Anaphylaxis can deteriorate within minutes, making the first treatment decision critical. This case focuses on recognising life-threatening anaphylaxis and identifying the drug that should be given immediately. Let’s work through the clinical clues, the correct intervention, and the common exam trap.
Clinical Case
A 24-year-old develops facial swelling, widespread urticaria and stridor within minutes of a bee sting, with blood pressure 82/50 mmHg. What should you do? A. IV hydrocortisone
B. IM adrenaline 0.5 mg (1:1000)
C. IV chlorphenamine
D. Nebulised salbutamol
E. IV adrenaline 1 mg (1:10,000)
Correct Answer B. Intramuscular adrenaline 0.5 mg (1:1000)
Anaphylaxis is a clinical diagnosis, and IM adrenaline into the anterolateral thigh is the single life-saving intervention — it reverses airway oedema, bronchospasm and vasodilatation. Adult dose 0.5 mg (0.5 mL of 1:1000), repeated after 5 minutes if there is no improvement.
Why the other options are wrong
A. Hydrocortisone has a slow onset and no role in immediate reversal; it is an adjunct.
C. Antihistamines relieve cutaneous symptoms only.
D. Nebulised salbutamol may help bronchospasm but not laryngeal oedema or hypotension.
E. IV adrenaline (dilute 1:10,000) is reserved for refractory anaphylaxis under monitoring; giving it first, or 1:1000 IV, risks fatal arrhythmia.
Exam Trap
Grabbing the antihistamine or steroid first — neither treats the airway or the shock. IM adrenaline is always the first drug.
Reference Resuscitation Council UK — Emergency treatment of anaphylactic reactions.
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