Anaphylaxis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍diffuse rashhives

Onset was ‍gradualsudden, after exposure to ‍ ‍medicationfoodnutsfishshellfishinsect sting

Symptoms include:

‍hives

‍swelling of lips/face

‍swelling of tongue

‍swelling of throat

‍difficulty breathing

‍wheezing

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍chest tightness

‍dizziness

‍fainting

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍palpitations

‍feeling of impending doom



Alleviating factors: ‍noneepinephrine auto-injectorantihistamines, ‍effectiveineffective



‍previous episodes of anaphylaxis, ‍allergies, ‍asthma, ‍atopic dermatitis

‍beta-blockers, ‍ACE inhibitors





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Anaphylaxis ‍likelysuspectedpossible, due to ‍

DDx: anaphylaxis, allergic reaction, acute urticaria, asthma exacerbation, vasovagal syncope, panic attack, carcinoid syndrome, mastocytosis, hereditary angioedema, vocal cord dysfunction, foreign body aspiration, pulmonary embolism, myocardial infarction, sepsis, hyperventilation syndrome, poisoning, drug reaction with eosinophilia and systemic symptoms (DRESS), contact dermatitis





PLAN:

Investigations:

Treatments:

- ‍Epinephrine

- ‍Diphenhydramine

- ‍Ranitidine

- ‍Prednisone

- ‍Salbutamol

- IV fluids

- Monitor vital signs every 15 minutes

- Epinephrine autoinjector

- Avoidance of suspected allergen

- Education on anaphylaxis management

Further care:

- Referral to allergist

- Follow-up in ‍ ‍daysweeksmonths

- Go to ER if symptoms reoccur