What’s In Your Crash Cart? Anaphylaxis Preparedness

It’s a good time to review your “crash cart” supplies! As the end of the year approaches, we hope these highlights from our Clinical Care Statement offer some insights to ensure that you have all your supply needs met.

Definition

Anaphylaxis is defined as a serious allergic reaction that is rapid in onset and may cause death. The acute onset of a reaction (minutes to hours) with involvement of the skin, mucosal tissue or both and at least one of the following: a) respiratory compromise or b) reduction in systemic blood pressure or signs/symptoms of end-organ dysfunction. The prevalence of anaphylaxis is estimated to be as high as 2%, and appears to be rising, particularly in the younger age group. 

Anaphylaxis Management Supplies

Supplies for anaphylaxis should be organized in such a way that they are readily accessible and can be easily moved to the patient experiencing anaphylaxis. The crash cart should be regularly checked to ensure that all the medications are not past their expiration date.

Anaphylaxis Kit Essentials

·   Medications (track expiration dates)

o   Epinephrine 1:1000

o   Either auto-injectors, or at least 2 prefilled syringes with 0.1 ml for pediatrics, 0.3 ml for adults in an easily accessible location or top of kit

o   Albuterol mdi (may stock disposable spacers)

o   H1 blocker (po, iv)

o   H2 blocker (po, iv)

o   Corticosteroid (po, iv)

o   Consider dopamine

·   Airway management supplies

o   Suction (yankauer and flexible for ETT), can use suction on SMR cart or need machine

o   O2 tank with nasal cannula(s), mask(s)

o   Ambu-bag, mask(s)

o   Oral airways of various sizes

o   Intubating laryngoscope

o   Etts in various sizes

o   Cricothyrotomy and/or tracheostomy supplies

·   IV access supplies

o   Angiocatheters

o   Tubing

o   Fluids (NS or LR)

o   Tape

o   IV pole

·   Access to AED

·   Anaphylaxis treatment recording sheets

In addition to having a crash cart readily available, physicians and nursing staff should collaborate to develop a customized written protocol for the management of anaphylaxis in the office. Once developed, it should be posted in all patient areas of the office with the emergency supplies for ready access.

Regular, organized, mock anaphylaxis drills in which all staff members, clerical and medical, are required to participate can help ensure preparedness for these events.

Maintaining clinical proficiency with anaphylaxis management involves certification in basic cardiopulmonary resuscitation and, ideally, advanced life support to ensure the proper skill set for treatment of refractory anaphylaxis, including airway management, cardiac compressions, venous access, and parenteral medication calculation and delivery.

Basic Medications and Dosing for Office Management of Anaphylaxis

Epinephrine   Adult dosing      0.3–0.5 mg IM (0.3–0.5 mL of a 1:1000 solution)      May repeat every 5–10 minutes   Pediatric Dosing      0.01–0.03 mg/kg IM (0.1–0.3 mL/kg of 1:1000 solution)      May repeat at 15-minute intervals

Albuterol   Adult: metered dose inhaler: 2–4 puffs   Pediatric: (nebulizer) 0.25–0.5 mL in 1.5–2 mL saline

Diphenhydramine   Adult: 100 mg IV push   Pediatric: 1 mg/kg IV push

H2 Blockers   Adult: 50 mg slow IV push   Pediatric: 2 mg/kg (up to 50 mg) slow IV push

Dexamethasone   Adult: 20 mg IV or PO   Children: 0.5–1 mg/kg up to 20 mg IV

Methylprednisolone   Adult: 40 mg IV   Pediatric: 0.5 mg/kg IV

IM = intramuscular; IV = intravenous; PO = by mouth (per os)

Leatherman BD. Anaphylaxis in the allergy practice. Int Forum Allergy Rhinol . 2014;4:S60–S65.

Note: American Academy of Otolaryngic Allergy’s (AAOA) Clinical Care Statements attempt to assist otolaryngic allergists by sharing summaries of recommended therapies and practices from current medical literature. They do not attempt to define a quality of care for legal malpractice proceedings. They should not be taken as recommending for or against a particular company’s products. The Statements are not meant for patients to use in treating themselves or making decisions about their care. Advances constantly occur in medicine, and some advances will doubtless occur faster than these Statements can be updated. Otolaryngic allergists will want to keep abreast of the most recent medical literature in deciding the best course for treating their patients.

*Excerpt from AAOA’s Clinical Care Statements

The “Anaphylaxis” and “Anaphylaxis Crash Cart Supplies” Clinical Care Statements are available to AAOA Members.

For a list of emergency supplies for an “anaphylaxis kit” for your practice, review the “Otolaryngic Allergy Start Up Checklist” section in the Practice Resource Tool Kit. 

For more on managing anaphylaxis, register for the hybrid AAOA Basic Course 2026, hosted in Hollywood, Florida. The Basic Course focuses on:

• More integration of SLIT into treatment discussions
• Introduction to Allergy
• Allergy Testing (Prick, IT, IDT, In Vitro)
• Basic principles of allergy
• Treatment of Allergy (SCIT, SLIT, Dose Calculations, Vial Prep)
• Introduction to Advanced Topics (Unified Airway, Asthma, Food Allergies, SLIT)

Pre-Work Launch: June 9, 2026

Live In-Person & Live Streaming: Thursday, July 9 – Saturday, July 11, 2026

Post Content Access: July 12 – September 14, 2026

Registration Open

The American Academy of Otolaryngic Allergy (AAOA) Practice Resources are intended as a guide to help AAOA members integrate allergy into their otolaryngology practice and to continually improve on this integration as new information, regulations, and resources become available.

While these tools are meant as resources, we highly recommend seeking input from your practice counsel and local/state medical associations and regulatory authorities, as rules vary between states. Each practice is responsible for confirming coverage, coding, and payment parameters for those payers and regulators affecting their practice.  Our intention is to offer insights by sharing what others within AAOA do. These are not meant as recommendations.