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60 ANAPHYLACTIC SHOCK PEER REVIEWED that is unresponsive to epinephrine and fluid resuscitation should be treated symptomatically with vasopressors and/or anticholinergics. Vasopressors Use of vasopressors should be considered when epinephrine and fluid resuscitation fail to improve blood pressure. Vasopressors act to increase myocardial contractility and cause vasoconstriction. 2,16 These effects may help to counteract the vasodilation and myocardial dysfunction that occur during an anaphylactic reaction. Anticholinergics For patients with persistent bradycardia in which epinephrine does not aid in the treatment of bronchospasm, anticholinergics may be administered. 2,16 MONITORING Patients experiencing anaphylactic shock should be hospitalized for an observational period of 48 to 72 hours. 16 Organs involved in the initial reaction may quickly deteriorate and should be monitored closely. These organ systems can experience a secondary or biphasic response. Jennifer L. Lyons Jennifer L. Lyons, MS, is a veterinary technician at BluePearl Veterinary Partners in Midvale, Utah. Before moving to Utah, she attended the University of California, Davis, for 6 years where she received a BS in animal biology and an MS in animal biology with a specialization in reproduction. Her interests include emergency triage, critical care, and endocrinology. Jordan R. Scherk Jordan R. Scherk, DVM, DACVECC, is a staff criticalist and the medical director of BluePearl Veterinary Partners in Midvale, Utah. He graduated from Western University of Health Sciences, completed an internship at VCA Veterinary Special Center of Seattle, and completed his residency training at the University of Georgia. His interests include trauma, acute kidney injury disease, cardiac critical care, cardiopulmonary resuscitation (CPR), and mechanical ventilation. He has lectured on CPR, congestive heart failure, and respiratory distress, as well as anaphylaxis. SUMMARY Anaphylaxis is a severe condition that requires rapid emergency treatment. Because of the lack of definitive diagnostic criteria, it may be difficult to diagnose and is often overlooked. Rapid patient history and assessment are key in diagnosing and treating anaphylaxis. REFERENCES 1. Kemp SF. Anaphylaxis: current concepts in pathophysiology, diagnosis, and management. J Allergy Clin Immunol 2001;22(4):611- 634. 2. Simons FE. Anaphylaxis. J Allergy Clin Immunol 2008;121(2 Suppl):S402-S407. 3. Kemp SF, Lockey RF. Anaphylaxis: a review of causes and mechanisms. J Allergy Clin Immunol 2002;110(3):341-348. 4. Golden DB, Moffitt J, Nicklas RA, et al. Stinging insect hypersensitivity: a practice parameter update 2011. J Allergy Clin Immunol 2011;127(4):852-854.e1-23. 5. Cowell AK, Cowell RL, Tyler RD, Nieves MA. Severe systemic reactions to Hymenoptera stings in three dogs. JAVMA 1991;198(6):1014-1016. 6. Mueller RS, Janda J, Jensen-Jarolim E, Rhyner C, Marti E. 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