After epinephrine administration in a known severe allergy with swelling, what should you do?

• A. Administer antihistamine only
• B. Wait 15 minutes and observe
• C. Place patient on back and rest
• D. Monitor airway closely, administer second epinephrine dose if symptoms persist or worsen, and call EMS

Answer: (D)

Anaphylaxis requires ongoing management beyond the first dose of epinephrine. After initial epinephrine, the priority is to watch the airway, breathing, and circulation closely because symptoms can worsen rapidly or recur (biphasic reactions are possible). If symptoms persist or worsen, a second dose of epinephrine should be given after about 5 to 15 minutes, and EMS should be called for urgent transport and further care. This approach ensures the patient receives escalation of treatment and monitoring in a setting where airway support and advanced care are available.

Antihistamines alone do not reverse the life-threatening airway and vascular effects of anaphylaxis, waiting and observing misses the opportunity to intervene early, and simply placing the patient on their back to rest doesn’t address the risk to the airway or circulation.