Reframing Anaphylaxis; Roadside to Resus

Anaphylaxis management requires a paradigm shift, moving away from the traditional focus on cardiovascular collapse toward recognizing respiratory failure as the primary driver of mortality in pediatric food-related cases. Research indicates that fatal episodes are often characterized by severe bronchospasm in patients with coexisting asthma, necessitating aggressive, early intervention. Intramuscular adrenaline remains the first-line treatment, and clinicians should not hesitate to administer multiple doses if the patient fails to stabilize within five minutes. When patients progress to hypoxemic bradycardia, oxygenation becomes the absolute priority, often requiring rapid intubation to overcome high airway resistance. The AMAX4 algorithm—emphasizing adrenaline, muscle relaxation, airway management, and extreme oxygenation—provides a structured approach for clinicians to prevent hypoxic brain injury. Emergency physician Ben McKenzie highlights these critical strategies, underscoring the necessity of rapid, decisive action in pre-hospital and emergency settings.