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Difficulty: EasyInitial Stabilization and Triage

A 19-year-old male college student is transported to the emergency department after suddenly developing severe difficulty breathing and facial swelling while at a local seafood restaurant. He states that his throat feels tight. He has no known past medical history and takes no daily medications. On presentation, the patient is visibly anxious and using accessory muscles of respiration. Temperature is 37.0∘37.0^\circ C (98.6∘98.6^\circ F), blood pressure is 86/5086/50 mmHg, pulse is 128128/min, respirations are 2828/min, and oxygen saturation is 94%94\% on room air. Physical examination reveals audible stridor, diffuse bilateral wheezing, and raised, erythematous plaques on his anterior chest. Which of the following is the most appropriate initial step in the management of this patient?

  1. A
    Intravenous diphenhydramine
  2. B
    Portable chest radiography
  3. Intramuscular epinephrineAnswer
  4. D
    Intravenous methylprednisolone
  5. E
    Orotracheal intubation

Answer

Intramuscular epinephrine
The patient is experiencing anaphylactic shock, characterized by airway compromise (stridor, wheezing, throat tightness), hemodynamic instability (hypotension, tachycardia), and cutaneous manifestations (erythematous plaques). The most appropriate and critical initial step in the management of anaphylaxis is the immediate administration of intramuscular epinephrine. Epinephrine rapidly acts on alpha-1, beta-1, and beta-2 receptors to increase peripheral vascular resistance, reduce mucosal edema, and induce bronchodilation.

Step-by-Step Solution

1
Identify the clinical syndrome from the presentation.
The patient has acute respiratory distress, stridor, hypotension, and urticaria following potential allergen exposure, which is highly consistent with anaphylactic shock.
Recognizing the multisystem, life-threatening nature of the reaction determines the immediate triage and stabilization priority.
2
Determine the priority of emergency interventions.
Immediate pharmacological reversal of vasodilation and airway edema is required before considering adjunct therapies or diagnostic imaging.
Anaphylaxis can rapidly progress to complete airway obstruction and cardiovascular collapse if not treated instantly.
3
Select the most effective initial stabilizing treatment.
Intramuscular epinephrine is identified as the first-line, life-saving therapy.
Epinephrine provides rapid alpha-adrenergic vasoconstriction and beta-adrenergic bronchodilation.

Key Concept

Immediate administration of intramuscular epinephrine is the first-line treatment for anaphylaxis to rapidly reverse cardiovascular collapse and airway obstruction.
Estimated Time:1m 0s
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Topics

Initial Stabilization and Triage

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