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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the signs and symptoms of anaphylaxis

  • Identify the goals of therapy for anaphylaxis

  • Develop an appropriate treatment and monitoring plan for anaphylaxis based on individual patient characteristics

  • Select an appropriate product for treating the underlying condition on the basis of patient's allergic history

  • Properly educate a patient with a history of drug allergies

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PATIENT PRESENTATION

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Chief Complaint

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"I was walking back from the mailbox when I heard a rustling sound in the woods. A raccoon came charging out of the woods at me. I tried to run but he caught up to me and bit my leg."

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History of Present Illness

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Faith Stevens is a 19-year-old woman who presents to the emergency department with a raccoon bite to her left leg. While walking in her yard during daylight hours, a raccoon (whose whereabouts are currently unknown) raced across the lawn to bite her. The patient describes attempting to shake the raccoon from her leg. Damage to the leg confirms raccoon-inflicted significant damage to the skin and muscles on the left calf.

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On arrival at the hospital, cleaning of the wound began with soap and water, followed by povidine–iodine. During this time, a single dose of amoxicillin/clavulanate 875/125 mg was orally administered. Within 30 minutes of the dose, the patient began complaining of SOB, abdominal pain, itchiness, nausea, and rapid heart rate. Nurse noted audible wheezing and pruritis on trunk and arms.

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Past Medical History

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History of Stevens–Johnson syndrome with sulfa

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Family History

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Father is alive with no significant medical history at age 44. Mother is alive with no significant medical history at age 42. She has two young sisters who are healthy.

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Social History

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College student pursuing a degree in psychology. Single, lives with her parents and sisters; has no children. Works part-time at a local library

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Tobacco/Alcohol/Substance Use

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Social drinker; (−) tobacco or illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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Sulfa-induced Stevens–Johnson syndrome

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Codeine-induced nausea

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Ibuprofen (GI upset and abdominal pain)

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Meperidine (hallucinations)

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Medications (Current)

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No outpatient medications

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Physical Examination

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General
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Teenaged, Caucasian woman in acute distress

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Vital Signs
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BP 90/45 mm Hg, P 98, RR 16, T 37.2°C

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Weight 134.2 lb (61 kg)

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Height 68 in. (173 cm)

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Pain 7 (scale 0–10)

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Skin
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Clammy skin

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Laceration of left calf 4 inch (10 cm) in diameter ...

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