doc4mindia
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A 30-year-old woman presents to the ED complaining of acute onset of swelling of her tongue and lips for the past 2 hours. She has just had a cavity filled. She has had similar swelling several times since she was a teenager but is now having some difficulty swallowing. She is currently managing her own secretions. Which intervention would be most helpful for this patient?
A. Benadryl 50 mg IM
B. Atarax 50 mg IV
C. 1 unit of fresh frozen plasma
D. Hydrocortisone 125 mg IV
E. Tagamet 300 mg IV
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| alice8
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D ?
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| dimps
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ya i too go for D
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| doorz
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i wouldnt go for d cz i read on usmle world while doin mcqs that steroids have no role in the acute management ( they take along time to work) i would prefere to give him IM epinephrine but that's not one of the choices so i'll go with A Benadryl!
anyone?
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| irresistible_doc
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i will go for -A
s/c epinephrine is treatment of choice for anaphylactic shock.....but this women is not in anaphylactic shock...she is not in respiratory distress....only problem with swallowing....so an antihistaminic would be the choice of treatment......
as rightly said above steroids take 4-6 hrs for there peak effect to take
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| msyamp
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A no steroids for acute
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| Ouli Maty
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I will go with C
As this is a chronic problem it could be Hereditary angioedema in acute phase. And with C1-INH concentrates not being an option, I will go with FFP.
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| jyotimittal
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Hi ouli,
I think internal medicine does not work this way. This pt has some kind of allegy, may be due to anesthetics. You have to give antihistaminics( control the symptoms first) and then go for further investigations.
Hereditary angioedema is not a very common disease. go for common things first( Allergy).
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| msyamp
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its actually an allergy to mercury in the silver amalgam used for dental fillings. she shud have previously had allegy. answer shud be antihistaminics
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| Ouli Maty
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Yes I would love to think that it is an allergic reaction, but please read these papers.
jyotimittal
HAE is also known to be precipitated by stress, dental work....
http://www.emedicine.com/med/topic420.htm
http://www.blackwell-synergy.com/links/doi/10.111...
I wish the person who posted this Q came back to give us some insight.
Edited by Ouli Maty on 02/01/06 - 04:35 PM
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| msyamp
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ya ouli actually i am also getting tempted to go for FFP as its the treatment for the fascinating diseases and given here too
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| an
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wow...that was brilliant ouli...thanks to ur post, read on HAE and realized u r right.
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