5-25 mg q 6-8h ++++

Chart 2
Treatment of Anaphylaxis—Shock

IMMEDIATE TREATMENT MILD REACTION TREATMENT SEVERE REACTION TREATMENT
REACTION: Conjunctivitis, Rhinitis, Urticaria, Pruritus, Erythema
Epinephrine•HCl 0.3 ml (1:1,000) IM
Diphenhydramine•HCl 50 mg PO
Diphenhydramine•HCl 50 mg PO q 6h
REACTION: Laryngeal edema
Epinephrine•HCl 0.3 ml (1:1,000) IM
Diphenhydramine•HCl 50 mg IV
Diphenhydramine•HCl 50 mg q 6h IM or PO
Ephedrine sulfate 25 mg q 6h
Oxygen
Diphenhydramine•HCl 50 mg q 6h
Ephedrine sulfate 25 mg q 6h
Monitor blood gases
Hydrocortisone
Tracheostomy
REACTION: Bronchospasm
Epinephrine•HCl 0.3 ml (1:1,000) IM
Diphenhydramine•HCl 50 mg IV
Epinephrine•HCl 0.3 ml (1:1,000) IM
Aminophylline 250 mg IV over 10-min period of time
Oxygen
Aminophylline 500 mg IV q 6h
Hydrocortisone
IV fluids
Monitor blood gases
Observe for respiratory failure
REACTION: Hypotension
Epinephrine•HCl 0.3 ml (1:1,000) IM
Diphenhydramine•HCl 50 mg IV
Metaraminol bitartrate, 100 mg in 1,000 ml 5% dextrose in water Oxygen
Metaraminol bitartrate IV
IV fluids

Transcriber’s Notes