Asthma and COPD Q 37

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Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which of the following actions first?

  

     A. Administering oxygen.

     B. Inserting an I.V. catheter.

     C. Obtaining a complete blood count (CBC).

     D. Taking vital signs.

    

    

Correct Answer: A. Administering oxygen.

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Giving oxygen would be the best first action in this case. Airway management is paramount. Thoroughly examine the patient for airway patency or any indications of an impending loss of airway. Perioral edema, stridor, and angioedema are very high risk, and obtaining a definitive airway is imperative. Delay may reduce the chances of successful intubation as continued swelling occurs, increasing the risk for a surgical airway.

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Option B: If the client doesn’t already have an I.V. catheter, one may be inserted now if anaphylactic shock is developing. Anaphylaxis induces a distributive shock that typically is responsive to fluid resuscitation and the above epinephrine. One to 2 L or 10 to 20 mL/kg isotonic crystalloid bolus should be given for observed hypotension. Albumin or hypertonic solutions are not indicated.

Option C: Obtaining a CBC wouldn’t help the emergency situation. Laboratory testing is of little to no use, as there is no accurate testing for diagnosis or confirmation. Serum histamine is of no use due to transient elevation and late presentation. Serum tryptase can be considered for confirmation of an anaphylactic episode as it remains elevated for several hours, however, as a diagnostic modality, this has low sensitivity.

Option D: Vital signs then should be checked and the physician immediately notified. Anaphylaxis is most often a rapidly evolving presentation, usually within one hour of exposure. Roughly half of the anaphylactic-related fatalities occur within this first hour; therefore, the first hour after the initial symptom onset is the most crucial for treatment. It is important to note that the more rapid the onset and progression of symptoms, the more severe the disease process.

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