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Refractory paediatric anaphylaxis — DipIMC MCQ

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ModeratePre-hospital PharmacologyRefractory paediatric anaphylaxisDipIMC

A 4-year-old with anaphylaxis has received IM adrenaline 150 micrograms. Five minutes later she remains wheezy, pale and drowsy. What is the most appropriate drug/dose?

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

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Correct answer: D — Repeat IM adrenaline 150 micrograms and escalate for refractory anaphylaxis support

If life-threatening anaphylaxis features persist, IM adrenaline is repeated after about five minutes using the correct age-banded dose. Antihistamines do not treat shock or airway compromise. IV adrenaline requires experienced clinicians and careful dilution/infusion because bolus errors are dangerous. The pearl is that persistent ABC problems after adrenaline mean repeat adrenaline and escalation, not passive observation.

Reference: Resuscitation Council UK Anaphylaxis Guidance 2021; JRCALC Guidelines 2025