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Medical Emergencies · single question

Following a latex rubber dam placement, a 9-year-old child develops hives, rashes, and rhinitis. What is the most appropriate treatment at this time (acute reaction)?

  1. Administer bronchodilator
  2. Administer diphenhydramine
  3. Administer epinephrine
  4. Administer corticosteroid
Show answer and explanation

Correct answer: C. Administer epinephrine

The patient has developed signs of a TYPE I (IgE-mediated) hypersensitivity reaction to latex: urticaria (hives), rhinitis, and rashes. Given these are SYSTEMIC signs (not just localized), this is progressing toward anaphylaxis risk. The IMMEDIATE treatment for an acute systemic hypersensitivity reaction at this time is EPINEPHRINE (EpiPen) intramuscular — to reverse bronchospasm, hypotension, and prevent anaphylaxis. Remove the latex trigger immediately. Diphenhydramine (antihistamine) is used for mild/localized urticaria. The presentation with systemic signs warrants epinephrine as the first-line treatment.
  • A. INCORRECT. A bronchodilator (albuterol) addresses bronchospasm specifically but does not treat systemic anaphylaxis with urticaria and rhinitis. Epinephrine is broader and more appropriate for the full systemic reaction.
  • B. INCORRECT. Diphenhydramine (antihistamine) is appropriate for ISOLATED urticaria/hives without systemic involvement. When systemic signs are present, epinephrine comes first.
  • C. CORRECT. Epinephrine (0.3 mg IM for adults, 0.15 mg for children) is the FIRST-LINE treatment for anaphylaxis or systemic hypersensitivity reactions. With systemic signs (hives, rhinitis), immediate epinephrine is indicated. Remove the latex trigger, administer epinephrine IM, activate EMS.
  • D. INCORRECT. Corticosteroids (e.g., dexamethasone) are used as adjunct therapy in anaphylaxis to prevent biphasic reactions but are NOT first-line immediate treatment.

Note: ⚠️ FLAG: The source distinguishes two questions — at the TIME of the reaction with systemic signs (anaphylaxis): epinephrine. For isolated urticaria/hives only: antihistamine. Given rashes + rhinitis = systemic involvement → epinephrine is appropriate.

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