A
7-year-old presents to the ED with wheezing and hives after being stung by a
bee. On exam the patient has hives and wheezing with a normal blood pressure
for his age. He is mildly tachycardic.
Potentially useful treatments for this patient includes all of the following EXCEPT:
A) IV Diphenhydramine.
B) Subcutaneous epinephrine.
C) Subcutaneous diphenhydramine.
D) Intravenous cimetidine.
Potentially useful treatments for this patient includes all of the following EXCEPT:
A) IV Diphenhydramine.
B) Subcutaneous epinephrine.
C) Subcutaneous diphenhydramine.
D) Intravenous cimetidine.
Discussion
The correct answer is C. Subcutaneous diphenhydramine can cause skin necrosis and is contraindicated. Either IV or IM diphenhydramine can be used. Of the others, subcutaneous epinephrine should be used in the patient with anaphylaxis who fails to respond to diphenhydramine and cimetidine or who has respiratory distress, hypotension, etc. Intravenous H2 blockers (eg, cimetidine, ranitidine) are particularly
effective in the treatment of anaphylaxis and should be
used routinely in these patients.
The correct answer is C. Subcutaneous diphenhydramine can cause skin necrosis and is contraindicated. Either IV or IM diphenhydramine can be used. Of the others, subcutaneous epinephrine should be used in the patient with anaphylaxis who fails to respond to diphenhydramine and cimetidine or who has respiratory distress, hypotension, etc. Intravenous H2 blockers (eg, cimetidine, ranitidine) are particularly
effective in the treatment of anaphylaxis and should be
used routinely in these patients.
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