Transcription of Anaphylaxis Checklist and Flowsheet - AAIFNC
1 Anaphylaxis Checklist and Flowsheet Date_____ Name_____. Weight kg. ( )_____ 911 called_____am/pm Checklist . Call 911 Anaphylaxis Cart O2 E-cylinder VS q 5 min BP cuff Supine Bag & mask 6l/min Green face mask 6l/min Pulse oximeter Functioning IV (2). Epinephrine 1:1,000 IM q 5-10 min. Dosing guidelines Age Dose Age Dose 2-6 mo ml 5 yr ml 12 mo ml 6-9 yr ml 18 mo-4 yr ml 10-13 yr ml >14 yr ml Epinephrine 1:10,000 ml/kg IV q 5-10 min. Solumedrol 2 mg/kg IV up to 125mg Benadryl 1mg/kg PO or IV up to 50mg Zantac 1 mg/kg IV up to 50 mg IV pole with Ringer's Lactate macrodrip, stopcock, 50 cc syringe Glucagon 1-5 mg IV followed by infusion of 5 to 15 mcg/min (1 mg in 1L D5W @ 5-15 ml/min).
2 Time HR BP Pulse O2 sat Comments Meds/RX. Signatures 1.
