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Protocol For Management of Suspected Anaphylactic Shock: Communicable Disease Control
Protocol For Management of Suspected Anaphylactic Shock: Communicable Disease Control
1. Epinephrine (Adrenalin) 1:1000 aqueous solution: Administer 0.01 mL/kg (maximum 0.5 mL per
injection) intramuscularly (IM). Epinephrine, at the same dose as the initial one, can be repeated at 10-15
minute intervals to a maximum of 3 doses.
The following approximate dosages (0.01 mL/kg) Epinephrine (Adrenalin) administered:
may be used: 1st dose Amount: _______________ mL
2 to 6 months 0.07 mL (if given) Time: ________________
6 to 12 months 0.07-0.1 mL Site: ________________
12 to 18 months 0.1-0.15 mL 2nd dose Amount: _______________ mL
18 months to 4 years 0.15 mL (if given) Time: ________________
5 years 0.20 mL Site: ________________
6 to 9 years 0.30 mL
3rd dose Amount: _______________ mL
10 to 13 years 0.40 mL
(if given) Time: ________________
≥14 years 0.50 mL
Site: ________________
The above Drug Administration Record is to be reproduced and included in each anaphylaxis kit.
*Length of needle to be selected appropriate to patient size and body mass. Suggest: Needle gauge: 25G, needle
lenghts: 3 x 1˝; 3 x 5/8˝; 3 x 1.5˝
The kits can be stored at room temperature and should be closed with an elastic to ensure the drugs are not
exposed to light which can cause them to deteriorate. Additionally, the kits require regular verification to
replace drugs before the expiry date.
Assessment Guide and Record
Vital Signs
Respiration Pulse Blood Pressure Comments
(rate/min.) (rate/min.)
The use of the Assessment Guide and Record is optional since it is expected a detailed incident report as per the
existing policies and procedures set out by the immunization provider’s employer/regional health authority; and
the Public Health Agency of Canada (PHAC) form for Adverse Event Following Immunization (AEFI) are to
be completed in the event of a suspect or actual anaphylaxis.
References: National Advisory Committee on Immunization.
(2006). Canadian Immunization Guide. (7th Ed.).
Amercican Academy of Pediatrics. (2006). Red
Ottawa, ON: Public Health Agency of Canada
Book. 2006 Report of the Committee on Infectious
Diseases. (27th ed.). Elk Grove Village, IL: Author. Sampson, H. A. (2006). Second symposium on the
definition and management of anaphylaxis:
British Columbia Communicable Disease Control
Summary report – Second National Institute of
Immunization Manual. Anaphylaxis Section.
Allergy and Infectious Disease/Food Allergy and
October 2006.
Anaphylaxis Network Symposium. Annals of
Canadian Pharmacists Association. (2007). Emergency Medicine. 47 (4), 373-380.
Compendium of Pharmaceuticals and Specialties.
Sampson, H. A. et al. (2005). Symposium on the
The Canadian Drug Reference for Health
definition and management of anaphylaxis:
Professionals. Author.
Summary report. Journal of Allergy and Clinical
Centers for Disease Control and Prevention. (2006). Immunology, 115, 584-591.
General recommendations on immunization.
Sampson, H. A. et al. (2006). Second symposium on
Recommendations of the Advisory Committee on
the definition and management of anaphylaxis:
Immunization Practices. Morbidity and Mortality
Summary report—Second National Institute of
Weekly Report, 55 (RR-15),1-48.
Allergy and Infectious Disease/Food Allergy and
Ellis, A. K. and Day, J. H. (2003). Diagnosis and Anaphylaxis Network symposium. Journal of Allergy
management of anaphylaxis. Canadian Medical and Clinical Immunology. 117, (2), 391-397.
Association Journal. 169 (4); 307-310.
Simons, F. E. R., Roberts, J. R., Gu, X. and Simons,
Heart and Stoke Foundation. Manitoba Chapter. K. J. (1998). Epinephrine absorption in children
Lieberman, P. (2003). Use of epinephrine in the with a history of anaphylaxis. Journal of Allergy and
treatment of anaphylaxis. Current Opinion in Allergy Clinical Immunology. 101, 33-37.
and Clinical Immunology, 3, 313-318.
Lieberman, P. (2006). Anaphylaxis. The Medical
Clinics of North America. 90 (2006), 77-95.