19th March 2024

You are called to review a deteriorating patient in the emergency department

You are called to review a deteriorating patient in the emergency department. The patient arrived by ambulance after developing wheeze and syncope after eating a protein bar containing peanuts. The patient has a background of asthma, with multiple previous ICU admissions. She has a peanut allergy for which she is prescribed adrenaline auto-injectors, which she was not carrying at the time.

She has received 2 doses of 0.5ml 1:1000 IM adrenaline during the transfer to hospital. In the department, she has received fluid resuscitation and nebulised salbutamol but remains tachycardic, hypotensive and hypoxic. The anaesthetic registrar is away but is currently attending another emergency. What is the most appropriate next step?

Select the SINGLE most appropriate option from the list below. Select ONE option only.