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Refractory anaphylaxis — DIPIMC MCQ

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HardResuscitationRefractory anaphylaxisDIPIMCDipIMC

A 30-year-old developed stridor, widespread urticaria and hypotension after a wasp sting. She has received two doses of intramuscular adrenaline five minutes apart, plus high-flow oxygen and intravenous fluids, but remains hypotensive with persistent wheeze. What is the most appropriate next step?

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Correct answer: D — Start an intravenous adrenaline infusion titrated by a clinician experienced in its use

Refractory anaphylaxis is defined by inadequate response after two appropriate intramuscular doses, and management escalates to an intravenous adrenaline infusion titrated to effect by a clinician experienced in its use, alongside continued fluids. Corticosteroids are no longer recommended in routine acute management and do not act quickly enough here. Antihistamines have no role in treating airway or circulatory compromise. Pearl: intravenous adrenaline carries a real risk of arrhythmia and demands close haemodynamic monitoring.

Reference: Resuscitation Council UK (Emergency Treatment of Anaphylaxis)