| Author | 24 Posts |
dr_jojo
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4. A 13-year-old girl is brought to the emergency
department because
of shortness of breath for 2 hours. The symptoms
began after consuming
chili, cornbread, and fruit salad with strawberries,
kiwi, and bananas.
She has a 1-year history of shortness of breath while
playing soccer or
baseball and uses a bronchodilator inhaler as needed
while exercising.
She is allergic to penicillin and pineapples. Her
blood pressure is
80/60 mm Hg, pulse is 120/min and regular, and
respirations are 20/min
with use of accessory muscles. Examination of the
lungs shows poor air
entry bilaterally with diffuse expiratory wheezes.
Which of the
following is the most appropriate initial
pharmacotherapy?
A
) Inhaled bronchodilators
B
) Inhaled cromolyn sodium
C
) Inhaled ipratropium bromide
D
) Intravenous corticosteroids
E
) Subcutaneous epinephrine
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| robin082006
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A--> Inhaled bronchodilators
Acute episode of asthma
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| dr_jojo
|
E
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| robin082006
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this is not anaphylactic shock or croup, why do you use epinephrine?
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| Aashi
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She has got hx of exercise induced asthma--->for which is already on prophlaxis for one yr
blood pressure is 80/60 mm Hg, pulse is 120/min and regular, and respirations are 20/min
The symptoms began after consuming chili, cornbread, and fruit salad with strawberries, kiwi, and bananas.
Hemodynamically UNSTABLE--->can be anaphylaxis-->specially with hx of multiple allergy to food and asthma hx---->E
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| robin082006
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Kaplan has a similar q, even lower BP but still nebulized beta agonist
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| maiya
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i think we'd give her the epi if she were down for the count and it was obvious she was going into anaphylactic shock. but she's been short of breath for 2 hours already - she does have air entry to some degree. i think the bronchodilater inhaler should be good to go. but it shouldn't be assumed that she's not having an allergic reaction - fruit salads can often contain all sorts of fruit juices int he syrup and such it it was made from canned fruit.
any thoughts?
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| r_albayunen
Forum Senior
Topics: 0
Posts: 218
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ill go with E
food anaphylaxis
anaphylactic shock
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| damngood
Forum Newbie
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i ll go with A
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| vradojc1
Forum Elite
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I do not know what to pick, thinking between A and E. Somehow, use of accessory musculature and poor air entry would probably lead me to pick E. This is a q where I would spend a lot of time. The fruit salad had strawberries which are the one of the most potent food allergens, and that might tilt me in favor of epi as well. But then is the 2 hour delay of onset...
So hard
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| sixfeet
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EPN HAS NO ROLE IN THE FIRSTLINE RX OF STATUS ASTHMATICUS... O2 VIA NASAL CANULA.. ALBUTEROL .15MG/KG BODY WT..NEUBIZER Q 20MINS -----> ORAL OR IV CORT STRDS----.> IPRATROPIUM CAN BE ADDED---->THEN IF NO RESPONSE S/C TERBUTALINE OR EPN 1:1000.....
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| webjeee
Forum Guru
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not necessarily asthma,
just food anaphylaxis, E.
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| nadiabarati
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E
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| fongch
Forum Elite
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I also think it is E
Food allergic reaction looks more likely.
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| coolmavs
Forum Elite
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Anaphylaxis...presenting after 2 hrs! Seems a bit far fetched! Considering that stat SC Epi is the Rx of choice! Dont know....actually ditto vradojc's thought!
any more opinions?
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| dr_arc
Forum Senior
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Posts: 156
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i'll go with A.
sounds like an acute exacerbation of asthma, a person going into anaphylactic shock would most likely not make it to 2 hrs without the imm epinephrine.the important thing abt anaphylaxis is the urgency of treatment.it's touch and go. which is also why most pts with h/o allergies are advised to carry epipens with them at alltimes.
the question in addition gives us the contents of the fruit salad she had
also the previous h/o asthma, use of intercostals, expi wheeze decreased breath sounds point to a realy bad case of asthma.then it would be A , inhaled bronchodialtors and maybe systemic steroids later
my guess is the all that food was probably put in there as a distractor or maybe some food allergen triggered the asthma, as happens in people with extrinsic asthma.
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| hanwin
Forum Senior
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Posts: 157
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E is better answer.
We give bronchodilator neb in acute exacerbation of asthma.
Not inhaler.
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| liliaeliz
Forum Elite
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E BP80/60,pul.120 SOB accc muscle anaphi shock
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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E 
I think the key of this Q is this pte has INSPIRATORY problem ( poor air entry) that is more severe than just reversible obstructive disease- asthma.
Epinephrine is needed first.
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| ashfaque
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pt is in shok BP 80/60 will subcutaneous epinepherine be useful ?
in anaphylactc shock I/V epinephrine would b more useful n why we always forget ABCof Shock AIRway must be clerared first so Inhaled albuterol is a better choice
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| Justice
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E
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| kpmle2
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E) Subcutaneous epinephrine
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| aaroho
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A
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| donjuan
Forum Junior
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E she is already on prophylaxis for asthma for 1 year she is going into anaphlactic shock
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