A 55-year-old man develops sudden-onset generalized urticaria, wheezing, and a blood pressure of mm Hg shortly after receiving a dose of intravenous ceftriaxone on the medical ward. Arrange the following management steps in the correct chronological sequence, prioritizing immediate life-saving interventions first.
- 1Administer intramuscular epinephrine
- 2Administer rapid intravenous crystalloid fluids
- 3Administer intravenous antihistamines and glucocorticoids
- 4Observe the patient for a biphasic anaphylactic reaction
Answer
The correct sequence is: Administer intramuscular epinephrine, followed by intravenous crystalloid fluids, then adjunctive intravenous glucocorticoids and antihistamines, and finally observe for a biphasic reaction.
The priority in anaphylaxis is the immediate reversal of life-threatening respiratory and cardiovascular collapse. Intramuscular epinephrine is the only medication that achieves this rapidly. This is followed by intravenous fluids to treat distributive shock. Adjunctive therapies like antihistamines and glucocorticoids are given third because they do not treat the acute life-threatening features. Finally, observation is required for a potential biphasic reaction.
Step-by-Step Solution
Key Concept
In anaphylaxis, intramuscular epinephrine is the absolute first-line treatment and must never be delayed. Fluid resuscitation follows to treat distributive shock, followed by adjunctive therapies (antihistamines, glucocorticoids) and observation.