We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

You are working in a rural ED. A woman presents 20 minutes after eating shellfish at a sushi restaurant. She reports that her throat feels tight, and you notice hives all over her body. As you are speaking to her, she begins to vomit and says she is about to pass out. Her past medical history includes asthma and mild seasonal allergies. On examination, she appears uncomfortable.
BP 88/54 mmHg
HR 118 bpm
RR 24/min
O2 sat 94% on room air
On respiratory examination, she has expiratory wheezes. You note periorbital edema and widespread hives. (8 points)

1. What is the single most important immediate management step? Be specific (drug, dose, route)? (1 point)

   Answer: Immediate use of intramuscular epinephrine 0.5 mg (0.5 mL of 1:1000) into the anterolateral thigh

2. What would you include as part of your discharge counselling for this patient? (4 points)

   Answer:
   Counsel on trigger avoidance
   Epinephrine autoinjector prescription (preferably 2 devices)
   Education on immediate use at first signs of anaphylaxis
   Training on proper administration technique
   Written anaphylaxis action plan
   Referral to allergist
   Advise to carry an autoinjector at all times

3. Which of the following statements about anaphylaxis management is MOST accurate? (1 point)
   1. Antihistamines prevent biphasic reactions
   2. Corticosteroids should be given before epinephrine
   3. Epinephrine is the only treatment shown to reduce mortality
   4. Intravenous epinephrine is first-line in the outpatient setting
   5. Observation alone is appropriate if symptoms are mild

   Answer: C

4. A patient presents to the ED with anaphylaxis. Which of the following is the best current recommendation in Canada (as of late 2025)? (1 point)
   1. Use intranasal epinephrine as first-line
   2. Delay treatment until EMS arrives
   3. Use oral antihistamines first
   4. Administer intramuscular epinephrine
   5. Use inhaled salbutamol alone

   Answer: D (Intranasal epinephrine is not yet approved in Canada → do NOT delay IM epinephrine)

5. Which of the following patients should be prescribed an epinephrine autoinjector? (1 point)
   1. Patient with isolated mild urticaria after a known trigger
   2. Patient with prior anaphylaxis
   3. Patient with allergic rhinitis only
   4. Patient with mild rash and no risk factors
   5. Patient with food intolerance (non-IgE mediated)

   Answer: B

Helpful CMAJ Resource:
https://www.cmaj.ca/content/197/38/E1270