How should I manage a patient experiencing anaphylaxis in the practice before emergency services arrive?

Immediate management of anaphylaxis in the practice setting before emergency services arrive:

• Call for an ambulance immediately and ask for help from colleagues as anaphylaxis is a medical emergency ¹.
• Assess the patient using the ABCDE approach: check airway, breathing, circulation, disability, and exposure ¹.
• Look for and relieve airway obstruction, and check for normal breathing. If the patient is unresponsive and not breathing normally, start cardiopulmonary resuscitation (CPR) immediately ¹.
• Position the patient appropriately: do not allow them to stand or walk; if breathing is normal, place unconscious patients in the recovery position; those with airway or breathing problems may prefer a semi-recumbent position; patients with low blood pressure should lie flat with or without leg elevation; pregnant women should lie on their left side to prevent aortocaval compression ¹.
• Administer intramuscular adrenaline 1:1000 as soon as possible, ideally into the anterolateral aspect of the middle third of the thigh. Repeat the dose every 5 minutes if there is no improvement, up to two doses initially, then continue every 5 minutes if needed until adequate response ¹. Do not give intravenous adrenaline in primary care ¹.
• Remove the trigger if possible (e.g., remove a bee sting), but do not delay adrenaline administration to do so ¹.
• Give high-flow oxygen as soon as available using a mask with reservoir, aiming for oxygen saturation of 94-98% (or 88-92% if risk of hypercapnic respiratory failure) ¹.
• Monitor vital signs continuously (respiratory rate, oxygen saturation, heart rate, blood pressure, level of consciousness) and auscultate for wheeze ¹.
• If hypotension or shock is present, and if skills and equipment are available, establish intravenous access and give rapid IV fluid bolus (500–1000 mL in adults or 10 mL/kg in children) ¹.
• Consider inhaled bronchodilators (salbutamol or ipratropium) if wheeze is present, especially in patients with known asthma, but do not substitute for adrenaline ¹.
• Do not use antihistamines or corticosteroids as initial emergency treatment as they do not treat respiratory or cardiovascular symptoms and should not delay adrenaline administration ¹.

Summary: Call emergency services, assess and support ABCDE, give IM adrenaline promptly, position patient safely, provide oxygen, monitor closely, give IV fluids if shock, and consider bronchodilators if wheeze. Avoid delaying adrenaline for other interventions ¹.