A 7yo patient with peanut allergy at a rice krispy treat at a birthday party and discovered afterwards that it was made with peanut butter. She presents with hives, mild swelling of her lower lip and periorbital, and some faint wheezes. O2 sat is 99% on room air. Vital signs are temp 37.6, HR 120, RR 28, BP 90/60. What is your first priority treatment?
A. Diphenhydramine 1.25 mg/kg IV
B. Epinephrine 0.01 mg/kg of 1mg/mL solution IM
C. Methylprednisolone 2 mg/kg IV
D. Normal saline 20 cc/kg IV
E. RSI and prophylactic intubation
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May 19, 2017 at 2:58 pm
Epinephrine!
May 19, 2017 at 3:43 pm
B. Epinephrine 0.01 mg/kg of 1:1000 solution IM
This patient meets the definition of anaphylaxis, which is after exposure to an allergen, rapid development of two or more of: skin/mucosal symptoms, respiratory symptoms, hypotension or end-organ dysfunction, GI symptoms. She has hives and angioedema (skin), and wheezing (respiratory), but is not yet hypotensive. The priority in a patient with anaphylaxis is to give epinephrine 0.01 mg/kg, and IM is the preferred route, so the 1 mg/mL solution 0.01 mL/kg should be used to minimize the volume needed to be given IM. Note: there is a move to refer to what was formerly called 1:1000 epinephrine as 1 mg/mL, and 1:10000 epinephrine as 0.1mg/mL, to reduce dosing errors. The PEMsource anaphylaxis algorithm can be found at http://pemsource.org/wp-content/uploads/2016/06/Anaphylaxis.pdf