A patient with asthma has a rubber dam placed. The dentist hears wheezing and the patient's lips begin to swell. What is the FIRST step?

Correct answer: D. Administer intramuscular epinephrine

• A. Antihistamines relieve itch and hives only; they act too slowly and do not reverse airway or cardiovascular compromise. They are second-line adjuncts.
• B. Albuterol treats bronchospasm alone. It does nothing for angioedema, hypotension, or the systemic reaction — it is adjunctive AFTER epinephrine.
• C. EMS must be activated, but you give epinephrine FIRST and then call — you do not wait.
• D. CORRECT. Wheezing (airway) PLUS lip swelling (skin/mucosa) is involvement of two organ systems — this is ANAPHYLAXIS, most likely to the latex rubber dam. Epinephrine 0.3–0.5 mg IM in the mid-anterolateral thigh (0.15 mg for a child under 30 kg) is the first-line and only life-saving drug. Remove the rubber dam immediately. Delay in giving epinephrine is the leading cause of anaphylaxis fatality.

Note: Two organ systems involved = anaphylaxis = epinephrine IM, immediately. An asthmatic with rubber dam and lip swelling is latex allergy, not an asthma attack.