MEDICAL

A 24 YEAR OLD WOMAN IS SCHEDULED FOR AN URGENT APPENDECTOMY. SHE HAS SEVERE ABDOMINAL PAIN BUT IS OTHERWISE WELL. A RAPID SEQUENCE INDUCTION IS PERFORMED USING FENTANYL, PROPOFOL AND SUXAMETHONIUM. SOON AFTER INTUBATION HER PULSE RATE IS 140BPM, BP 60/40MMHG AND SHE HAS SIGNIFICANT BRONCHOSPASM. WHICH IS THE SINGLE MOST LIKELY CAUSE

  • A. Acute asthma
  • B. Anaphylaxis ✓
  • C. Inadvertent intubation of right main bronchus
  • D. Septic shock
  • E. Tension pneumothorax

 

The single most likely cause of the symptoms described in the scenario is Anaphylaxis. Anaphylaxis is a severe, potentially life-threatening allergic reaction that can occur rapidly after exposure to an allergen, such as a medication like suxamethonium or propofol in this case. The symptoms of anaphylaxis can include bronchospasm, tachycardia (elevated heart rate), hypotension (low blood pressure), and respiratory distress, which align with the patient’s presentation post-intubation.

In other words, Anaphylaxis is a severe, potentially life-threatening allergic reaction that can cause bronchospasm, tachycardia, hypotension, and cardiovascular collapse. In this case, the patient’s symptoms of bronchospasm, tachycardia (pulse rate of 140bpm), and hypotension (BP 60/40mmHg) are indicative of an anaphylactic reaction triggered by one of the medications used during the induction.

Treatment:

  • The immediate management for anaphylaxis includes stopping the triggering agent if identified, administering epinephrine as a first-line treatment to reverse bronchoconstriction and vasodilation, ensuring adequate oxygenation and ventilation, administering intravenous fluids to support blood pressure, and considering additional medications like antihistamines and corticosteroids.

In conclusion, given the sudden onset of symptoms following drug administration during induction, along with the presence of bronchospasm, tachycardia, and hypotension – all suggestive of anaphylactic shock – option B (Anaphylaxis) is the single most likely cause in this scenario.

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