Round 10 (Allergic Reaction)
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 1 May 2020
⏱️ 31 minutes
🧾️ Download transcript
Summary
CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
A 45 year old female is exposed to peanut butter and shrimp pizza and begins to have an apparent allergic reaction…
Initial Vitals
* Temp 98.8* HR 130* RR 35* BP 70/40* O2 92%
Critical Actions
* Verbalize Airway Evaluation* Complete a FOCUSED History and Exam* Normal Saline Bolus* Epinephrine both IM and (subsequently) IV* Glucagon 1mg IV
Final Diagnosis
Refractory Anaphylaxis Due to Beta Blockers
Tips and Tricks
You still need to obtain a quick history and exam even if you know the diagnosis in the first few seconds of the case
Additional Reading
* Basic approach to anaphylaxis (EM Clerkship)* Tranexamic acid as first-line emergency treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors. (PubMed)* Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. (PubMed)
Transcript
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| 0:00.0 | Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of |
| 0:07.1 | endless charting once you become a doctor? Do you think that doctors should be spending more |
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| 0:20.4 | secure, hippocompliant scribe that anybody can use. |
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| 0:29.5 | Use coupon code EM50 to save 50% the first month you try it, |
| 0:34.1 | and you can cancel at any time if you decide it's not right for you. You can learn more |
| 0:38.9 | at www.gitfreed.a.i. Hello, residents. My name is Zach Olson. I'm joined today by Mike |
| 0:48.2 | Estefan and thank you for downloading this month's episode of the EM Clerkship Podcast. This is EM Clerkship's Secret Residency Curriculum, and today is round number 10 of the game. |
| 1:00.7 | And I don't know. |
| 1:02.0 | Do you know what the score is, Mike? |
| 1:03.4 | Because I know what the score is. |
| 1:05.0 | Is it five to four? |
| 1:07.5 | It's five to four. |
| 1:08.7 | And you are winning. |
| 1:15.1 | Uh-oh. So I made this extra difficult for you because we got to tie it up to keep it interesting. Lovely. So yeah, Mike will need to perform today's case in real |
| 1:20.4 | ABEM oral boards format. He has 15 minutes to complete the case. He does not know what the case is |
| 1:25.4 | ahead of time. And if he hits all of the |
| 1:27.6 | critical actions that I listed out beforehand, he wins. And if he doesn't, or if he performs a |
| 1:31.8 | dangerous action, I win. These cases were created by me. And now, as always, let's check in with |
| 1:38.2 | Dr. Estefan here. How are you doing, man? I'm doing well. I'm doing well in spite of this whole |
| 1:43.7 | COVID thing. How are you, dude? |
... |
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