March Week 3: Urticaria/Anaphylaxis
1.A 12-year-old boy is brought to the emergency department after being stung by a bee. He had been well until he was stung on his right forearm, while playing in the yard. He initially complained of localized pain and swelling. Fifteen minutes later, he began to complain of shortness of breath. His parents observed him to be wheezing. He also said that he felt very weak and dizzy. His parents brought him immediately to the local emergency department.
Exam: VS T 37.1, P 120, R 39, BP 69/45. He is in mild respiratory distress. He is drowsy and pale, but awakens when you talk to him. He has generalized urticaria. He has no conjunctival edema. His lips and tongue are not swollen. His voice sounds normal. Heart tachycardic without murmurs. His lung examination shows mild expiratory wheezing and minimal retractions. His abdomen is soft and non-tender. His face is moderately pale. The bee sting site on his right forearm is unremarkable with no foreign body seen.
1. What does your patient have?
2. What is the primary treatment of severe anaphylaxis and what is the appropriate dose?
3. What are some of the adjunctive therapies for anaphylaxis?
4. Do you admit the patient? If he goes home, what medications would you send him on?
5. Two weeks following a viral illness, a teenage boy breaks out in an evolving rash that is remarkable for target lesions. What is the primary treatment?
e. Symptomatic or supportive therapy
6. A girl is brought to her pediatrician by her mother because of recurrent bouts of non-pitting, non pruritic facial swelling that have occurred three times prior. Her father also has an history of recurrent facial swelling. What is the probably diagnosis?
a. Environmental allergen
b. Hereditary angioedema
c. Child abuse
Case/Questions by Dr. Carolina Salvador