Lesson 4 – Patient Management of Mild to Moderate Allergic Reactions : Effective Interventions in the Prehospital Setting

Lesson 4 Overview

Managing mild to moderate allergic reactions, from initial approach to interventions. Stay ready for rapid escalation.

Game Plan

Prioritize scene safety. Use rapid assessment to guide interventions. Remove allergen only if safe. Reassess frequently. Have anaphylaxis treatment ready.

Removing the Allergen

Avoid inducing vomiting for food allergies unless directed. Scrape out insect stingers—don’t squeeze. Remove contaminated clothing and rinse chemicals. Stop offending meds and bring them to hospital. Protect yourself first.

Mild Reactions Management

Monitor closely. Administer oral antihistamines if allowed and patient can swallow. Use cold compresses for itching/swelling. Allow comfortable positioning. Provide reassurance and patient education.

Moderate Reactions Management

Administer oxygen liberally for respiratory symptoms. Use nebulized bronchodilators if wheezing and protocol allows. Establish IV access if in scope. Prepare epinephrine for possible escalation. Use cardiac monitor if available.

Oxygen Administration

Use for respiratory distress or SpO2 <94%. Start with nasal cannula for mild cases; escalate to non-rebreather for severe symptoms. Aim to keep SpO2 above 94%. Monitor patient’s breathing and overall condition for changes.

Patient Medications

Assist with patient’s own meds like antihistamines and inhalers per protocol. Verify prescription and expiration. Document medication, dose, time, and patient response thoroughly for hospital handoff.

Monitoring and Reassessment

Check vitals frequently (every 5 minutes for severe cases, every 15 for mild). Watch breathing effort and signs of worsening or anaphylaxis. Reassess after every intervention. Be alert for biphasic reactions.

Transport Considerations

Allow patient comfortable positioning (usually upright for breathing). Maintain close monitoring during transport. Be ready for sudden deterioration. Consider ALS intercept if moderate reaction. Notify receiving facility early.

Patient Education

Teach signs/symptoms to watch for, importance of follow-up, proper use of EpiPen, allergen avoidance, and when to call 911. Reinforce education even if patient refuses transport.

Documentation

Record all assessment findings including negatives. Document all interventions with details and patient response. Track vital sign trends. Note patient education and transport decisions/refusals carefully.

Scenario Practice

28-year-old with facial swelling and hives after shrimp. Breathing okay but anxious. Assess severity, provide interventions, monitor closely, prepare for escalation, educate patient, and decide transport. Keep reassessing and tailoring care.