Medical Emergencies · patient case question
What is the most appropriate immediate drug intervention?
Patient case: Medical Emergency in the Operatory
demo: 34-year-old female
chief: Composite restoration on tooth #3 under rubber dam isolation.
history: Asthma, well controlled. No known drug allergies. Latex sensitivity not previously documented.
meds: Albuterol inhaler as needed
findings: Ten minutes after rubber dam placement the patient develops audible wheezing, swelling of the lips and periorbital tissue, and urticaria over the neck.
Show answer and explanation
Correct answer: C. Epinephrine 1:1000, 0.3 mg intramuscularly
- A. Antihistamines are adjunctive and far too slow for airway compromise; they treat the cutaneous signs only.
- B. Corticosteroids blunt the late-phase reaction but have no useful onset in the first minutes.
- C. Correct. Wheezing plus angioedema and urticaria is anaphylaxis. Intramuscular epinephrine 1:1000 is the first-line drug — remove the dam, position the patient, give oxygen, and activate EMS.
- D. Albuterol addresses bronchospasm but does nothing for the angioedema or the circulatory component.
Note: Sequence matters: remove the allergen, epinephrine first, then oxygen, call 911, and give antihistamine and corticosteroid as secondary agents.
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