A first-aid provider can administer a second shot of epinephrine from a prescribed auto-injector if the victim’s symptoms of anaphylaxis persist for a few minutes following the first shot and more advanced medical help is not available. Under more typical circumstances, the usual advice stands: Seek medical assistance for persistent symptoms rather than administer a second dose of epinephrine.

This is the updated position of the American Heart Association and the American Red Cross, which have jointly issued a revision of first-aid guidelines. Primary-care clinicians should share this information with their allergy patients who may be considered at risk of an anaphylactic reaction.

The AHA/Red Cross also offer the following first-aid tips:

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  • Assume that chest discomfort is cardiac until proven otherwise. While waiting for medical help, the victim should try to chew one adult (not enteric-coated) or two low-dose baby aspirin if aspirin is not contraindicated by evidence of stroke, recent bleeding, allergy, or other conditions.
  • To control injury-related bleeding, apply firm pressure to the wound through gauze or other cloth until the bleeding stops, or wrap an elastic bandage firmly over gauze to apply pressure. Use tourniquets only if application of direct pressure is not possible or is not effective.
  • Cool down burns with cold tap water as soon as possible and continue cooling until pain is relieved; this will also reduce edema and depth of injury. Do not apply ice directly to the burn.
  • Irrigate human and animal bites with copious amounts of water to prevent rabies from animal bites as well as bacterial infection.