Q67: Emergency Medicine : PLAB/UK(MLA)/AKT Exam style question
Today we will discuss another Q67 Emergency Medicine PLAB 1/ UKMLA exam question. This is a common topic that has appeared in the past PLAB 1 exam.
A 25-year-old man with a history of severe allergic reactions presents to the emergency department with facial swelling, hives, and shortness of breath. His blood pressure is 80/50 mmHg, pulse rate is 120 beats per minute, and oxygen saturation is 97% on room air. What is the most appropriate initial treatment for this patient?
A. High-flow oxygen therapy
B. Intravenous corticosteroids
C. Intramuscular adrenaline
D. Nebulized bronchodilators
E. Subcutaneous epinephrine
Explanation:
The correct answer is C
This patient is presenting with signs and symptoms of anaphylaxis, a severe and potentially life-threatening allergic reaction. The first-line treatment for anaphylaxis is the prompt administration of adrenaline (also known as epinephrine).
In this case, the most appropriate way to give adrenaline is intramuscular, as recommended by the Resuscitation Council guidelines. Intramuscular injection of adrenaline should be given into the anterolateral aspect of the middle third of the thigh.
Other treatments that should be initiated immediately include high-flow oxygen therapy, intravenous access, and fluid resuscitation if the patient is hypotensive. Intravenous corticosteroids may also be given to help prevent a biphasic reaction. Nebulized bronchodilators are not recommended as a first-line treatment for anaphylaxis but may be used to manage bronchospasm if it is present. Subcutaneous epinephrine may be used as a temporary measure until intramuscular adrenaline can be administered, but should not be used as the primary route of administration.
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Reference:
One of them is a NICE guideline on anaphylaxis: assessment and referral after emergency treatment. It covers the assessment and referral for anaphylaxis, and it recommends that intramuscular adrenaline should be given as the first-line treatment for anaphylaxis, followed by high-flow oxygen therapy, intravenous access, and fluid resuscitation1.
Another link is a NICE evidence summary on the use of adrenaline auto-injectors for anaphylaxis. It provides information on the different types of adrenaline auto-injectors available in the UK, their indications, doses, administration techniques, and adverse effects. It also advises that people who have had an anaphylactic reaction should be prescribed two adrenaline auto-injectors before discharge, and that they should be advised to carry them at all times.
