Round 16 (Allergic Reaction)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!



Case Introduction



You are sitting at your computer on an otherwise beautiful Friday afternoon when a mother brings her 16 year old son to the ED with chief complaint of allergic reaction.



Initial Vitals



* Temp 98.7* HR 155* RR 28* BP 125/85* O2 99%



Critical Actions



* Interpret ECG * Interview patient alone (and identify trigger)* Perform vagal maneuver* Administer Adenosine* Discharge patient



Final Diagnosis



Supraventricular Tachycardia



Tips and Tricks



* Interview pediatric patients without family members in the patient’s room* Escort family out of patient room during invasive procedures* Ask about / rule out potential triggers (caffeine use, drugs, ischemia, electrolyte abnormalities, etc)



Further Reading



The REVERT Trial (RebelEM)