Thursday, July 22, 2010

Not Enough Information

You are outside at a picnic when a person shouts, "Do we have a doctor here?" You rush over to see a young man with visible dyspnea. He is using his accessory muscles and audibly wheezing. You notice the rash shown below. The person also has periorbital edema and conjunctival swelling. A bystander says that the person is otherwise healthy and has no past medical history and takes no medications.

Challenge: What is your next step in management?

Image is in the public domain.

2 comments:

Anonymous said...

Epi pen?

Craig Chen said...

yes..nicely done...i know the cases have been pretty easy, i'll step it up
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Not Enough Information

The rash shown is urticaria. The most likely diagnosis is anaphylaxis. Lab tests include plasma histamine and tryptase. Initial management includes IM injection of epinephrine (dose is 1mg/mL or 1:1000 or 0.1%, give 0.3-0.5 to mid-anterolateral thigh (vastus lateralis), repeat q5-15min).

Source: UpToDate; www.nlm.nih.gov.