se/b07/017: IM or IV
Woman on bed
Back to St Emlyn's Reception

1. What is the diagnosis?
This is almost certainly an anaphylactic reaction to something in the food that she was eating, though it is also possible that another allergen( e.g. wasp sting) may be the cause. The actual cause is probably irrelevant as she is in urgent need of resuscitation.

2. How are you going to treat it?
Whilst the SHO is well intentioned hydrocortisone is going to have little immediate effect. The treatment is Adrenaline. Give 0.5mg IM or if in a resuscitation area and skilled in it's administration you can use small aliquots of 1:100,000 adrenaline IV. If given IV you need to be in a resus are and have ECG monitoring.

3. How would you confirm it?
You can take a mast cell tryptase to confirm the diagnosis of anaphylaxis, but this will not come back from Immunology for several days. It is a useful test when the diagnosis is in doubt.

4. How would you treat them after their initial resuscitation?
After stabilisation with adrenaline and fluids +/- nebulised salbutamol for wheeze you can give chlorpheniramine and steroids. We advocate oral prednisolone 30mg OD for 3 days after such a serious reaction. You should also consider giving an Epi-pen if further reactions are likely. They should be observed in hospital for a minimum of 6 hours.

5. How would they be followed up?
In an immunology clinic.
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