This is our last case of the week for the 2017 Gorgas Diploma Course in Clinical Tropical Medicine. Sofia Zavala Clinical Rounds Coordinators for the Gorgas Courses for case selection, coordination of case summaries and images; Dr.
Lieberman et al have described this in great detail.Prehospital patients with symptoms of severe anaphylaxis should first receive standard interventions.Interventions include high-flow oxygen, cardiac monitoring, and intravenous (IV) access.These measures are appropriate for an asymptomatic patient who has a history of serious reaction and has been re-exposed to the inciting agent.Measures beyond basic life support (BLS) are not necessary for patients with purely local reactions.
Disposition of patients with anaphylaxis depends on the severity of the initial reaction and the response to treatment.The practitioner should recognize that sedation is part of the continuum that progresses from minimal to moderate to deep sedation and eventually reaches the state of general anesthesia.Each individual patient should be closely and continuously monitored to prevent this progression to the deeper sedated states .He has noted daily palpitations and two episodes of dyspnea on exertion associated with dizziness that resolves with rest. Epidemiology: Born and lived in Cajamarca and in the highlands and high jungle until age 26 with 2 years of military service during that time.He denies fevers, chest pain, syncope, and dyspnea at rest, orthopnea, nocturnal paroxysmal dyspnea or lower extremity edema. Subsequently, he travelled all over the country as an outdoor antenna installer which required him to sleep on the ground whenever working in the countryside.This is not a problem if the medication can be titrated, but oral and rectal medications are not really reasonable methods for titration.