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Adder (snake) envenomation — DIPIMC MCQ

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HardEnvironmental MedicineAdder (snake) envenomationDIPIMCDipIMC

A patient develops wheeze, hypotension and widespread urticaria after a wasp sting. They receive 500 micrograms IM adrenaline and oxygen. Five minutes later they remain hypotensive with persistent wheeze. What is the most appropriate next treatment while escalating support?

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Correct answer: B — Repeat IM adrenaline and give an intravenous crystalloid bolus

The best answer is “Repeat IM adrenaline and give an intravenous crystalloid bolus”. Persistent airway, breathing or circulation problems after five minutes require another IM adrenaline dose; hypotension also warrants early intravenous crystalloid and senior/critical-care escalation. Antihistamines and corticosteroids do not treat life-threatening shock, and bronchodilator therapy may help bronchospasm but cannot replace adrenaline. Tryptase can assist later diagnostic assessment, never immediate emergency treatment.

Reference: RCUK 2025 Special Circumstances Guidelines: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines