A client comes to the emergency department following a bee sting. The client has a diffuse. rash, hypotension, and throat tightness. One injection of IM epinephrine does not improve the client's condition. What action should the nurse take next?
Anaphylactic shock has an acute onset, and manifestations usually develop quickly (20- 30 minutes). Circulatory failure and respiratory manifestations, including laryngeal edema (from inflammation) and bronchoconstriction (primarily from release of histamine), can lead to cardiac/respiratory arrest.
The management of anaphylactic shock includes:
- Ensure patent airway, administer oxygen
- Remove insect stinger if present
- IM epinephrine is the drug of choice and should be given to this client. Epinephrine stimulates both alpha- and beta-adrenergic receptors and dilates bronchial smooth muscle (beta 2) and provides vasoconstriction (alpha 1). The IM route (mid anterior lateral thigh) is better than the subcutaneous route. Repeat dose every 5-15 minutes.
- Place in recumbent position and elevate legs
- Maintain blood pressure with IV fluids, volume expanders or vasopressors
- Bronchodilator (inhaled beta agonist) such as albuterol is administered to dilate the small airways and reverse bronchoconstriction
- Antihistamine (diphenhydramine) is administered to modify the hypersensitivity reaction and relieve pruritus
- Corticosteroids (methylprednisolone [Solu-Medrol]) are administered to decrease airway inflammation and swelling associated with the allergic reaction
- Anticipate cricothyrotomy or tracheostomy with severe laryngeal edema
(Option 1, 2, and 3) These are appropriate responses that should come after a repeat dose of epinephrine has been given.
Educational objective:
- IM epinephrine is the single most important medication to be given in anaphylactic shock.
- The dose should be repeated every 5-15 minutes if symptoms are still present.
Anaphylactic shock has an acute onset, and manifestations usually develop quickly (20- 30 minutes). Circulatory failure and respiratory manifestations, including laryngeal edema (from inflammation) and bronchoconstriction (primarily from release of histamine), can lead to cardiac/respiratory arrest.
The management of anaphylactic shock includes:
- Ensure patent airway, administer oxygen
- Remove insect stinger if present
- IM epinephrine is the drug of choice and should be given to this client. Epinephrine stimulates both alpha- and beta-adrenergic receptors and dilates bronchial smooth muscle (beta 2) and provides vasoconstriction (alpha 1). The IM route (mid anterior lateral thigh) is better than the subcutaneous route. Repeat dose every 5-15 minutes.
- Place in recumbent position and elevate legs
- Maintain blood pressure with IV fluids, volume expanders or vasopressors
- Bronchodilator (inhaled beta agonist) such as albuterol is administered to dilate the small airways and reverse bronchoconstriction
- Antihistamine (diphenhydramine) is administered to modify the hypersensitivity reaction and relieve pruritus
- Corticosteroids (methylprednisolone [Solu-Medrol]) are administered to decrease airway inflammation and swelling associated with the allergic reaction
- Anticipate cricothyrotomy or tracheostomy with severe laryngeal edema
(Option 1, 2, and 3) These are appropriate responses that should come after a repeat dose of epinephrine has been given.
Educational objective:
- IM epinephrine is the single most important medication to be given in anaphylactic shock.
- The dose should be repeated every 5-15 minutes if symptoms are still present.
