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Emergency Response to Anaphylaxis

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Emergency Response to Anaphylaxis

A 45-year-old man receives a Tdap vaccine at the pharmacy. Within 5 minutes, he develops hives, facial swelling, and difficulty breathing. He has no known allergies and no history of anaphylaxis. The pharmacy has an anaphylaxis kit that includes epinephrine 1:1000 (1 mg/mL) ampules, syringes, alcohol swabs, and diphenhydramine. The pharmacist is present and assesses the patient as having anaphylaxis. The patient weighs 80 kg. The pharmacy's emergency protocol follows CDC guidelines for adult epinephrine dosing: 0.5 mg IM (1:1000) into the anterolateral thigh, repeated every 5-15 minutes as needed. Diphenhydramine 50 mg IM/IV can be given as adjunct. The pharmacy does not have oxygen or IV fluids. Emergency medical services (EMS) have been called and are 8 minutes away.

1. What are the immediate steps you should take to manage this patient?

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  1. Recognize anaphylaxis: Hives, facial swelling, and difficulty breathing after vaccination indicate anaphylaxis.
  2. Call for help: Ensure EMS has been called (already done) and alert the pharmacist.
  3. Administer epinephrine: Draw up 0.5 mg of epinephrine 1:1000 (0.5 mL) and inject IM into the anterolateral thigh. Note the time.
  4. Position the patient: Place the patient supine with legs elevated to improve blood flow; if breathing is difficult, allow sitting up. Do not stand the patient up.
  5. Monitor vital signs: Check pulse, breathing, and consciousness. Be prepared to repeat epinephrine every 5-15 minutes if symptoms persist or worsen.
  6. Administer adjunctive treatment: If available, give diphenhydramine 50 mg IM/IV for hives, but do not delay epinephrine.
  7. Prepare for EMS: Document the time and dose of epinephrine, and any other interventions. Stay with the patient until EMS arrives.
  8. Follow-up: After stabilization, report the event to the vaccine adverse event reporting system (VAERS) and document in the patient's record.

2. What should you document about this incident?

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Document the following in detail:

  • Patient information: Name, DOB, date and time of vaccination.
  • Vaccine administered: Tdap, lot number, site, dose, and time.
  • Onset of symptoms: Time and description of hives, facial swelling, difficulty breathing.
  • Assessment: Anaphylaxis diagnosis by pharmacist.
  • Treatment: Epinephrine dose (0.5 mg), route (IM), site (anterolateral thigh), time given. Any repeat doses. Diphenhydramine if given (dose, route, time).
  • Patient response: Improvement or worsening of symptoms, vital signs if taken.
  • EMS notification: Time called, time of arrival, and transfer of care.
  • Follow-up: Recommendation for allergy testing, VAERS reporting, and counseling.
  • Signature: Pharmacist and technician involved.