In anaphylaxis, after initial treatment, if symptoms persist after several minutes, what is the most appropriate next action on the scene?

• A. Call for advanced life support.
• B. Give a second dose of diphenhydramine.
• C. Administer a second dose of epinephrine.
• D. Place patient in Trendelenburg.

Answer: (C)

Epinephrine is the life-saving treatment for anaphylaxis, addressing airway swelling, bronchospasm, and hypotension. When symptoms persist after the first dose, a second dose should be given promptly to keep reversing those processes. The usual approach is an additional intramuscular epinephrine dose every few minutes (often 5–15 minutes) as needed, while you continue to monitor the patient, provide oxygen, and prepare for rapid transport.

Giving diphenhydramine afterward does not reverse airway obstruction or shock quickly enough and is not a substitute for epinephrine. Placing the patient in a Trendelenburg position is not recommended and does not improve outcomes in anaphylaxis. If symptoms continue to worsen after a second dose or if the patient deteriorates, escalate to advanced care and airway management, but the immediate next step is repeating the epinephrine dose.