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FOCUSED SHIFT VIEW

Anaphylaxis & Angioedema

Airway, breathing, circulation: epinephrine first when anaphylaxis is suspected.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Call for airway help early when voice, tongue, floor-of-mouth, or breathing changes appear.
  2. Give IM epinephrine promptly for suspected anaphylaxis per local protocol; do not delay for antihistamines or steroids.
  3. Observe according to severity, treatment response, comorbidity, and local policy; discharge only with education and an autoinjector plan where appropriate.

2 · Escalate now if

  • Stridor, hoarseness, drooling, tongue/floor-of-mouth swelling
  • Hypotension, syncope, cyanosis, severe wheeze
  • Rapid progression or repeated epinephrine requirement
  • Severe asthma or delayed presentation
  • ACE-inhibitor/hereditary angioedema with voice change

3 · Immediate workup

  • Continuous monitoring, repeat airway examinations, ECG/glucose as clinically indicated
  • Treat first; testing is not required to diagnose anaphylaxis

4 · Don’t miss

  • Anaphylaxis with airway/breathing/circulation involvement
    IM epinephrine and resuscitation per local protocol; prepare for a difficult airway.
  • Rapidly progressive tongue/laryngeal angioedema
    Voice change, drooling, stridor, or inability to manage secretions requires immediate expert airway planning.
  • Refractory shock
    Escalate to monitored resuscitation and vasopressor/critical-care pathway after repeated IM treatment and fluids per protocol.

5 · Disposition lane

Admit / monitored observation

Persistent symptoms, severe asthma, significant comorbidity, unreliable access to rescue treatment, or evolving angioedema.

Resuscitation / ICU / airway team

Airway compromise, shock, refractory symptoms, or repeated epinephrine requirement.