St Emlyn’s Lesson Plans
Recognising and treating anaphylaxis
Practise recognising anaphylaxis, giving the first treatment promptly and explaining why recovery needs a discharge plan.
Medical Students · 45-minute session
For learners
Before: Allow about 13 minutes in total.
When we meet: We will work through immediate treatment, reassessment after adrenaline and the decisions needed before a patient goes home.
For facilitators
Send: the learner preparation link before teaching.
Bring: Algorithm, training syringe/ampoule or clearly labelled illustration, and trainer autoinjector if available.
Before the session
If you are attending this session, complete the core preparation below before you come. Allow about 13 minutes in total.
Core preparation
RCUK emergency treatment of anaphylaxis · About 10 minutes
Read printed pages 7 and 10 for the key recommendations and emergency algorithm, then the observation and discharge advice on pages 43–44. Focus on recognising anaphylaxis, IM adrenaline and reassessment; the specialist infusion sections are not required preparation.
https://www.resus.org.uk/sites/default/files/2021-05/Emergency%20Treatment%20of%20Anaphylaxis%20May%202021_0.pdf
Prepare (allow 3 minutes): Write the adult IM adrenaline dose and the volume needed from a 1 mg/mL preparation, then check both against the algorithm.
Think about: Which findings would make you treat sudden wheeze as anaphylaxis rather than an asthma attack?
Picture the scene
A 23-year-old arrives with sudden wheeze and a rash after a meal. They have asthma, but are now light-headed and their voice sounds different.
By the end of the session
- Recognise rapidly developing airway, breathing or circulation problems compatible with anaphylaxis.
- State the adult intramuscular adrenaline dose and reassessment interval.
- Describe the senior-led observation and discharge decisions after recovery.
After the session
- Locate the anaphylaxis pack on your placement and rehearse asking for help with your supervisor.
Facilitator guide
Send learners the preparation link several days before teaching. Allow about 13 minutes in total.
Before learners arrive
- Open the current anaphylaxis and refractory-anaphylaxis algorithms.
- Find the local emergency-call method, anaphylaxis pack, allergy referral route and autoinjector training devices.
Equipment: Algorithm, training syringe/ampoule or clearly labelled illustration, and trainer autoinjector if available.
Setup: Pairs alternate the role of first responder and colleague checking the plan. Do not use real drugs for rehearsal.
If the preparation has not been completed
Use five minutes in place of “Establish the essentials”. Display the RCUK algorithm and a photograph or training sample labelled adrenaline 1 mg/mL. Give pairs two minutes to find the adult IM dose and repeat interval, two to check the dose-to-volume calculation, and one to explain when further help is needed. Use no live medication.
Suggested session plan
- 0–5 min — Explore. Ask what changes the label from asthma to anaphylaxis.
- 5–10 min — Establish the essentials. Locate the adult dose and interval on the algorithm.
- 10–32 min — Discuss & Apply. Spend 14 minutes on recognition and reassessment, 8 on discharge teach-back.
- 32–40 min — Consolidate. Ask pairs to show the adult adrenaline dose and volume, state what happens after five minutes and explain the discharge plan.
- 40–45 min — Reflect & Transfer. Ask learners to identify where the anaphylaxis pack is kept on their placement and how they will check the emergency-call route.
Start the discussion
Read the opening scenario together. Give everyone a moment to think, then ask what concerns them and what they need to know next.
Cases and discussion
Use these cases, or invite an anonymised case from the group that addresses the same questions.
Asthma, or anaphylaxis?
The patient is wheezy, has lip swelling, BP 85/50 and widespread urticaria. Symptoms developed within minutes after food.
Add this information as the discussion develops:
- The group proposes nebulised salbutamol and waits for a cannula.
- After correct initial treatment, five minutes pass and breathing and circulation remain compromised.
Ask the group:
- Which findings make this more than an asthma attack?
- What treatment must happen now, by which route, dose and site?
- Who should be called if the second IM dose does not resolve the ABC problems?
Discussion notes
Points to draw out:
- Call for help, assess ABC and give adult adrenaline 500 micrograms IM: 0.5 mL of 1 mg/mL into the anterolateral thigh. Repeat after 5 minutes if ABC problems persist.
