Round 10 (Allergic Reaction)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!











Case Introduction











A 45 year old female is exposed to peanut butter and shrimp pizza and begins to have an apparent allergic reaction…























Initial Vitals











* Temp 98.8* HR 130* RR 35* BP 70/40* O2 92%











Critical Actions











* Verbalize Airway Evaluation* Complete a FOCUSED History and Exam* Normal Saline Bolus* Epinephrine both IM and (subsequently) IV* Glucagon 1mg IV











Final Diagnosis











Refractory Anaphylaxis Due to Beta Blockers











Tips and Tricks











You still need to obtain a quick history and exam even if you know the diagnosis in the first few seconds of the case











Additional Reading











* Basic approach to anaphylaxis (EM Clerkship)* Tranexamic acid as first-line emergency treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors. (PubMed)* Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. (PubMed)