A 70-years-old man was administered penicillin intravenously. Within 5 minutes, he developed generalized urticaria, swelling of lips, hypotension and bronchospasm. The first choice of treatment is to administer:

Question

Image below highlights jugular foramen. Which of the following structures do not pass through the marked structure “A”?

Answer 1

The patient's picture of sudden urticaria, lip swelling, low blood pressure and bronchospasm right after intravenous penicillin is anaphylaxis, a life-threatening allergic emergency. Let's look at what each drug can and cannot do here.

Chlorpheniramine injection: An antihistamine calms itching and hives but has no useful effect on blood pressure or airway narrowing, so it cannot be relied on as the first drug in a reaction this severe.
Epinephrine injection: Acting on both alpha and beta receptors, epinephrine tightens blood vessels to bring blood pressure back up, opens the airway by relaxing bronchial muscle, and slows further release of the chemicals driving the reaction. It is the only drug that treats all three danger signs (skin, airway and circulation) at once and works within minutes.
High-dose hydrocortisone tablet: Steroids take several hours to act and a tablet would be poorly absorbed in a patient with low blood pressure and gut hypoperfusion, so this has no role as an immediate treatment; it is added later to prevent a delayed relapse.
Nebulized salbutamol: This eases the wheeze but leaves the hypotension and swelling untreated, so on its own it is not enough for full-blown anaphylaxis.

Only epinephrine reverses hypotension, bronchospasm and mediator release together, which is exactly what this patient needs right away.

Let's summarize:

Anaphylaxis is a combined skin, airway and circulatory emergency.
Epinephrine is the only drug that treats all three problems fast enough to save the patient.

So the first choice of treatment is epinephrine injection, option (2).

Answer 2

The patient's picture of sudden urticaria, lip swelling, low blood pressure and bronchospasm right after intravenous penicillin is anaphylaxis, a life-threatening allergic emergency. Let's look at what each drug can and cannot do here.

Chlorpheniramine injection: An antihistamine calms itching and hives but has no useful effect on blood pressure or airway narrowing, so it cannot be relied on as the first drug in a reaction this severe.
Epinephrine injection: Acting on both alpha and beta receptors, epinephrine tightens blood vessels to bring blood pressure back up, opens the airway by relaxing bronchial muscle, and slows further release of the chemicals driving the reaction. It is the only drug that treats all three danger signs (skin, airway and circulation) at once and works within minutes.
High-dose hydrocortisone tablet: Steroids take several hours to act and a tablet would be poorly absorbed in a patient with low blood pressure and gut hypoperfusion, so this has no role as an immediate treatment; it is added later to prevent a delayed relapse.
Nebulized salbutamol: This eases the wheeze but leaves the hypotension and swelling untreated, so on its own it is not enough for full-blown anaphylaxis.

Only epinephrine reverses hypotension, bronchospasm and mediator release together, which is exactly what this patient needs right away.

Let's summarize:

Anaphylaxis is a combined skin, airway and circulatory emergency.
Epinephrine is the only drug that treats all three problems fast enough to save the patient.

So the first choice of treatment is epinephrine injection, option (2).

A 70-years-old man was administered penicillin intravenously. Within 5 minutes, he developed generalized urticaria, swelling of lips, hypotension and bronchospasm. The first choice of treatment is to administer:

Show Hint

The Correct Option is B

Solution and Explanation

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