A fictional 38-year-old develops wheeze, widespread urticaria and hypotension minutes after an intravenous antibiotic. Symptoms persist after two correctly administered intramuscular adrenaline doses.
Listen for the assumption.
Two doses have been given, so I was preparing an intravenous adrenaline bolus.
Before changing route, confirm positioning, oxygenation, monitoring, fluid resuscitation and whether the intramuscular doses were correctly timed and delivered.
Persistent airway, breathing or circulation compromise after two appropriate doses is refractory anaphylaxis and needs immediate expert critical-care support.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Persistent hypotension and wheeze
- Two appropriate intramuscular doses documented
- Continuous monitoring and large-bore access established
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Continue the anaphylaxis algorithm, reassess after every intervention and prepare for advanced airway and vasopressor support.
Correct. An adrenaline infusion belongs in a monitored environment with clinicians familiar with its use; avoid improvised intravenous boluses.
I will document trigger, timing, dose, route, physiological response and the post-reaction follow-up plan.
What must remain explicit.
- Follow the current Resuscitation Council UK algorithm and local emergency policy.
- Do not allow tests to delay treatment.
- Use intravenous adrenaline only with appropriate expertise and monitoring.
Where reasoning fails.
- Treating skin signs rather than ABC compromise
- Unsupervised intravenous adrenaline bolus
- Failing to reassess dose timing and response
Suspected trigger [detail], onset [time], ABC features [trend], adrenaline [dose/route/times], fluids and adjuncts [response], refractory criteria [details] and critical-care plan [status].
Where is the refractory anaphylaxis algorithm located in your clinical area?