A 16-year-old male tells you he is allergic to bees and that he was stung. Five minutes ago, he used his epinephrine autoinjector and felt better, but now he is having increasing difficulty breathing. You hear audible stridor and wheezes. You should first:

• A. locate and remove the stinger.
• B. assess his oxygen saturation level.
• C. contact his parent to obtain consent to treat him.
• D. administer a second dose of epinephrine.

Answer: (D)

In anaphylaxis, the immediate goal is to reverse the life-threatening airway and breathing problems with epinephrine. When symptoms recur or worsen after an initial dose—stridor and wheezes indicate airway involvement—the best move is to administer a second dose of epinephrine. This reinforces the fight against swelling and bronchospasm and helps prevent progression to severe compromise.

Removing the stinger isn’t enough once systemic symptoms have developed, and delaying treatment to check oxygen saturation could allow airway edema to worsen. Getting consent isn’t the top priority in a life-threatening emergency for a minor; implied consent for urgent treatment applies, and you treat to protect the patient’s life. After the second dose, continue monitoring and arrange transport as needed.