Medications to give to kid in anaphylactic shock?

[mclee0033]

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Kid who was stung by a bee developed hives and SOB then collapsed. His HR is 200 bpm, RR 10, palpable BP is 60. After establishing an airway what do you give him next?

Albuterol
Dexamethasone
Diphenhydramine
Epinephrine
Loratadine


I know EPP is given for anaphylaxis, but wouldn't that increase his HR? And albuterol is given for broncho and venous dilation, but that would raise HR too right? Can someone help please?

 

[tiedyeddog]

Kid who was stung by a bee developed hives and SOB then collapsed. His HR is 200 bpm, RR 10, palpable BP is 60. After establishing an airway what do you give him next?

Albuterol
Dexamethasone
Diphenhydramine
Epinephrine
Loratadine


I know EPP is given for anaphylaxis, but wouldn't that increase his HR? And albuterol is given for broncho and venous dilation, but that would raise HR too right? Can someone help please?

I remember this question. I got it wrong too, haha.

Ok, here is how I think about it:
The kid is in anaphylactic shock. Basically, he is vasodilated which caused his blood pressure to plummet. In response to this, he became tachycardic trying to bring cardiac output back up. Right now his blood pressure is dangerously low and his heart rate is secondary to that.

Epinipherine is going to immediately fix the primary problem, which is systemic dilation. TPR is going to shoot up and heart rate will likely come down, even though epi is a cardiac stimulant.

Albuterol is the only other drug that could make sense. It is a B agonist, it is not going to bring his TPR up. Loratadine and Dephen are both antihistamines, they aren't going to change TPR. Dex is going to take a long time to take effect, due to its function on changing gene expression.

 

[SLC]

Kid who was stung by a bee developed hives and SOB then collapsed. His HR is 200 bpm, RR 10, palpable BP is 60. After establishing an airway what do you give him next?

Albuterol
Dexamethasone
Diphenhydramine
Epinephrine
Loratadine


I know EPP is given for anaphylaxis, but wouldn't that increase his HR? And albuterol is given for broncho and venous dilation, but that would raise HR too right? Can someone help please?

I've seen this question pop up in multiple places, and even on my COMLEX exam. It's always Epi, you want the Alpha-1 stimulation it brings so you can have vasoconstriction.

Loratidine and Diphenhydramine are ok for hives/urticaria, but won't touch anaphylactic shock, these drugs are best for your run of the mill seasonal allergy types of reactions, not anaphylaxis.

Dexamethasone could work for prophylaxis but won't correct shock either (I've only seen dexamethasone used in challenge testing though).

Albuterol is for asthma, not anaphylactic shock, it could make this kid worse because beta-2 receptors cause vasodilation, which is part of the kid's problem right now.

 

[FIREitUP]

high dose epi--on the vasculature alpha-1 outweighs the beta-2 so you get an increase in TPR and an increase in BP. the beta-2 bronchodilates. the answer would not be any antihistamine because the bronchoconstriction is mediated by leukotrienes, and they would likely not do much to help increase the BP substantially. albuterol is inhaled B-2 so you would only get a reversal of the bronchoconstriction, not the severe decrease in BP; it could also serve to further decrease the BP.
His HR is increased because he is in shock--severe hypotension activates baroreceptors to increase the heart rate (reflex tachycardia) and hopefully increase the blood pressure, once you correct the shock the pulse will actually go down.

 

[Armadillos]

plz plz plz stop over thinking these things, all of you are thinking way too hard.


Everybody in America has heard of an Epi pen and know thats what you give someone having a bad allergic reaction, spend 10 secs on this question and move on.

 

[CaptainSSO]

plz plz plz stop over thinking these things, all of you are thinking way too hard.


Everybody in America has heard of an Epi pen and know thats what you give someone having a bad allergic reaction, spend 10 secs on this question and move on.

