Examkin

Question

Difficulty: MediumInitial Stabilization and Triage

A 3131-year-old man is rushed to the emergency department by his coworkers after developing sudden, severe respiratory distress while eating at a company luncheon. He is clutching his throat, visibly agitated, and speaking in one-word gasps. His past medical history is significant for mild intermittent asthma and an undocumented food allergy. Vital signs reveal a temperature of 37.1∘C37.1^\circ\text{C} (98.8∘F98.8^\circ\text{F}), pulse of 134/min134/\text{min}, blood pressure of 82/45 mmHg82/45\text{ mmHg}, and respiratory rate of 32/min32/\text{min}. Oxygen saturation is 88%88\% on room air. Physical examination demonstrates prominent perioral swelling, diffuse wheezing in all lung fields, and a widespread erythematous rash on his chest and arms. Which of the following is the single most urgent initial step in the stabilization of this patient?

  1. Intramuscular administration of epinephrineAnswer
  2. B
    Request an emergent anesthesiology consultation for airway management
  3. C
    Obtain a portable soft-tissue radiograph of the neck
  4. D
    Intravenous administration of diphenhydramine
  5. E
    Intravenous infusion of methylprednisolone

Answer

Intramuscular administration of epinephrine
The patient is presenting with severe anaphylactic shock, characterized by upper airway edema, bronchospasm, and profound hypotension. Intramuscular epinephrine is the definitive first-line therapy because its alpha-1 agonist effects rapidly reverse peripheral vasodilation to improve blood pressure and reduce upper airway edema, while its beta-2 agonist effects promote bronchodilation and decrease mast cell degranulation. It must be administered immediately upon recognition of the clinical syndrome.

Step-by-Step Solution

1
Assess the clinical presentation and vital signs.
The patient exhibits airway compromise (perioral swelling, speaking in gasps), breathing difficulty (wheezing, hypoxia), and circulatory collapse (hypotension, tachycardia) following food exposure.
Identifying the simultaneous failure of the airway, respiratory, and cardiovascular systems confirms the diagnosis of severe anaphylactic shock.
2
Determine the highest priority intervention according to emergency stabilization protocols.
Immediate reversal of systemic vasodilation, bronchoconstriction, and mucosal edema is required.
In anaphylaxis, the immediate threat to life is profound shock and airway occlusion. Stabilization must precede diagnostic workups or specialty consultations.
3
Select the most appropriate pharmacologic or procedural intervention.
Intramuscular epinephrine is selected as the definitive first-line treatment.
Epinephrine provides rapid alpha-1 mediated vasoconstriction (increasing blood pressure and decreasing mucosal edema) and beta-2 mediated bronchodilation, effectively reversing the pathophysiology of anaphylaxis.

Key Concept

Immediate administration of intramuscular epinephrine is the fundamental first step in the stabilization of a patient presenting with anaphylactic shock, taking precedence over adjunct medications, imaging, or specialty consultations.
Estimated Time:1m 0s
Rate this question

Topics

Initial Stabilization and Triage

More questions from this topic