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Refractory anaphylaxis — DIPIMC MCQ

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HardMedical EmergenciesRefractory anaphylaxisDIPIMCDipIMC

An adult with anaphylaxis remains profoundly hypotensive and wheezy despite positioning, oxygen, rapid crystalloid and three correctly timed IM adrenaline doses. An experienced critical-care team has invasive monitoring and an infusion pump. What is the next vasoactive strategy?

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Correct answer: D — Start a closely titrated IV adrenaline infusion and continue resuscitation

The best answer is “Start a closely titrated IV adrenaline infusion and continue resuscitation”. This is refractory anaphylaxis. Resuscitation Council UK guidance supports expert, closely monitored IV adrenaline infusion when repeated IM doses and appropriate fluid resuscitation have not restored the circulation. A 1 mg IV bolus is a cardiac-arrest dose and risks severe harm in a perfusing patient. Bronchodilator, antihistamine and corticosteroid treatments do not replace adrenaline or shock resuscitation.

Reference: Resuscitation Council UK, Emergency treatment of anaphylaxis: https://www.resus.org.uk/library/additional-guidance/guidance-anaphylaxis/emergency-treatment-anaphylactic-reactions