Calm down dude, I just had an NBME 7 question that mentioned someone going into respiratory distress after a bee sting, and which pharmaceutical is the best option:

alpha 1 ag, alpha 2 ag, alpha 1 antag, alpha 2 antag, or b1 ag or ant or b2 ag or ant

 

[loveoforganic2]

Calm down dude, I just had an NBME 7 question that mentioned someone going into respiratory distress after a bee sting, and which pharmaceutical is the best option:

alpha 1 ag, alpha 2 ag, alpha 1 antag, alpha 2 antag, or b1 ag or ant or b2 ag or ant

That question specifically asked about curing the resp distress though, and the answer of beta 2 wouldn't have excluded epi as what was possibly being referred to. Epi will fix the bronchoconstriction in anaphylaxis by beta 2, the opposing action is muscarinics. I agree that this is probably a case of overthinking

 

[CaptainSSO]

That question specifically asked about curing the resp distress though, and the answer of beta 2 wouldn't have excluded epi as what was possibly being referred to. Epi will fix the bronchoconstriction in anaphylaxis by beta 2, the opposing action is muscarinics. I agree that this is probably a case of overthinking

I didn't mean it would exclude epi--i just meant that it's not bad to delve into the mechanism of why epi is the right choice.

Speaking of which....is laryngeal edema not another mechanism that would be considered respiratory distress, which would be corrected with an alpha 1 agonist? I get why beta 2 bronchodilation is correct, but I've also heard laryngeal edema in particular is often a cause of death WRT anaphylactic shock.

 

[Anastomoses]

thanks for posting this question...this was a good read.

 

[SLC]

plz plz plz stop over thinking these things, all of you are thinking way too hard.


Everybody in America has heard of an Epi pen and know thats what you give someone having a bad allergic reaction, spend 10 secs on this question and move on.

Fellas, I think we got a bad-ass up in here!!!!

 

[loveoforganic2]

I didn't mean it would exclude epi--i just meant that it's not bad to delve into the mechanism of why epi is the right choice.

Speaking of which....is laryngeal edema not another mechanism that would be considered respiratory distress, which would be corrected with an alpha 1 agonist? I get why beta 2 bronchodilation is correct, but I've also heard laryngeal edema in particular is often a cause of death WRT anaphylactic shock.

I don't think I've ever heard that, but it would make sense. Epi is apparently a tx for acute life threatening angioedema (along with intubation), and idk what the mechanism would be other than a1 agonism

 

[Anastomoses]

In which class are you guys learning about what acts on the receptors? pharmacology?

 

[loveoforganic2]

thanks for posting this question...this was a good read.

In which class are you guys learning about what acts on the receptors? pharmacology?

You learn about receptors and what acts on them in biochem, have you started first year yet??





























Ok, I'm kidding, you learn them in pharm. Now simmer down the gunnertude to a slow boil 🙂

Was it really a good read? I don't know how any of this would make sense without pharm

 

[loveoforganic2]

Kid who was stung by a bee developed hives and SOB then collapsed. His HR is 200 bpm, RR 10, palpable BP is 60. After establishing an airway what do you give him next?

Albuterol
Dexamethasone
Diphenhydramine
Epinephrine
Loratadine


I know EPP is given for anaphylaxis, but wouldn't that increase his HR? And albuterol is given for broncho and venous dilation, but that would raise HR too right? Can someone help please?

I don't think it was addressed, so just to round out the explanation - the HR is more or less tapped out, it's as high as it's going to go. I would think even if it was say 170 though, the immediate threat to life is the airway - young heart should be able to take a pounding, but not without O2

 

[Sanzy]

Epinephrine is not only the right answer, but the question stem literally says you've established an airway, so there's no ambiguity in which one you should choose.

 

[Anastomoses]

You learn about receptors and what acts on them in biochem, have you started first year yet??


Ok, I'm kidding, you learn them in pharm. Now simmer down the gunnertude to a slow boil 🙂

Was it really a good read? I don't know how any of this would make sense without pharm

Whoa, that had exactly the intended effect. My face dropped from here to the ground when you said biochem. And yes, it was a good read because of course in physio we've covered basics on alpha adrenergic and beta adrenergic receptors and epinephrine and anaphylactic shock.
Now I know that epinephrine is administered for anaphylactic shock! Is it gunning if you listen to goljan lectures in the car all day before starting 2nd year? 😛

 

[tiedyeddog]

Now I know that epinephrine is administered for anaphylactic shock! Is it gunning if you listen to goljan lectures in the car all day before starting 2nd year? 😛

That's pretty normal, if this is a serious question...

I personally don't like him but most of my friends do.