- Remove a trigger if feasible, position safely, provide oxygen and IV crystalloid as indicated. Do not let the patient stand or walk; position should accommodate breathing and circulatory compromise.
- Persistent ABC problems after two appropriate IM doses require urgent expert management of refractory anaphylaxis, usually including an adrenaline infusion in a suitable monitored setting.
- Bronchodilators may help bronchospasm but cannot replace adrenaline. Antihistamines do not treat ABC compromise; corticosteroids are not routine initial treatment.
Common misconceptions:
- Waiting for a rash or IV access.
- Confusing anaphylaxis IM adrenaline with cardiac-arrest dosing.
- Assuming previous asthma explains hypotension.
For a more experienced group: Ask how a reaction without skin signs would alter recognition, and why a student should summon the expert team instead of improvising IV adrenaline.
Better, and ready to leave?
A 47-year-old has recovered after prehospital adrenaline for nut-triggered anaphylaxis. Their old autoinjector failed and they want to go home.
Add this information as the discussion develops:
- Clarify the number and timing of doses, response, respiratory severity, previous biphasic reaction and continuing allergen absorption.
- They live alone far from emergency help and cannot demonstrate their replacement autoinjector.
Ask the group:
- Which facts alter the observation decision?
- What must be arranged before discharge?
- How would you explain uncertainty about recurrent symptoms?
Discussion notes
Points to draw out:
- Use the RCUK risk-stratified observation guidance with the responsible senior; there is no universal six-hour rule for everyone.
- Recovery alone is insufficient for discharge. Provide the appropriate autoinjectors and device-specific teaching, emergency advice and allergy referral.
- Practise explaining the discharge advice and check the patient’s understanding. Agree the observation and discharge decision with the responsible senior clinician.
Common misconceptions:
- Counting observation from arrival rather than using the guideline’s symptom-resolution framework.
- Handing over a prescription without ensuring access to devices and teaching.
For a more experienced group: Compare a rapid response to one early dose with severe respiratory compromise or several doses.
Important clinical points
- Adult dose here is 500 micrograms IM, not an IV bolus. Use age-appropriate guidance for children.
- Do not delay adrenaline for antihistamines, steroids, tryptase sampling or IV access.
- IV adrenaline requires clinicians experienced in its use and appropriate monitoring.
Closing the session
Use these questions to check what the group will take away. Go back over any clinical points that remain unclear.
- Show the adult IM dose and volume from the concentration label.
- Describe what changes at five minutes if ABC problems continue.
- Name three discharge requirements beyond symptom resolution.
Key teaching points:
- Recognise and treat airway, breathing or circulation compromise promptly.
- Give adult IM adrenaline as the first-line drug treatment.
- Reassess after treatment and arrange an appropriate observation and discharge plan.
Before leaving, ask each person to choose one action from After the session and say when they will try it. They complete that follow-up in practice, with supervision where needed.
Adapting the discussion
Uncertainty and local practice
The culprit may be unknown and skin changes absent. Observation duration depends on risk and practical safety, not a fixed rule.
If the discussion drifts
Which immediate threat remains, and what is the next action?
For a more experienced group
Discuss refractory anaphylaxis as a recognition and escalation problem; specialist infusion prescribing is outside this student session.
A 30-minute version
30 minutes: opening 3, algorithm 5, first case 12, discharge 5, consolidation 3, reflection 2.
Evidence and guidance
- RCUK anaphylaxis guideline 2021 — RCUK’s detailed anaphylaxis guidance, including initial treatment, refractory reactions and observation.https://www.resus.org.uk/sites/default/files/2021-05/Emergency%20Treatment%20of%20Anaphylaxis%20May%202021_0.pdf
- RCUK 2025 special circumstances — Confirms immediate 500 micrograms IM and repeat after 5 minutes if no improvement.https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines
Suggested curriculum links
GMC Outcomes for graduates / MLA 2026: Anaphylaxis; recognising and managing acute illness
Recognition, first response, escalation and patient education are proportionate undergraduate outcomes.
Check these links against the learner’s stage and programme. Attendance at a teaching session does not establish competence.
First published 2021-03-16 · Iain Beardsell.