Angioedema

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍swellingredness of the ‍facelipstonguethroat

Onset was ‍gradualsudden, after exposure to ‍ ‍medicationfoodnutsfishshellfishinsect sting

Symptoms include:

‍swelling of the face

‍swelling of the lips

‍swelling of the tongue

‍swelling of the throat

‍difficulty swallowing

‍hoarseness

‍difficulty breathing

‍wheezing

‍feeling of choking

‍itching

‍hives



Alleviating factors: ‍noneepinephrine auto-injectorantihistamines, ‍effectiveineffective



Contributing factors:

‍known allergies

‍recent exposure to allergens

no history of: ‍angioedema, ‍allergies, ‍asthma, ‍atopic dermatitis

no use of: ‍beta-blockers, ‍ACE inhibitors

no family history of: ‍angioedema





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal

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, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

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:

‍Angioedema ‍likelysuspectedpossible

DDx: allergic reaction, anaphylaxis, hereditary angioedema, ACE inhibitor-induced angioedema, NSAID-induced angioedema, idiopathic angioedema, urticaria, contact dermatitis, insect bites/stings, food allergies, hypersensitivity to blood products, C1 inhibitor deficiency, systemic lupus erythematosus, lymphoma, leukemia, thyroid disorders, stress-related angioedema





PLAN:

Treatments:

- ‍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

Further care:

- 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