A 23 year old woman attends the assessment unit 3 days after spontaneous vaginal delivery complaining of fever, increasing pain and pus from her episiotomy. T = 37.8, P = 102 / min, BP = 120/72 mmHg. Following assessment, treatment with iv co-amoxiclav is initiated. Five minutes after the first dose, she develops a florid rash, swelling around her face and difficulty breathing. T = 36.9, P = 150 / min, BP = 80/45 mmHg and SPO2 = 92%. Intramuscular adrenaline has been administered. Which additional treatment is required?
You have put the answer as give IM chlorpenamine and hydrocortisone, however the UK Resus Council have updated their guidance to state that antihistamines and steroids are not indicated in the acute management of anaphylaxis (this has been the case since 2021). They say that they may be considered (orally) later if the patient has symptoms of rash that are irritating them, or if ongoing symptoms of asthma requiring treatment.
