Anaphylaxis prevention, action plans and autoinjectors — branching viva

Opening question

Examiner: Take me through this boy. What is your frame for the prevention prescription, and what are you going to write today? ^[1]

Candidate: My frame is that a child at risk of anaphylaxis is kept alive by a package, not by a single intervention, and the visit today is about building that package so it travels with him. He has had a confirmed anaphylactic reaction to peanut, so he is at risk of recurrence, and my job is to make sure that the next reaction is survivable wherever it happens. The package has six components: confirmed trigger avoidance, the green and red ASCIA action plans, the weight-appropriate adrenaline autoinjector, two devices and a trainer, rehearsed education of every carer, and optimised asthma control with a review date. I am going to write all six today, because any one of them alone is insufficient. ^[10]

Examiner: Why two plans rather than one? ^[10]

Candidate: Because the decision the plan exists to make is when to cross from a mild reaction to anaphylaxis, and the colour coding removes that deliberation at the moment of crisis. The green plan covers mild-to-moderate reactions — skin and mild gut symptoms — where the carer gives an antihistamine and watches closely for escalation. The red plan triggers adrenaline the moment anaphylaxis is recognised: any airway or breathing problem, collapse or pallor, or a rapid reaction involving skin plus another body system. The carer does not diagnose; they read the colour, and that single design feature is what makes the plan usable under stress by a non-clinician. ^[10]