A fictional 34-year-old develops widespread flushing, wheeze, throat tightness and dizziness minutes after receiving an intravenous medicine.
Frame the danger first.
- Suspect anaphylaxis when there is sudden illness with life-threatening airway, breathing or circulation compromise, usually with skin or mucosal change.
- Skin features may be absent, and isolated skin symptoms do not by themselves establish anaphylaxis.
- Consider important mimics while treating a convincing time-critical presentation.
Act, escalate, reassess.
- Stop the suspected trigger where possible, call for emergency help and use an ABCDE approach.
- Follow the current Resuscitation Council UK and local anaphylaxis algorithm without delay.
- Position, oxygenate, monitor and establish access as the clinical situation requires.
- Reassess continuously and escalate refractory features early to critical care and experienced support.
Red flags that change pace.
- Stridor, upper-airway swelling, severe bronchospasm or exhaustion
- Hypotension, collapse, altered consciousness or rapidly worsening physiology
- Persistent airway, breathing or circulation compromise despite initial protocol treatment
What makes care less safe.
- Waiting for a rash before acting
- Using antihistamines or corticosteroids to treat airway, breathing or circulation compromise
- Allowing a hypotensive patient to stand or sit suddenly
Say the concern plainly.
Suspected anaphylaxis after [possible trigger] at [time], with [airway/breathing/circulation findings]. The emergency pathway is active; response so far is [summary]. I need immediate senior/critical-care support for [persistent concern].