Administration of Adrenaline (Epinephrine) 1:1000 injection to any patient suffering from anaphylaxis

NHS Borders clinical guidelines
NHS Borders

Objectives

The purpose of this guideline is to ensure that anaphylactic reactions in any patient are managed promptly in the absence of medical staff

Protocol for the administration of Adrenaline (Epinephrine) 1:1000 Injection or auto-injector device without a prescription for a named individual by registered health professionals employed by NHS Borders or in NHS Borders GP Practices.

This document is NOT a PGD as Intra-Muscular administration of Adrenaline is exempt from legislation where it is being used for the emergency treatment of Anaphylaxis

This Document Incorporates

Resuscitation Council (UK) Anaphylactic Initial Treatment Algorithm at the end of the document - this is taken un-adapted and titled exactly as on the Resuscitation Council website - see final page of this document

TREATMENT OF ANAPHYLAXIS IN ALL CASES OF SUSPECTED ANAPHYLAXIS DIAL 999
IMMEDIATELY OR 2222 IF IN THE BGH 1. This Protocol relates to the following specific preparation:

Name of medicine,
strength, formulation		 Adrenaline (Epinephrine) injection
Legal status POM Prescription Only Medicine
Storage
  • Injection: Do not store above 25°C. Keep container in outer carton.
  • Auto-Injector device: Keep in the outer carton.  Do not store above 25oC

Not to be kept in fridge
Dose IM Doses of 1:1000 Adrenaline (repeat after 5 min if no better)
  • Adult 500 micrograms IM
  • Child more than 12 years 500 micrograms IM
  • Child 6-12 years 300 micrograms IM
  • Child less than 6 years 150 micrograms IM
  • 1:10,000 strength of adrenaline to be excluded under this protocol
Route/method  Intramuscular injection
Frequency Repeat dosing if required after 5 minutes up to a maximum of 2 doses over fifteen minutes, in opposing outer aspect of thigh to avoid tissue necrosis
Total dose Quantity
(Maximum)		  2
Advice to Patients Reassure patient, explain procedure and course of action. Monitor patient and provide full handover to supporting staff or paramedics
Relevant Warnings Possible Side Effects
  • Tachycardia, angina, hypertension and ventricular arrhythmias
  • Anxiety, headache, cerebral bleeding,
  • Nausea and Vomiting
  • Sweating, weakness, dizziness and hyperglycaemia
 

Staff should also record in patients notes cause of anaphylaxis and this information should be disseminated widely to ensure future exposure to
allergen is avoided
Follow up arrangements Initiate CPR, Ensure patient transferred to hospital if in the community. Ensure patient is reviewed by medical staff.

 

2. Clinical condition:

Clinical Condition to be treated Emergency management of acute anaphylaxis/anaphylactoid allergic reaction
Criteria for inclusion
  • Patients who present with the clinical signs of anaphylactic/ anaphylactoid reaction.
  • Symptoms of Anaphylaxis (one or more of the following)
  • General - Pallor, Limpness, Weakness, Giddiness, Apnoea
  • Cardiovascular - profound hypotension in association with tachycardia
  • Upper Airway obstruction - angioedema- swelling of lips, face, neck and tongue, difficulty in breathing, speaking and swallowing, hoarseness, stridor
  • Lower Airway obstruction - subjective feeling of retrosternal tightness and dyspnoea, bronchospasm-audible expiratory wheeze, diffuse erythema.
  • Skin - urticaria-itchy wheals with erythematous edges and pale blanched centres, peripheral oedema.

Do not administer adrenaline on the basis of an isolated skin rash.
NB: If in doubt assume anaphylaxis and treat.
Criteria for exclusion None
Action if excluded Not relevant
Action if declines Ring 999 (Community) or 2222 (In the BGH) and transfer to medical care urgently
Interactions with
other medicaments		 Although some medications interact, timing is absolutely critical and is unlikely to allow a full medication history.
Risks of not administering outweigh the risk of giving in this life-saving situation.

3. Records: Patient Notes, MIU Records, GP system, dependent on location
The following records should be kept (either paper or computer based):

The GP practice, clinic, hospital, and ward or department

The patient name and CHI number

The medicine name, dose, route, time of dose(s), and where appropriate, start date, number of doses and or period of time, for which the medicine is to be supplied or administered

Drug batch number and expiry

The signature and printed name of the registered healthcare professional that supplied or administered the medicine

Explanation that the Adrenaline was given following this protocol

Whether patient met the inclusion criteria and whether the exclusion criteria were assessed

Quantity supplied / received and current stock balance

Preparation, audit trail, data collection and reconciliation

Stock balances should be reconcilable with receipts, administration, records and disposals on a patient by patient basis.

Storage

  • Injection: Do not store above 25°C. Keep container in outer carton.
  • Auto-Injector device: Keep in the outer carton. Do not store above 25 °C
    Not to be kept in fridge.

4. Professional Responsibility:

  • All registered Health Professionals will ensure they have the relevant training and is competent in all aspects of medication, including contra-indications and the recognition and treatment of adverse effects. They will attend training updates as appropriate. For those involved in immunization, regular anaphylaxis updates are mandatory.
  • Nurses will have due regard for the NMC Standards of Proficiency ( 2018)

 

 

 

Resuscitation Council UK Anaphylactic Reactions Initial Treatment (2021)

Resuscitation Council (UK) Anaphylactic Reactions Initial Treatment (2021)

Editorial Information

Last reviewed: 31/03/2025

Next review date: 31/03/2028

Author(s): Morrison R.

Version: V 5

Reviewer name(s): Morrison R, O'Reilly M.

Related guidelines
References