16th February 2025

A 66-year-old lady with a background of COPD and T4N2M0 HER2-negative breast cancer attends the chemotherapy day unit for her second cycle of neoadjuvant chemotherapy.

A 66-year-old lady with a background of COPD and T4N2M0 HER2-negative breast cancer attends the chemotherapy day unit for her second cycle of neoadjuvant chemotherapy. During administration of IV paclitaxel, she develops facial & tongue swelling, widespread urticaria, a heart rate of 130, a blood pressure of 80/47 and oxygen saturations of 85% on room air. On examination, she has a capillary refill time of 5 seconds and global wheeze. 

Venous blood gas analysis on room air shows: pH 7.45, pCO2 3.9 kPa, bicarbonate 23 mEq/L, lactate 2.6, base excess +1 mmol/L.

Which of the following is the LEAST appropriate intervention for this lady’s likely anaphylaxis?

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