What is the most appropriate initial treatment for the following patient?
A healthy 27 year old male presents to the ED after being stung by something while apple picking.Â He complains of throat tightness and shortness of breath.Â On exam there is no rash and his lungs are clear to auscultation.Â His initial vitals are HR 119, BP 68/42, RR 26, O2 98% RA.
A. Methylprednisolone 125 mg IV B. Diphenhydramine 50 mg IV C. Epinephrine 0.3 mg 1:10,000 solution IM D. Nebulized albuterol 2.5 mg diluted to 3 mL of normal saline E. Epinephrine 0.1 mg of 1:10,000 solution IV over 5 minutes
Epinephrine 0.1 mg of 1:10,000 solution iv over 5 minutes-since most of the morbidity and mortality associated with anaphylaxis originates from acute respiratory failure or cardiovascular collapse, the immediate goal in the ed is to stabilize any cardiorespiratory insufficiencies while confirming the diagnosis of anaphylaxis and anaphylactic shock along with other diagnostic alternatives. if the patient demonstrates severe upper airway obstruction, acute respiratory failure, or shock, intravenous epinephrine should be administered. use of the intravenous route with epinephrine increases the risk of supraventricular, accelerated idioventricular, and ventricular tachydysrhythmia; accelerated hypertension; and myocardial ischemia, including the stunned heart syndrome. because of these risks, dilution and slow administration are recommended and continuous cardiac monitoring should be done at all times. see rosens chapter 117, box 117-5 for treatment options for anaphylaxis. 2005 american heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care (circulation. 2005;112:iv-143 iv-145.)epinephrine: administer epinephrine by im injection early to all patients with signs of a systemic reaction, especially hypotension, airway swelling, or definite difficulty breathing. use an im dose of 0.3 to 0.5 mg (1:1000) repeated every 15 to 20 minutes if there is no clinical improvement.administer iv epinephrine if anaphylaxis appears to be severe with immediate life-threatening manifestations.12 use epinephrine (1:10 000) 0.1 mg iv slowly over 5 minutes. epinephrine may be diluted to a 1:10 000 solution before infusion. an iv infusion at rates of 1 to 4 µg/min may prevent the need to repeat epinephrine injections frequently.(chapter 117)