Emergency Medicine
Throat Tightness After Dinner: Anaphylaxis with Airway Compromise
Presentation
A 24-year-old woman is brought to the ED 15 minutes after eating shrimp at a restaurant. She has diffuse urticaria, lip and tongue swelling, a hoarse muffled voice, and audible wheezing, and she feels lightheaded. She has a history of migraines treated with propranolol.
BP 88/54 mmHg, HR 122 bpm, RR 24, SpO2 91% on room air, T 37.0 C
↻ Epinephrine is given. Two minutes later the urticaria is fading, but she develops inspiratory stridor, more muffled voice, and visibly enlarging tongue and lip edema.
This patient meets criteria for anaphylaxis with hypotension and airway involvement. What is the single most appropriate FIRST-line treatment?