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Anaphylaxis management — MRCEM SBA MCQ

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EasyEmergency MedicineAnaphylaxis managementMRCEM SBAMRCGP AKTUKMLAPARAPSA

A 26-year-old adult develops wheeze, stridor, hypotension and widespread urticaria minutes after eating peanuts. Which initial adrenaline prescription is correct?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — 500 micrograms IM of 1 mg/mL adrenaline into the anterolateral thigh

The correct adult initial dose is 500 micrograms intramuscular adrenaline, drawn as 0.5 mL of the 1 mg/mL solution, into the anterolateral thigh. Repeat after 5 minutes if airway, breathing or circulation problems persist while following ABC emergency care. Subcutaneous absorption is slower and unreliable. Intravenous adrenaline boluses are hazardous and restricted to appropriately experienced specialists in monitored settings; 1 mg is the cardiac-arrest dose, not the initial anaphylaxis dose. Nebulised adrenaline can be an adjunct for upper-airway obstruction but cannot replace IM treatment.

Reference: Resuscitation Council UK. 2025 Resuscitation Guidelines: Special circumstances. https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines