zeeec2000
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10 boy stung with insect in ER has hives and SOB His father said this symptoms with dyspnia and uricaria happen 2 years ago, physical exam: SOB and generalized uricaria has hoarse voice. RR 36 pulse 120
BP 70/40.
1- Most important first step in management:
a) Diphenhydramine oral
b) epinephrine SC
c) O2 by face mask
d) establish IV access
e) Obtain ABG values
2- after 10 min no change in the child condition most appropriate next step:
a) Diphenhydramine Oral
b) Dopamine iv
c) Epinephrine SC
d) Predinsone Oral
e) Ranitidine Oral
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| dr9576
Forum Newbie
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D
C
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| zeeec2000
Forum Junior
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how about
b
b
that what i think any comment?
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| dr9576
Forum Newbie
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Actually I wanted to go for B for the 1st question but changed my mind because ABC should be the first step as BP is decreasing. So, I went for IV line for the first step and the second step Epinephrine.
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| mjl1717
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first-b
then answer-c
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| peter90036
Forum Elite
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pump him with epi
on the 2nd, i would have thought to start intubation etc but since only epi, pump more epi
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| guangyu
Forum Elite
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fist chiost 2, for the second q only reasonable is b or c, i preper b
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| aspire
Forum Senior
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C-Secure airway first
C-
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| vibrio
Forum Newbie
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Hello
First and foremost in ABC is Airway.
so i wud like to go with C-oxygen
nxt is epinephine.
just to confirm i searched few articles in internet.
i found few.One of which iam giving as reference is from
medscape.com.
These consensus guidelines include a schema for the identification of an anaphylactic reaction and the progression of treatment based on the continuation or resolution of symptoms. Treatment by first responders included oxygen treatment and epinephrine (1: 1000 solution, 0.5 ml [500 µg] intramuscularly). Repeat epinephrine and antihistamine (10-20 mg intramuscularly or slowly intravenously) treatment was recommended for patients whose symptoms did not resolve after initial treatment. Intramuscular or slow intravenous hydrocortisone (100-500 mg) and intravenous fluids (1-2 l intravenously) were recommended for patients who did not respond or progressed to clinical manifestations of shock.
please correct me if iam wrong.
Thanks
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| peter90036
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that sounds right ABCs 1st Airway, Breathing
Edited by peter90036 on 03/25/08 - 09:58 PM
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| peter90036
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hey dont let me add to the confusion.
Diagnose the presence or likely presence of anaphylaxis.
Place patient in recumbent position and elevate lower extremities.
Monitor vital signs frequently (every two to five minutes) and stay with the patient.
Administer epinephrine 1:1,000 (weight-based) (adults: 0.01 mL per kg, up to a maximum of 0.2 to 0.5 mL every 10 to 15 minutes as needed; children: 0.01 mL per kg, up to a maximum dose of 0.2 to 0.5 mL) by SC or IM route and, if necessary, repeat every 15 minutes, up to two doses).
Administer oxygen, usually 8 to 10 L per minute; lower concentrations may be appropriate for patients with chronic obstructive pulmonary disease.
Maintain airway with an oropharyngeal airway device.
Administer the antihistamine diphenhydramine . etc
http://209.85.173.104/search?q=cache:2joOXRoPBM4J...
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| aspire
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What is the answer please? 
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| peter90036
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i revert to my original pick -- epi + epi
"Epinephrine is still the key therapeutic agent. However, it has to be given promptly in adequate doses."
-- scroll to last Q: http://www.aaaai.org/aadmc/ate/epinephrine.html
& http://web.archive.org/web/20040726204706/www.jca...
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| Vietnamese
Forum Elite
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Posts: 285
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B
C
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