What should be done if there are persistent signs of anaphylaxis after two doses of adrenaline?

In cases of persistent signs of anaphylaxis after administering two doses of adrenaline, initiating a refractory algorithm is the appropriate course of action. This approach involves following a systematic protocol that is designed to manage anaphylaxis that does not respond to standard treatment. The refractory algorithm helps identify additional interventions that may be necessary, such as further doses of adrenaline, early consultation with specialists, or considering other medications like corticosteroids if indicated.

The refractory algorithm ensures that healthcare providers take a thorough and decisive approach to persistent anaphylactic reactions, which can be life-threatening. It guides clinicians in closely monitoring the patient's condition and considering advanced support measures as required.

While other interventions like increased fluid intake or the use of corticosteroids may have roles in managing anaphylaxis or its aftermath, they do not address the immediate need to manage ongoing symptoms effectively. Antihistamines, although useful for milder allergic reactions, do not play a critical role in treating severe anaphylaxis and are not effective in resolving acute symptoms when adrenaline has already been administered. Therefore, initiating a refractory algorithm serves as a structured response to optimize patient care in this critical setting.