How to Give an Injection 545
Be prepared to treat allergic reaction and allergic shock
Some medicines, especially antibiotics like penicillin and ampicillin, can produce an
allergic reaction, usually within 30 minutes after an injection. An allergic reaction can
progress to allergic shock, which is an emergency. To prevent allergic reaction and
allergic shock, before giving an injection ask the person: “Have you ever had a reaction
to this medicine—like hives, itching, swelling, or trouble breathing?” If the answer is
yes, do not use that medicine in any form, or any medicine from the same family of
medicines. Whenever you inject medicines, watch for signs of allergic reaction and
allergic shock and have medicines for treating them nearby.
Mild allergic reaction
Signs: • itching
• sneezing
• hives or rash
Treatment:
Give 25 mg diphenhydramine by mouth 3 times a day until the signs disappear.
Pregnant or breastfeeding women may find the discomfort of a mild allergic reaction better than the
risks of taking an antihistamine.
Moderate to severe allergic reaction
Signs: • itching
• swollen mouth
• difficulty breathing
• hives
and tongue
Treatment:
1. Inject 0.5 mg of epinephrine immediately under the skin. See the drawing on page 544.
Give a second injection in 20 minutes if the signs do not get better.
2. Give 25 mg diphenhydramine or promethazine by mouth or by injection into a muscle.
Repeat in 8 hours or less if the signs do not get better.
3. Watch the person for at least 4 hours to make sure the reaction does not progress to
allergic shock.
Allergic shock
Signs: • itching or hives
• swollen mouth and tongue • weak, rapid pulse or
• sudden paleness or cool, • difficulty breathing
moist skin (cold sweats) • loss of consciousness
Treatment:
heartbeat (more than
100 beats per minute
for an adult)
1. Inject 0.5 mg of epinephrine immediately under the skin. See the drawing on page 544.
Give a second injection in 20 minutes if the signs do not get better.
2. Inject 50 mg diphenhydramine or promethazine into muscle. Repeat in 8 hours or less
if the signs do not get better.
3. Inject 500 mg hydrocortisone (cortisol) into muscle and repeat in 4 hours if needed.
Or inject 20 mg dexamethasone into muscle and repeat in 6 hours if needed.
4. Watch the person for 8 to 12 hours to make sure the signs do not come back. Leave
her with steroid medicines to take by mouth if her signs return. She should take 500 to
1000 mg of hydrocortisone and repeat after 4 hours if needed. Or she can take 20 mg
of dexamethasone and repeat after 6 hours if needed.
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