16th February 2025

The crash team is called to the Medical Admissions Unit because a 60-year-old male has developed an urticarial rash, angioedema, hypotension and respiratory distress following administration of intravenous co-amoxiclav for community-acquired pneumonia.

The crash team is called to the Medical Admissions Unit because a 60-year-old male has developed an urticarial rash, angioedema, hypotension and respiratory distress following administration of intravenous co-amoxiclav for community-acquired pneumonia.

On arrival of the crash team, he has been treated for presumed anaphylaxis with 2 doses of IM adrenaline (0.5 ml of 1:1000) and 1 L IV crystalloid fluid. It is now 5 minutes since his last dose of adrenaline and he continues to have facial swelling, with a respiratory rate of 26, oxygen saturation 98% on 15 L oxygen, HR 120, BP 82/52. He is speaking in full sentences, and there is widespread wheeze on auscultation. 

Which of the following is the most important next management step?

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