After administering 0.3 mg of epinephrine via auto-injector to a patient with an allergic reaction, breathing improves but they remain anxious and tachycardic. What is the appropriate course of action?

• A. Contact medical control and obtain authorization to administer another 0.3 mg of epinephrine.
• B. Transport her rapidly, as it is obvious that she is having a severe reaction to the epinephrine.
• C. Monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.
• D. Consider administering 0.15 mg of epinephrine to completely resolve her allergic reaction.

Answer: (C)

The main idea is recognizing expected side effects of epinephrine. When treating anaphylaxis, epinephrine stimulates the sympathetic nervous system, which can cause anxiety, tremor, and a fast heart rate. These feelings and tachycardia are common and do not by themselves mean the treatment failed or that the patient is getting worse from the dose.

Because breathing has improved, the airway obstruction is relieved, and the patient should be monitored closely for any progression. You should reassess regularly, keep the patient calm, ensure airway and breathing remain stable, and be prepared to administer a second dose if symptoms persist or worsen according to your protocol. The presence of anxiety and tachycardia is consistent with epinephrine’s effects, not a directive to change course immediately.

Giving a smaller dose isn’t standard practice for adults, and assuming the patient is having a reaction to the epinephrine itself isn’t indicated. If symptoms recur or the patient shows signs of ongoing anaphylaxis, follow your local guidelines for additional epinephrine and transport to definitive care.