A 24-year-old woman with a history of migraine, on propranolol and oral contraceptives, presents with severe dyspnea, hoarseness, rash, nausea and vomiting 30 minutes after taking metamizole. His blood pressure is 90/40 mmHg and SatO2 is 90%. The most correct initial treatment would be to administer:
We are faced with an anaphylactic reaction to metamizole, in which it is necessary to act quickly or the patient could progress to cardiac arrest. It is important to assess the severity of the allergic reactions, since, in this case, early treatment is essential to prevent high mortality if not applied. The treatment of choice is IM adrenaline (only switch to IV if anaphylaxis is refractory), which has been shown to increase survival, and administration can be repeated every 5-15 minutes if symptoms do not subside. As adjuvant treatment, dexchlorpheniramine could be administered. In this particular case, since the patient was previously treated with propranolol, this indicates that the correct answer is 4, which includes the administration of glucagon, which is administered because patients taking beta-blockers can be resistant to treatment with adrenaline and develop refractory hypotension and prolonged bradycardia. The dose in adults is 1 to 2mg, IV or IM, which can be repeated in 5 minutes or followed by an infusion at 5-15mcg/min.
Adrenaline.
Adrenaline and dexchlorpheniramine.
Adrenaline, dexchlorpheniramine and methylprednisolone.
Adrenaline, dexchlorpheniramine and glucagon.
In this particular case, since the patient was previously treated with propranolol, this indicates that the correct answer is 4, which includes the administration of glucagon, which is administered because patients taking beta-blockers can be resistant to treatment with adrenaline and develop refractory hypotension and prolonged bradycardia.