Your patient is a seven-year-old female with a history of bee-sting anaphylaxis. She was stung by a bee and nearly immediately began having difficulty swallowing and breathing. Her father administered her prescribed 0.15 mg epinephrine auto-injector without result. On your arrival, the patient responds to painful stimuli; has labored, rapid, wheezing respirations; a heart rate of 60; and a blood pressure of 92/60. Her father tells you that she weighs 48 pounds. Which of the following is the best sequence of treatment for this patient?

Question

A) Hyperventilate for 1 to 2 minutes, intubate the trachea, administer 1:10,000 epinephrine endotracheally, start an IV of normal saline, and administer diphenhydramine, IV
B) Assist ventilations with a bag-valve-mask device and supplemental oxygen, administer diphenhydramine subcutaneously, start an IV of normal saline, and administer 1:1,000 epinephrine intravenously.
C) Begin a nebulized albuterol treatment with supplemental oxygen, administer 1:1,000 epinephrine subcutaneously, start an IV of normal saline and infuse a 400-mL bolus, and administer diphenhydramine, IM
D) Assist ventilations with a bag-valve-mask device and supplemental oxygen, initiate a large-bore IV of normal saline, and administer 1:10,000 epinephrine intravenously, followed by diphenhydramine, IV

Answer 1

D