ACUTE HYPERSENSITIVITY GUIDELINES		version 3/16/2023		

Acute Hypersensitivity Guidelines 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	PRN	S	Until discont'd	
		Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
	1. Stop the infusion.
	2. Place the patient on continuous monitoring.
	3. Obtain vital signs.
	4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
	5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
	6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
	7. Notify the treating physician.
	8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
	9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.		
	☐	Nursing communication	PRN	S	Until discont'd	
		Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
	1. Stop the infusion.
	2. Notify the CERT team and treating physician immediately.
	3. Place the patient on continuous monitoring.
	4. Obtain vital signs.
	5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
	6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
	7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
	8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
	9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.		
	☐	Nursing communication	PRN	S	Until discont'd	
		Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
	1. Stop the infusion.
	2. Notify the CERT team and treating physician immediately.
	3. Place the patient on continuous monitoring.
	4. Obtain vital signs.
	5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
	6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
	7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
	8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
	9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
	10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.		
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, once PRN, Increased temperature, Starting when released, Until Discontinued
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, PRN, Allergic reaction, Starting when released, Until Discontinued		
	☐	cetirizine (ZyrTEC) tablet 10 mg	PRN	S	Until discont'd	
		10 mg, oral, once PRN, allergic reaction, Starting when released, Until Discontinued		
	☐	famotidine (PEPCID) injection 20 mg	PRN	S	Until discont'd	
		20 mg, intravenous, PRN, Allergic reaction, Starting when released, Until Discontinued
	Indication(s) for H2 Receptor Antagonist (H2RA) Therapy: Allergic Reaction		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, PRN, Allergic reaction, Until Discontinued		
	☐	dexAMETHasone (DECADRON) IV 4 mg	PRN	S	Until discont'd	
		4 mg, intravenous, PRN, Allergic reaction, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	PRN	S	Until discont'd	
		0.3 mg, subcutaneous, PRN, anaphylaxis, Starting when released, Until Discontinued