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Anaphylaxis cardiac arrest — DipIMC MCQ

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HardResuscitationAnaphylaxis cardiac arrestDipIMC

A 49-year-old man collapses after a bee sting. He is pulseless on arrival; bystanders report facial swelling and wheeze before collapse. What is the most appropriate management?

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Correct answer: D — Start standard ALS with early intravenous adrenaline according to cardiac arrest rhythm

Once anaphylaxis has progressed to cardiac arrest, standard ALS with high-quality CPR, airway management and intravenous adrenaline according to the arrest algorithm is required. Intramuscular adrenaline absorption is unreliable during arrest and should not delay CPR. Antihistamines do not treat life-threatening airway, breathing or circulatory collapse. The pearl is that anaphylaxis before arrest and anaphylaxis arrest have different adrenaline routes and priorities.

Reference: Resuscitation Council UK Anaphylaxis Guidance; Adult ALS Guidelines 2025