Anaphylaxis Emergency & Adrenaline Dosing
Step-by-step UK protocol — recognition, IM adrenaline doses, escalation, and post‑reaction care based on Resuscitation Council UK guidance.
“Intramuscular (IM) Adrenaline is the single most effective treatment for anaphylaxis. It must be administered immediately as soon as a reaction is suspected — delays in giving Adrenaline are directly linked to fatal outcomes.” — Resuscitation Council UK Anaphylaxis Guidelines
1. Recognising Anaphylaxis
Anaphylaxis is a sudden, life‑threatening systemic allergic reaction causing airway, breathing, or circulatory compromise. It can be triggered by medications, IV antibiotics, blood products, contrast media, latex, or food — and can progress to fatal collapse within minutes.
🚨 ANAPHYLAXIS RED FLAGS — A, B, or C Compromise
- A — Airway: Swelling of lips/tongue/throat, hoarseness, difficulty swallowing, inspiratory stridor.
- B — Breathing: Rapid shallow breathing, wheeze, chest tightness, confusion from low oxygen, SpO₂ < 92%.
- C — Circulation: Hypotension (systolic BP < 90 mmHg), fast weak pulse, pallor, clamminess, dizziness, collapse, loss of consciousness.
- Skin signs: Hives, flushing, itching — but may be absent in up to 20% of severe reactions! Do not wait for a rash to treat.
2. The First 60 Seconds — What to Do
- STOP the trigger: If an infusion is running — stop it immediately. Disconnect at the cannula hub. Do NOT flush the line — this pushes more allergen in.
- CALL 2222: Declare medical emergency. Request resus team and trolley.
- Position correctly:
- Shock → lie flat, raise legs.
- Breathing difficulty → allow sitting upright.
- Never stand or walk them — sudden posture change can cause fatal collapse.
- High‑flow oxygen: 15 L/min via non‑rebreathe mask.
- Give IM Adrenaline 1:1000 — do not wait for BP or monitor confirmation.
3. IM Adrenaline Dosing — Resuscitation Council UK
Adrenaline 1 in 1000 given into the anterolateral aspect of the mid‑thigh — the safest, most reliable site. Repeat every 5 minutes if no improvement.
💉 IM ADRENALINE (1:1000) — DOSE BY AGE
4. Second‑Line Treatments
Once adrenaline is given and the emergency team has arrived, these are started as adjuncts — they do not replace adrenaline:
- IV fluids: 500–1000 mL crystalloid (Hartmann’s or 0.9% saline) rapidly — replaces volume lost to vasodilation.
- Chlorphenamine (Piriton): 10 mg IV/IM — treats skin/mucosal symptoms only.
- Hydrocortisone: 200 mg IV/IM — helps prevent delayed or biphasic reaction.
- Blood tests: Tryptase levels — take 3 samples: immediately, 1–2 hours later, and at 24 hours/baseline. Confirms diagnosis for future allergy workup.
5. Escalation Script — Word for Word
Looking for another emergency protocol?
Head back to the main directory to access rapid guides for STEMI, Sepsis, Hypoglycaemia, Anaphylaxis, and more.
← Back to The Panic Zone – The Student Nurse