“Although anaphylaxis management recommendations depend on practice resources and proximity to emergency services, key components for medical clinics include a highly visible anaphylaxis protocol, regular rehearsals, appropriately maintained supplies, and a treatment log to record events.[3,19]

Clinic staff should be familiar with an anaphylaxis management protocol that is tailored to their office and incorporates input from staff members across multiple disciplines.[20] This protocol should feature flow charts for initial management of respiratory distress and hypotension/shock, and should include drug dosages, supplemental oxygen and intravenous fluid recommendations, and contact information for emergency medical services.[7] The importance of a protocolized approach to anaphylaxis care cannot be overstated because the rapidly evolving nature of anaphylaxis does not afford the time to look up information or recall memorized algorithms.[6] In one pediatric emergency department, implementing an anaphylaxis protocol enhanced anaphylaxis management by improving the rates of epinephrine administration and appropriate observation, and by reducing the rate of corticosteroid monotherapy.[21]

Guidelines strongly recommend regular anaphylaxis rehearsals; however, they do not specify the content or frequency of those events, but rather defer this to the discretion of the attending physician.[3,7,19] At the least, medical professionals should be able to quickly locate and assemble necessary supplies for administration, and roles for calling emergency services and treatment logging should be established.[3,19] Readily available supplies should be maintained, and their contents and expiry dates should be regularly documented.[3] Recommended anaphylaxis supplies are provided in the Box. Treatment logs should be readily accessible for documenting clinical events, vital signs, and medications/treatments administered.[7]”

More on In situ simulation training for in-office anaphylaxis preparedness via BCMJ.

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