2nd August 2023

You are working as an SHO on a night shift on ITU and are called to see a patient who was admitted during the day.

You are working as an SHO on a night shift on ITU and are called to see a patient who was admitted during the day. The patient was transferred due to hypotension and tachycardia and was presumed to have sepsis. Their antibiotics had been changed during the day to a different type of IV antibiotic; however, you cannot find the drug chart, and the nurse is unsure which antibiotic was changed/they received.

They are concerned and ask you to review the patient as they have just received their new antibiotics and have become more unwell with worsening hypotension. Current BP is 70/45, HR 135, sats 92% on 4L NC, temperature 37.2. The patient looks pale and slightly clammy, and they have some mild swelling of their lips. On exposure, you note they have a rash which the nurse reports is new and was not handed over by the day team.

You are concerned about anaphylaxis as the cause of the shock.

What is the most appropriate immediate treatment for this patient?

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