Case Study: Tayyab S/O Nadeem (12 Years Old)

 

• • Chief Complaints

     

    • • Urticarial rash, respiratory distress, and irritability persisting for one day.
    • • reatment for gastritis at a local setup (rHistory of IV tecords unavailable).
    • • Similar complaints yesterday; IV treatment given, discharged, and now presents again with worsening symptoms.

• • Condition at Presentation:
    

     

    • • Conscious but in acute respiratory distress.
    • • Urticarial rash over the body.

Initial Examination and Assessment

 

1. 1. Primary Assessment

      :

       

      • • A – Airway: Maintainable; positioning and suctioning performed.

      • • B – Breathing

          :

           

          • • Respiratory rate: 22 breaths/min.
          • • SpO2: 92% on room air.
          • • Decreased air entry bilaterally.
          • • No audible adventitious sounds.

      • • C – Circulation

          :

           

          • • HR: 116 bpm (tachycardia).
          • • BP: 130/80 mmHg.
          • • CRT: 2–3 seconds.
          • • Warm peripheries with good, palpable pulses.

      • • D – Disability:

           

          • • Alert (AVPU: Alert).
          • • Pupils bilaterally reactive to light.
          • • Blood sugar: 89 mg/dL.

      • • E – Exposure

          :

           

          • • Temperature: 37.6°C.
          • • Urticarial rash present.
          • • Weight: 33 kg.

Management Plan

Immediate Interventions

 

1. 1. Oxygen Therapy:

       

      • • Administered via nasal prongs at 2 L/min to maintain SpO2 >94%.

1. 1. Pharmacological Treatment:

       

      • • Adrenaline IM: 0.01 mg/kg (max dose 0.5 mg).
      • • Hydrocortisone IV: Administered to reduce inflammation and prevent delayed hypersensitivity.
      • • Avil (Pheniramine) IV: For histamine blockade.

1. 1. Nebulization:

       

      • • Back-to-back nebulizations with Salbutamol to relieve bronchospasm.

1. 1. Fluids

      :

       

      • • Maintenance IV fluids attached to ensure hydration and stabilize circulation.

1. 1. Investigations

      :

       

      • • Blood samples sent to the lab (awaiting results).

1. 1. Monitoring and Observation:

       

      • • Cardiac monitoring initiated (ECG electrodes attached).
      • • Continuous reassessment of airway, breathing, and circulation.

Provisional Diagnosis

Anaphylaxis with Bronchospasm

 

• • Trigger: Likely related to prior IV treatment or an undetermined allergen.

Detailed Observations Post-Treatment

 

• • Breathing: Slight improvement in SpO2 and respiratory effort post-nebulization.

• • Circulation: BP and HR stabilized; pulses remained good.

• • Skin Rash: Persistent but less severe following antihistamines and corticosteroids.

Further Recommendations

Hospital Admission and Monitoring

 

• • Continue observation in a monitored setting for at least 24–48 hours.

• • Watch for potential biphasic anaphylaxis (reoccurrence within 72 hours).

Additional Investigations

 

• • CBC, CRP, and ESR to rule out secondary infections or inflammation.

• • Serum IgE levels and allergen-specific tests (after stabilization).

Patient and Attendant Counseling

 

1. 1. Educate on:
      

       

      • • Signs of anaphylaxis and respiratory distress.
      • • Importance of seeking immediate medical attention if symptoms recur.

1. 1. Provide a written action plan upon discharge:
      

       

      • • Prescribe oral antihistamines and corticosteroids.
      • • Train on the use of an epinephrine auto-injector.

Conclusion

This case highlights the rapid progression of anaphylaxis and the importance of early administration of adrenaline. Effective initial stabilization and close observation prevented further deterioration. The patient’s condition is stable but requires continued monitoring to ensure complete resolution