After administering 0.3 mg of epinephrine via auto-injector to a patient with an allergic reaction, you note improvement in breathing and hives. However, she is still anxious and tachycardic. You should:

• A. Administer another epinephrine dose immediately.
• B. Monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.
• C. Check her blood glucose immediately before proceeding.
• D. Begin pulmonary function testing.

Answer: (B)

After an epinephrine dose for an anaphylactic reaction, you can see real improvement in airway symptoms and skin signs, but the patient may also feel anxious and be tachycardic because epinephrine stimulates the heart and sympathetic nervous system. These effects are common and expected, not a sign that you must jump to another dose right away. The important next step is to keep the patient under close observation, reassess vital signs, and ensure the airway remains protected and breathing stable. A second dose of epinephrine is considered if symptoms persist or recur or if there are signs of deterioration, typically after a few minutes, not immediately. Checking blood glucose right now or performing pulmonary function testing doesn’t fit the acute EMS priorities in this scenario.