Angioedema

HISTORY:

‍SwellingRedness of the ‍facelipstonguethroat for ‍ ‍hoursdays

Onset: ‍gradualsudden, after exposure to ‍ ‍medicationfoodnutsfishshellfishinsect sting

‍face swelling

‍lips swelling

‍tongue swelling

‍throat swelling

‍difficulty swallowing

‍hoarseness

‍difficulty breathing

‍wheezing

‍feeling of choking

‍itching

‍hives

Treatments tried: ‍noneepinephrine auto-injectorantihistamines, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Eyes: -R: ‍normal, -L: ‍normal, ‍

Throat: ‍normalrednessexudate

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Musculoskeletal: joints ‍ ‍normal, ‍no limited ROM

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought process ‍organized, ‍no suicidal ideation, judgment ‍good



ASSESSMENT:

‍Angioedema ‍likelysuspectedpossible

DDx: ‍



PLAN:

- ‍Epinephrine

- ‍Diphenhydramine

- ‍H2 blockers

- ‍Steroids

- Normal saline 1L bolus

- Glucagon 1-10mg iv if refractory to epinephrine and on beta-blocker

- NPO

- Avoidance of known triggers

- Sting removal

- Stop ACE inhibitors

- Call anesthesiologist for intubation

- Referral to allergist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as difficulty breathing, swelling of the lips or tongue, or dizziness

- Go to ER if severe allergic reaction occurs