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.
Initial observations
- BP 88/54 mmHg
- HR 122 bpm
- RR 24
- SpO2 91% on room air
- T 37.0 C
This patient meets criteria for anaphylaxis with hypotension and airway involvement. What is the single most appropriate FIRST-line treatment?