PRESCRIPTION FOR A CASE OF ANAPHYLAXIS IN AN ADULT AFTER PENICILLIN INJECTION

Doctor’s name

Reg No.:

Name :

Age :

Sex:

Address:

DIAGNOSIS: ANAPHYLAXIS AFTER PENICILLIN INJECTION

• Oxygen inhalation 4 litres/ min

• Injection ADRENALINE 0.5ml 1: 1000 solution

Dispense 1 ampoule

0.5 ml of 1: 1000 solution to be given I.m. stat.

• Inj. CHLORPHENIRAMINE 10mg

Dispense 1 ampoule

10mg to be given i.m. stat

• Inj. HYDROCORTISONE HEMISUCCINATE 100mg

Dispense 1 ampoule.

100mg to be given by slow I.V. injection

Signature of the doctor

Date

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