An ambulance arrives at the emergency department with a 28-year-old woman who collapsed during dinner at a seafood restaurant. Bystanders report she developed severe lip swelling, intense pruritus, and a hoarse voice minutes after eating a crab cake, followed shortly by unresponsiveness. Upon arrival, her blood pressure is 76/40 mm Hg, heart rate is 138/min, and respiratory rate is 28/min. Oxygen saturation is 89% on room air. Physical examination reveals a lethargic patient with pronounced angioedema of the lips and tongue, audible inspiratory stridor, and a diffuse urticarial rash. Which of the following simultaneous interventions represent the most appropriate immediate initial stabilization steps? (Select 2 options)
- Intramuscular injection of epinephrineCevap
- Rapid infusion of intravenous crystalloidsCevap
- CIntravenous administration of diphenhydramine
- DIntravenous administration of methylprednisolone
- EStat plain radiography of the soft tissues of the neck
Cevap
The most appropriate immediate stabilization steps are the intramuscular injection of epinephrine and the rapid infusion of intravenous crystalloids.
The patient is presenting with severe anaphylaxis characterized by distributive shock (profound hypotension, compensatory tachycardia) and impending airway obstruction (angioedema, inspiratory stridor). The absolute cornerstone of initial stabilization in anaphylaxis is the immediate administration of intramuscular epinephrine to induce vasoconstriction, reduce mucosal edema, and promote bronchodilation. Simultaneously, because anaphylaxis causes a massive shift of intravascular fluid into the extravascular space, rapid infusion of intravenous crystalloids is required to restore preload and maintain perfusion.
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Anahtar Kavram
Immediate resuscitation in anaphylactic shock requires the simultaneous administration of intramuscular epinephrine and aggressive intravenous fluid resuscitation.