Reconcile the allergy list and document the nature and severity of prior reactions.
Assess for current reaction signs across systems — skin, airway and breathing, circulation, and gastrointestinal — recognizing that two systems or hypotension alone define anaphylaxis.
Confirm the epinephrine auto-injector is present, not expired, and that the patient or caregiver can demonstrate its use, and review the action plan.
Review the immunosuppressant regimen and screen for toxicity and for infection, taking the temperature.
In immunosuppression, treat a single fever as significant and assess for a source.
Confirm vaccine status against the recommended plan.
Identify allergen exposures in the home and review the avoidance plan.
For anaphylaxis, give epinephrine per order or auto-injector immediately and then activate EMS — do not delay epinephrine to complete an assessment.
