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Kaplan Qbank USMLE



Author11 Posts
  #1

1. an 8yr old was stung by a bee. He had difficulty breathing and facial edema. What is the best treatment.
a. IV Adrenaline
b. IV antihistamine
c. IV hydrocortisone
d. IV fluids +
e. SC Adrenaline

  #2

e SC adrenaline

  #3

y not IV?

  #4

:arrow: . the intravenous route should be reserved for extreme emergency
Where the patient is severely ill and there is real doubt about adequacy of the circulation and absorption from the intramuscular injection site, adrenaline (epinephrine) may be given by slow intravenous injection

why not IM ?

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  #5

rate of absorption is fater through the subcutaneous route I guess
:?

  #6

alice thanks for the explanation smiling face

  #7

my pleasure :oops: :P
by the way i searched lots of articles and stuff about pharmacokinetics of adrenaline and the conclusion i got from all is :
:arrow: The intramuscular route is the first choice route for the administration of adrenaline (epinephrine) in the management of anaphylactic shock. Adrenaline has a rapid onset of action after intramuscular administration and in the shocked patient its absorption from the intramuscular site is faster and more reliable than from the subcutaneous site

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Dream on 'til your dream comes true.

  #8

thanks alice, but in this context i guess the answer is SC adrenaline.

  #9

Difficulty breathing and facial edema are emergency situation need urgent adrenaline injection IV 1:10000 or IM 1:1000
SC is slow and must not be considered inemergency
So the best answer is a

  #10

It is a life threatening condition, you can not wait for the slow absorption of SC adrenaline, the patient may die soon
You should give it IV or IM

  #11

the best answer is E ie sc adrenalineepinephrine

y not iv most of us ask, one good reason is half life of iv adrenaline it is short isn't it . second many studies have done which show no benifit of short term use of iv adrenaline over sc adrenalin in that situation which show effect with in 15 min and last longer than iv epinephrine

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Maverick







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