Anaphylaxis & Refractory Shock
IM epinephrine first → airway/oxygen/fluids → repeat epinephrine → monitored IV epinephrine infusion for refractory shock.
An educational representation of clinical reasoning, not a diagnostic algorithm or personalized medical advice — always apply clinical judgment and institutional protocols.
Caution
Escalate — Red Flags & Critical Warnings
- Do not delay time-critical therapy while waiting for confirmatory testing when the syndrome is clinically apparent.
Related Bedside Clinical Problems (18)
Bedside PresentationsAlgorithmic troubleshooting of acute patient-ventilator collapse: the DOPE framework, peak vs plateau pressure differentiation, auto-PEEP evaluation, and manual bagging separation.
Bedside management of the gasping, tachypneic patient: work-of-breathing assessment, accessory muscle use, P-SILI prevention, and timely intubation vs noninvasive support.
Airway preservation and bleeding localization: non-massive vs massive hemoptysis (> 100–200 mL/hr), lateral decubitus positioning, isolation of the bleeding lung, and endovascular/bronchoscopic intervention.
Linked Deep-Dive Topics (3)
Reference KnowledgeImmediate epinephrine-first management of airway edema, bronchospasm, vasoplegia and refractory anaphylactic shock in the ICU.
Cellular dysoxia, DO2/VO2 physiology, the 4 shock phenotypes, dynamic fluid responsiveness (PLR/PPV) vs fluid tolerance (VExUS), and vasoactive pharmacology.
The 7 Ps of ICU intubation, the physiologically difficult airway, BOUGIE/DEVICE video laryngoscopy trials, hemodynamic optimization, waveform capnography, and scalpel-bougie cricothyroidotomy.
Evidence status
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