C: Circulation

Consider the following points:

• If the patient has had 2 IM adrenalines start titrating IV adrenaline if you are competent in doing so or if not, call for someone more experienced who is.
• Position the patient flat unless there is absolutely no circulation concern as sitting them up can lead to circulatory collapse.
• Give a non-glucose containing crystalloid (e.g. Hartmanns or Plasma-lyte). Colloids can cause further reaction. Normal saline can cause hyperchloraemic acidosis as a large quantity of fluids may need to be given.
• Give 500- 1000ml boluses.
• 3-5L of IV fluids may be needed in the treatment of severe anaphylaxis.
• Consider inserting an arterial line.