Medical Emergencies · single question
A patient with asthma develops wheezing and lip swelling shortly after a rubber dam is placed. What is the MOST appropriate immediate management?
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Correct answer: B. Administer epinephrine 1:1000 IM
The combination of wheezing + lip swelling (angioedema) after rubber dam placement indicates anaphylaxis — not a simple asthma attack. The rubber dam likely contains latex, triggering a type I IgE-mediated hypersensitivity reaction. Anaphylaxis management: epinephrine 1:1000 IM (0.3–0.5 mg in adults, 0.01 mg/kg in children) into the anterolateral thigh is the FIRST and most critical intervention. Albuterol addresses only bronchospasm; Benadryl is secondary. Call 911 simultaneously but epinephrine must not be delayed.
- A. ❌ Diphenhydramine (Benadryl) is a secondary treatment for anaphylaxis — it works too slowly and does not reverse cardiovascular collapse.
- B. ✅ CORRECT – Epinephrine 1:1000 IM is the first-line treatment for anaphylaxis. The combination of wheezing + angioedema indicates anaphylaxis, not simple asthma.
- C. ❌ Calling 911 is important but should not precede or delay epinephrine administration.
- D. ❌ Albuterol only treats bronchospasm — it does not address the systemic anaphylactic reaction (angioedema, vasodilation, cardiovascular collapse).
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