MedBugs: SAQ #28

Case: Anaphylactic shock

A 59-year-old woman is brought to your resus room by paramedics. She was unwell until about 30 minutes prior to arrival, when she complained of feeling weak, dizzy and nauseated whilst geting her hair dyed at the hairdresser. CDA were contacted she was found to be hypotensive with SBP 70 and GCS 13 on their arrival. She was given 500mL IVF. She vomited once en route. She has a known anaphylaxis to peanuts and her only other past history is hypertension for which is on metoprolol. Her friend reports she ate a salad sandwich an hour ago. Current vitals are : HR 90 BP 70/40 RR 24 Sats 98%RA GCS 14 You suspect anaphylactic shock.

1. What immediate drug should be administered? Please advise dose, route and location of administration. 1 mark

2. What is the clinical definition of anaphylaxis? 3 marks

It has now been 15 minutes since her arrival. She has completed 1L of IVF and now 2 doses of your initial prescribed medication. Despite initial improvement, her BP has dropped back down to 70 systolic.

3. What will you next prescribe in her management? Include your complete prescription as provided to the nursing staff, inclusive of drug and dose, dilution and diluent, route and initial rate. 2 marks

She has now been on this treatment for 10 minutes, and although she has clinically improved, she is now complaining of chest pain. Her ECG shows obvious anterolateral STEMI. You assess the ECG and diagnose the patient with Kounis Syndrome. “What’s that?” asks your RMO.

4. Name (2) additional vasoactive drugs that could be considered if your above management had not been adequate. Include dose and route. 2 marks

5. What is Kounis Syndrome? How is it further classified? 4 marks

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