A -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 (), pulse of , blood pressure of , and respiratory rate of . Oxygen saturation is 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?
- Intramuscular administration of epinephrineCevap
- BRequest an emergent anesthesiology consultation for airway management
- CObtain a portable soft-tissue radiograph of the neck
- DIntravenous administration of diphenhydramine
- EIntravenous infusion of methylprednisolone
Cevap
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.
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Anahtar Kavram
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.
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