SPOT THE ANAPHYLAXIS BEFORE IT SPOTS YOU
This cardinal respiratory sign is life‑threatening and requires immediate IM adrenaline.
Difficult/noisy breathing or stridor.
What is the first-line medication for anaphylaxis?
Adrenaline IM
Adult IM adrenaline dose?
0.5 mg IM (0.5 mL of 1:1000).
Fluid bolus for hypotension?
1 L 0.9% sodium chloride.
True or false: antihistamines treat anaphylaxis
False — they only treat skin symptoms.
True or false: anaphylaxis can occur without any skin involvement.
True
Where should IM adrenaline be given?
Mid‑outer thigh, into muscle
Why avoid IV adrenaline boluses?
Arrhythmias, ischaemia, and dosing errors.
First‑line bronchodilator for persistent wheeze?
Salbutamol 5 mg nebulised
Medication that must NOT be used IM due to hypotension/necrosis risk?
Injectable promethazine.
Name one GI symptom that is diagnostic for insect‑venom anaphylaxis.
Vomiting or abdominal pain.
How often can IM adrenaline be repeated if there’s no improvement?
Every 5 minutes.
When is an adrenaline infusion considered?
After two IM doses with inadequate response
Adjunct for severe bronchospasm not improving with bronchodilators?
IV magnesium sulphate 10 mmol
First step when anaphylaxis occurs during IV antibiotics?
Stop infusion immediately; give IM adrenaline.
List two airway‑swelling differentials that are not anaphylaxis.
ACE‑inhibitor angioedema, vocal cord dysfunction
What is the correct patient position during anaphylaxis?
Flat; sit only with significant respiratory distress — never stand/walk.
Nebulised adrenaline dose for airway oedema?
5 mg = 5 mL of 1 mg/mL.
Give 2 medications that we can consider adding to the treatment when adrenaline infusion isn’t enough for hypotension?
Noradrenaline; glucagon for beta‑blocker considerations.
Minimum observation period after last adrenaline dose?
4 hours minimum; longer if severe.
This airway‑related presentation can fool clinicians because it has wheeze, poor bronchodilator response, escalating distress, and no improvement with salbutamol — what is it actually?
Anaphylaxis with severe lower‑airway involvement (bronchospasm) — not asthma.
Name three immediate non‑adrenaline actions.
Stop trigger, high‑flow O₂, large‑bore IV, call Code Blue/MET, ABC reassessment.
Which receptor actions of adrenaline are primarily responsible for reversing hypotension during anaphylaxis?
α‑1 receptor–mediated vasoconstriction (↑ systemic vascular resistance) and β‑1 receptor stimulation (↑ cardiac contractility and heart rate).
Three differential diagnoses for persistent hypotension despite appropriate treatment
Tension pneumothorax, MI, PE, cardiac tamponade, hypovolaemia
Mandatory action for anaphylaxis caused by packaged food.
Notify Department of Health within 24 hours.