Round 16 (Allergic Reaction)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!











Case Introduction











You are sitting at your computer on an otherwise beautiful Friday afternoon when a mother brings her 16 year old son to the ED with chief complaint of allergic reaction.  











Initial Vitals











* Temp 98.7* HR 155* RR 28* BP 125/85* O2 99%











Critical Actions











* Interpret ECG * Interview patient alone (and identify trigger)* Perform vagal maneuver* Administer Adenosine* Discharge patient











Final Diagnosis











Supraventricular Tachycardia











Tips and Tricks











* Interview pediatric patients without family members in the patient’s room* Escort family out of patient room during invasive procedures* Ask about / rule out potential triggers (caffeine use, drugs, ischemia, electrolyte abnormalities, etc)











Further Reading











The REVERT Trial (RebelEM)