The UK Resuscitation Guidelines advise the following doses when administering adrenaline using an auto-injector:

Most patients require only a single dose but if symptoms do not improve or they recur, the dose can be repeated after five minutes. Each patient will respond differently to adrenaline, this necessitates patient responses to be monitored and additional adrenaline dose to be administered where appropriate.

After administering adrenaline the patient should be positioned as advised below and monitored.

The most appropriate position for each patient will be determined by their key presenting symptoms:

• Patients who have airway or breathing problems may be more comfortable to sit up as this makes breathing easier.
• Patients with low blood pressure should lie flat with or without their legs elevated.
• Patients who are unconscious but breathing should be placed in the recovery position

Patients who are unresponsive and not breathing normally should be treated with cardiopulmonary resuscitation (CPR) immediately. Before starting CPR it is essential to ensure an ambulance has been called and medical support is on the way.

Following administration of adrenaline patients should be admitted to hospital and observed for at least six hours. Where the patient responds well to treatment, they should be warned of the possibility of a relapse in their symptoms; the biphasic reaction as discussed earlier.

In certain circumstances the patient will be monitored for up to 24 hours. This would include:

• Severe reactions associated with a slow onset with an unknown trigger.
• Patients with severe asthma.
• Reactions where ongoing absorption of the allergen is possible.
• Previous history of biphasic reactions.
• Evening or night time presentation where there may be reduced response to deterioration.
• Areas where there is difficult or limited access to emergency care.