● Immediate medical evaluation and treatment (i.e., transfer to hospital). Follow-up Actions ● Counsel employee regarding pre- vention of recurrence. ● Note sensitivity reaction in promi- nent place on employee health record. ● Instruct employee having known sensitivity to keep an anaphylaxis kit with her or him at all times. Institute emergency action. ● Maintain an open airway. ● Administer epinephrine 0.3–0.5 mL of 1:1,000 solution subcutaneously or intra- muscularly per standing order. ● Administer oxygen as indicated. ● Start intravenous solution of normal saline or lactated Ringer’s solution per standing order. ● Monitor employee vital signs. 169 Anaphylactic Shock 83 Definition An antigen-antibody reaction that occurs when a foreign protein substance enters the body of a sensitized person. The reaction can cause a histamine release, with subsequent arteriole or capillary dilation, capillary permeability, intravascular fluid leak, and hypovolemia, result- ing in inadequate perfusion of the cells. Characteristics Anaphylactic shock can trigger respiratory difficulty, bronchospasm, wheezing, warm skin, blotchy areas of redness, urticaria, rapid weak pulse, facial swelling, anxiety, loss of con- sciousness, and cardiovascular collapse. The reaction is considered life threatening. Com- mon sensitizing agents can include antibiotics or other medications, dyes, venom of stinging insect (such as yellow jackets, bees, wasps, or fire ants), foods (such as shellfish, nuts, fruit, wheat, milk, or eggs), latex, and blood transfusions. Reactions usually occur within seconds to minutes of exposure. Policy Administer immediate treatment in the occupational health unit or on site by an appropriately licensed person. Then, promptly arrange for medical treatment and/or transport to hospital. Objectives Clinical Assessments and Interventions Referral for Medical Action Guideline continues on next page