In the moderate/severe anaphylaxis protocol, which medication is used as the bronchodilator?

• A. Epinephrine 1:1000 0.5 mg IM
• B. ALBUTEROL 2.5 mg in 3 mL
• C. Diphenhydramine 50 mg IM/IV/IO/PO
• D. Vascular access 500 mL; may repeat up to 2000 mL

Answer: (B)

In moderate to severe anaphylaxis, addressing bronchospasm directly is essential. The bronchodilator used is albuterol, a short-acting inhaled beta-2 agonist. It relaxes the smooth muscles of the airways, rapidly widening the bronchi and improving ventilation, which helps relieve wheezing and dyspnea that can accompany anaphylaxis. The typical route is nebulized, 2.5 mg in 3 mL, with repeats as dictated by the protocol if symptoms persist. While epinephrine remains the main treatment for anaphylaxis because of its overall effects (vasoconstriction, bronchodilation, and anti-inflammatory actions), the medication specifically designated to dilate the airways in this protocol is albuterol. Diphenhydramine is an antihistamine and does not provide bronchodilation, and IV fluids address volume status rather than bronchial relaxation.