You are an Emergency Medicine consultant in charge of resus this shift. An 18 year old girl is brought in by ambulance after using her epi-pen 10 minutes ago after accidentally eating nuts to which she is allergic. She is on high flow oxygen, a 1 litre bag of Hartmann's is being pressure bagged into her cannula and she is lying flat. The ambulance has given a dose of 500mcg IM adrenaline. She is not pregnant.
Observations on the monitor are as follows: HR 140, BP 79/40, Sats 99% on 15L NRB, RR 20, T 36.8.
You give another dose of IM Adrenaline, and a further 1L of Hartmann's to no effect. What is the next best step in management?
A
3rd dose IM Adrenaline 500mcg
B
200mg IV Hydrocortisone
C
10mg IV Chlorphenamine
D
Adrenaline infusion 1mg in 100ml 0.9% saline at 0.5-1.0 ml/kg/hour
E
Adrenaline infusion 1ml in 1000ml 0.9% saline at 0.5-1.0ml/kg/hour