myocardial ischemia Symptoms of impaired cardiovascular function include dizziness, syncope, seizures, and altered mental status Triage Considerations Because evaluation and management of anaphylaxis is time sensitive, rapid recognition is critical to mitigate risk of complications Upon ED arrival, a rapid cardiopulmonary assessment including a full set of vital signs should be obtained Emergent resuscitation should be initiated as indicated After confirming a patent airway, supplemental oxygen should be administered for all children with cardiorespiratory involvement Children with hypotension or other signs of impaired cardiac function should be placed in the Trendelenburg position When possible, the offending allergen should be removed to prevent further clinical deterioration The patient should be monitored for symptoms of life-threatening anaphylactic reactions including hypotension or signs of respiratory failure (voice changes, dyspnea, or a sense of impending doom) Clinical Assessment After a rapid cardiopulmonary assessment and appropriate interventions have been initiated (see Fig 85.1 and Management section), a more detailed assessment should be performed A detailed history should include information regarding potential triggers and timing of allergen exposure, initial and current symptomatology, prehospital therapies, and historical features that may portend an increased risk of severe and biphasic reactions (e.g., history of asthma, prior anaphylactic reactions) Identifying the offending allergen may be obvious especially among children with prior allergic reactions; however, the trigger may be unknown or difficult to determine especially for patients exposed to numerous potential allergens during meals Although use is uncommon in children, concurrent medications such as β-blockers, calcium channel blockers, and angiotensin-converting enzyme inhibitors may augment reaction severity and complicate management