What is the appropriate action to take in cases of refractory anaphylaxis according to the guidelines?

In cases of refractory anaphylaxis, the guidelines recommend administering intramuscular (IM) adrenaline every 5 minutes until an intravenous infusion is established. This approach is based on the urgent need to ensure a rapid response to life-threatening allergic reactions, as the effects of adrenaline can significantly help alleviate symptoms of anaphylaxis such as airway swelling, hypotension, and bronchospasm.

Intramuscular administration of adrenaline allows for quick absorption into the bloodstream, making it crucial for managing severe anaphylactic reactions. Administering adrenaline every 5 minutes provides a systematic approach to ensure that the patient receives sufficient doses to counteract the severe symptoms while the healthcare team prepares to establish an intravenous line for further treatment.

This method is supported by clinical practice guidelines, which emphasize the importance of timely and adequate dosing of adrenaline in the management of anaphylaxis. The additional options involving different dosing intervals or routes, such as subcutaneous or oral administration, do not align with the most effective and rapid interventions needed in such emergencies. Subcutaneous and oral routes are not as effective as IM for treating acute anaphylaxis, particularly in severe cases.