Abstract
Answer A. Administer a second dose of intramuscular adrenaline into the contralateral thigh
In ongoing or refractory anaphylaxis, intramuscular (IM) adrenaline should be repeated every 5 minutes if there is no improvement, and the second dose should be given in the contralateral thigh. This is because adrenaline causes local vasoconstriction at the injection site, which can impair absorption if repeated in the same thigh. Adjunctive treatments such as oxygen, antihistamines and steroids do not replace adrenaline and should not delay repeat dosing. Adrenaline infusions are reserved for specialist settings after failure of repeated IM doses.
InnovAiT article: Anaphylaxis in general practice. DOI: 10.1177/17557380261419014.