GRADE 3 REACTION

This patient is experiencing GRADE 3 CRS REACTION

Management Plan:

High risk of Proceeding to Grade 4 reaction – Discuss plan for ICU admission or ensure ICU is given notice about possible admission

Check vital signs frequently

Treat fever with antipyretics

If hypotensive, provide high dose vasopressor with or without vasopressin

Provide O2 support with FiO2 ≥40% : high flow nasal cannula (>6L/min), Venti-mask, non-rebreather

Administer Tocilizumab

Look for signs of other organ toxicities along with CRS triads such as bleeding, decreased urine output or tachycardia.

If more than 1 vasopressor is used, symptoms has progressed. Proceed to GRADE 4 REACTION (Go to PAGE 7)

(Lee et al., 2019; Neelapu et al., 2018; Novartis Pharmaceuticals Canada Inc., 2018)