Anaphylaxis Flashcard
Rationale
C. Rationale: This patient is likely having a severe anaphylactic reaction, with effects seen in multiple organ systems likely triggered by an allergy-inducing food at the restaurant. The patient is hypotensive and at risk for deterioration. The first treatment should be IM epinephrine—preferably using an autoinjector. IM drug delivery promotes a rapid increase in epinephrine blood levels and is preferred over subcutaneous injection. While the patient has respiratory symptoms, multiorgan system involvement and upper airway signs (stridor) make severe asthma less likely, and thus inhaled beta-2 agonists are not a priority. Corticosteroids may be recommended for this patient to decrease inflammation, but the patient should not receive anything by mouth at this time.
Question
A patient presents to the emergency department with stridor, abdominal pain, and raised, reddened eruptions noted on the skin. His blood pressure is 90/55 mm Hg, and he appears pale. The patient had been eating at a restaurant when the symptoms began. What is the best next step in management?
a. Inhaled beta-2 agonist
b. Oral corticosteroids
c. IM epinephrine
d. Subcutaneous epinephrine
Answer
c. IM epinephrine
Rationale
C. Rationale: Patients with anaphylaxis will usually have hypovolemia not hypervolemia. This is due to systemic vasodilation and the loss of intravascular fluid due to capillary leak. Other signs and symptoms include stridor, wheezing, abdominal pain, emesis, conjunctivitis, urticaria, flushing or paleness of skin, and anxiety.
Question
Clinical signs and symptoms of anaphylaxis include all of the following EXCEPT:
a. stridor and wheezing
b. abdominal pain
c. hypervolemia
d. conjunctivitis
Answer
c. hypervolemia
Rationale
D. Rationale: IV corticosteroids can be used at the beginning of the treatment for anaphylaxis as their onset of action is delayed for as long as 4–6 hours after administration.
Question
The team should administer IV corticosteroids immediately for the treatment of anaphylaxis since their onset of action may be as long as:
a. 30 minutes to 1 hour after administration
b. 1–2 hours after administration
c. 2–3 hours after administration
d. 4–6 hours after administration
Answer
d. 4–6 hours after administration