Management of Anaphylactic Shock: Emergency Treatment, Steps & Prevention Guide (2026)

 Management of Anaphylactic Shock

Management of Anaphylactic Shock: Emergency Treatment, Steps & Prevention Guide (2026)

Management of Anaphylactic Shock 

Immediate treatment is indicated for all patients with significant respiratory, cardiac, or gastrointestinal symptoms as symptoms can progress rapidly to shock, respiratory failure, and death, and there are NO absolute contraindications to epinephrine.

If impending respiratory collapse (stridor, wheezing, tachypnea, dyspnea, difficulty swallowing) is suspected: Place patient in recumbent position. Obtain large-bore IV access (but do not delay epinephrine). Continuous monitoring of blood pressure, heart rate, oxygen saturation, and respiratory symptoms. IM epinephrine 0-0.5 mg 1:1000 (0.3-0.5 mg). Repeat after 5 minutes as needed (up to 70% can require doses).

FOR SEVERE SYMPTOMS OR POOR RESPONSE GIVE:

IV epinephrine 0.1-0.2 mg 1:10,000 (1-2 mL), can repeat every 5-10 min.

IF HYPOTENSIVE GIVE: 1-2 L IV 0.9% NaCl rapid infusion.

If positive Clinical Response: Treat all patients with histamine 1 and 2 (H1, H2) blockers:

1. Diphenhydramine (H1) 25-50 mg IV and either

2. Ranitidine (H2) 50 mg IV or Famotidine (H2) 20 mg IV

Continued Treatment (if no clinical response):

If patient taking home beta-blocker:

1. Glucagon 1-2 mg IV/IM q5min to effect

2. Start continuous IV epinephrine infusion at 0.1-1 µg/kg/min titrated to effect.

3. Continued aggressive fluid resuscitation (via rapid transfuser if available).

For continued respiratory symptoms, if not intubated:

Inhaled beta-agonists (albuterol 0.5 mL 0.5% soln in 2.5 mL 0.9% NaCl) nebulized q15min.

Immediate Clinical Response:

Immediate intubation as delay may increase difficulty of endotracheal intubation.

Corticosteoids may be necessary if severe airway edema.

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