A 58-year-old man is brought to the emergency department 40 minutes after a wasp sting while gardening, followed by generalized urticaria, wheezing, and lightheadedness. He has hypertension and stable angina and takes bisoprolol daily; he has no known allergies and has never been stung with a reaction before. Paramedics gave epinephrine 0.5 mg IM. In the emergency department he has received two further 0.5 mg IM epinephrine doses (the last 5 minutes ago), 2 L of IV crystalloid, and high-flow oxygen. He remains drowsy and confused, with diffuse wheeze and urticaria; IV access and cardiac monitoring are in place.
| Heart rate | 64/min |
| Respiratory rate | 28/min |
| Temperature | 36.8 °C |
| O2 saturation | 92% on high-flow oxygen |
| Blood pressure | 78/44 mm Hg |
Question 1 of 15
Which of the following are the most appropriate next steps in management?
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