– Observation and H-1 antihistamine (diphenhydramine- 25-50mg PO/IM/IV)

1. ADD – IV fluids (normal saline, Lactated ringers)
2. Epinephrine (1:10,000)- 0.1mg – IV slowly
3. Epinephrine (1:1000) – 0.1-0.3mg – subcutaneously
4. H-2 antihistamine

• cimetidine injectable-300mg-diluted to 20 ml-IV slowly [Pediatric-5-10mg/kg-diluted to 20ml- IV slowly]
• ranitidine injectable-50mg-diluted to 20ml-IV slowly

– 10 L/min

– 2-3 deep inhalations (metaproterenol, terbutaline or abuterol) Use nebulizer if available- albuterol 0.5% solution- 0.5ml in 3ml normal saline- breathe through nebulizer tube for 8-10 minutes

(1:1000)-0.1-0.2mg- may give 0.3mg – subcutaneously [Pediatric- 0.01mg/kg up to 0.3mg maximum- subcutaneously]

(1:10,000) – 0.1mg – IV slowly [Pediatric- 0.01mg/kg – IV slowly]

1. normal saline or lactated ringers solution-Rapidly
2. If hypotension unresponsive- vasopressor (epinephrine or dopamine)
3. get appropriate assistance – Call CODE
4. Epinephrine – (1:10,000)- 0.1mg- IV slowly
5. IV solution – 1mg in 250ml D5W- start at 4mcgm/min (1ml/min)

- normal saline or lactated ringers solution- Rapidly

0.6-1.0mg IV- repeat q 3-5 min (as needed)- 3mg total [Pediatric- 0.02mg/kg IV-starting dose- 0.1-0.6mg dose- 2mg total]

– as needed

– if hypotensive

(10 L/min)

– normal saline or lactated ringers solution- Rapidly

– (1:10,000)- 0.1mg- IV slowly – incrementally over 2-5 minutes [Pediatric- 0.01mg/kg – IV slowly – 0.1mg total (Limit amount of Epinephrine in patients taking non-cardioselective beta-adrenergic blocking drugs]

• Isoproterenol- (1:5000)- 0.2mg/ml- IV slowly- 0.5-1.0ml diluted to 10ml with normal saline- 1ml (20 microgram) increments
• Glucagon- 1-5 mg IV bolus- followed by IV infusion of 5-15 microgram/min (may cause hypotension)

1. H-1 blocker : diphenydramine 25-50mg- IV slowly- (may exacerbate or cause hypotension-may thicken bronchial secretions)
2. H-2 blocker

• cimetidine injectable 300mg- diluted to 20 ml- IV slowly [Pediatric- 5-10mg/kg- diluted- IV slowly]
• ranitidine injectable 50mg- diluted to 20 ml- IV slowly

- 2-3 deep inhalations (metaproterenol, terbutaline or abuterol)- Use nebulizer if availablealbuterol 0.5% solution- 0.5ml in 3ml normal saline- breathe through nebulizer tube for 8-10 minutes

- Hydrocortisone 200mg IV slowly - Methylprednisolone 80mg IV slowly

– 10 L/min

– very slowly

– 0.4mg-sublingually- may repeat q 15 minutes

– 2 mg IV slowly

– 10 L/min

– very slowly- primarily to maintain IV access

– 0.4mg-sublingually or 2% ointment topically-1-2 inch strip

~nifedipine 10mg capsule- punctured or chewed and swallowed (nifedipine sublingually- is no longer recommended as the first line drug for treatment of all hypertensive crises- due to very poor sublingual absorption and reported serious adverse effects)

- phentolamine- 5mg- IV slowly

- suction as needed- monitor airway for tongue obstruction

– 10 L/min

- treat per protocols

- consider diazepam- 5mg IV slowly

– 10 L/min

– D5W

– Dextrose 50% solution- IV push

– glass of orange juice plus sugar or glass of milk