MedBugs: SAQ #342

Case: Anaphylactic shock with allergic myocardial infarction

A 59-year-old woman is brought to the resus room by paramedics after becoming weak, dizzy and nauseated while getting her hair dyed. She was hypotensive with an SBP of 70 mmHg and vomited once en route. She has a known anaphylaxis to peanuts and is on metoprolol for hypertension. She ate a salad sandwich one hour prior. On arrival her vitals are HR 90, BP 70/40, RR 24, sats 98% on room air, GCS 14. You suspect anaphylactic shock.

1. What drug should be immediately administered? Advise dose, route and location of administration. 2 marks

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

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

3. What will you prescribe next in your management? Include your complete prescription including drug, dose, dilution, diluent, route and initial rate. 3 marks

4. What is your interpretation of the ECG? 1 mark

5. In this clinical context, what is the name of this specific syndrome and its definition? 2 marks

6. Name (2) additional vasoactive drugs that could be considered if your management of anaphylactic shock has not been adequate. Include dose and route. 2 marks

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