An 18-year-old woman presents to urgent care with sudden onset of facial swelling, particularly around her lips, along with wheezing. She also complains of “itchy bumps” on her upper chest. She is accompanied by her mother, who says the patient has no known allergies and no history of asthma. The mother reports that the symptoms began about an hour ago, shortly after the patient ate some homemade hummus. Which of the following is the best first step in the management of this patient?
- Administer IM epinephrine.
- Prescribe antihistamines.
- Administer IV corticosteroids.
- Tell the mother to take the patient to the nearest ED.
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Answer: A. Given the patient’s wheezing and symptoms suggestive of an acute allergic reaction, the most appropriate initial treatment is to administer epinephrine via the IM route. This is particularly important in cases of severe angioedema with respiratory involvement and/or signs of anaphylaxis.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
