Clinical Allergic Reaction. Such as Erythroderma, urticaria, angioedema or wheezing present and not rapidly resolving
• Nontoxic appearance
• Minimum 2 hours of stability or improvement in ED after treatment
• Worsening condition despite treatments in ED
• Hypotension or unstable vital signs
• O2 saturation consistently less than 90% on room air
• Stridor, respiratory distress, hoarseness, drooling at the time of transfer
• Tongue or posterior oropharynx swelling
• IV vasopressors required
• IV fluids as needed
• Frequent rechecks and documentation of clear airway
• Antihistamines, corticosteroids
• Cardiac Monitoring (if indicated)
• Inhaler or nebulizer treatments (if indicated)
• Pulse oximetry
• Repeat doses of SQ epinephrine
Disposition
Resolution or improvement in clinical condition
Stable VS
Ensure patient has Epi Pen on discharge.
• Worsening of condition
Development of stridor
Inadequate response to therapy during observation
Inability to take oral medications
Abnormal or worsening vital signs