Sudden breathlessness and itching after an infusion
PLAB 2 practice station

The task

You are a foundation doctor on a surgical ward. Mrs Bronagh Doyle, aged 47, is the day after an appendicectomy. A healthcare assistant, Kwame, calls you urgently to her bedside. An intravenous antibiotic was started ten minutes ago. Assess and manage the situation. The healthcare assistant is with you and will do as you ask. A resuscitation trolley is nearby. The examiner will report any findings you ask for. The examiner will not take part in the conversation.

What this station tests

• Anaphylaxis is an airway, breathing or circulation problem after exposure to a trigger; treat on recognition.
• Intramuscular adrenaline 500 micrograms (0.5 mL of 1 in 1,000) into the thigh is first-line; do not delay it for other treatments.
• Call 2222 early, give oxygen and fluids, and repeat adrenaline after five minutes if no improvement.
• Antihistamines and steroids are not first-line and must never delay adrenaline.
• Take tryptase, observe for biphasic reactions and refer to an allergy specialist.

Sources for the clinical content

• NICE NG258: Anaphylaxis: assessment and referral after emergency treatment
• Resuscitation Council UK: Emergency treatment of anaphylaxis, guidelines for healthcare providers

An original practice scenario with invented patients. Not an exam question.

Practise next

• Unwell ward patient with a rising early warning score
• Vomiting blood in the emergency department
• Wheezy and breathless young woman
• Confused and sweaty patient on the ward