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You are seeing a 6 year old boy who sustained a bee sting. He presents with diffuse urticaria, wheezing and shortness of breath, and crampy abdominal pain, nausea, and vomiting. There is no angioedema. His vital signs are: temperature 37.7 C, HR 140, RR 30, BP 76/36, pulse oximetry 92% on room air.
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September 4, 2022 at 4:08 pm
D) IV methylprednisolone 2 mg/kg
The patient is in anaphylaxis, defined as symptoms involving 2 or more of: skin (pruritis, flushing, urticaria, angioedema), respiratory (dyspnea, wheezing, stridor, hypoxemia), GI (crampy abdominal pain, vomiting, diarrhea), and hypotension. ABC’s take first priority, including oxygen for hypoxemia and fluid resuscitation for hypotension. If his vomiting and respiratory distress are not prohibitory, supine positioning with legs elevated would also be appropriate to improve core perfusion. The top priority for treating anaphylaxis specifically is epinephrine administration, preferably IM. Because the patient is wheezing and hypoxemic, nebulized albuterol may also be helpful. Glucocorticoids are often given in anaphylaxis even though they have not been proven in clinical trials to be helpful and any benefit would not occur for several hours.