A 40-year-old develops urticaria, lip swelling and wheeze 10 minutes after starting IV co-amoxiclav. BP 78/40. How do you manage?

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Anaphylaxis — I'd stop the infusion, call the arrest team, lie the patient flat with legs raised and start high-flow oxygen. Adrenaline 500 mcg IM to the anterolateral thigh, repeated at five minutes if no improvement, plus a 500-1000 mL crystalloid bolus. If refractory after two IM doses I'd escalate to critical care for IV adrenaline infusion. I'd send mast cell tryptase immediately, at 1-2 hours and at 24 hours, and write up the reaction clearly in the notes. Once stable the patient needs an observation period of 6 hours for severe reactions, two auto-injectors with training, a written emergency plan, allergy clinic referral and a yellow card report. I'd debrief the team and review whether the antibiotic indication and allergy history check could have been improved.

Anaphylaxis in the medical assessment unit

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