A patient develops acute urticaria, wheezing, angioedema, and hypotension immediately after an intramuscular penicillin injection. What is the immediate first-line medication and route?

Answer and explanation

Correct answer: C. Intramuscular epinephrine in the anterolateral thigh

  1. Step 1: Sudden systemic allergic reaction involving cutaneous manifestations and respiratory or cardiovascular compromise defines life-threatening anaphylaxis.
  2. Step 2: Intramuscular epinephrine injected into the mid-anterolateral thigh is the first-line medication of choice, rapidly reversing bronchospasm, peripheral vasodilation, and mucosal edema.
Answer
Intramuscular epinephrine in the anterolateral thigh.
Why not the others: Antihistamines like diphenhydramine are adjunctive therapies that treat itch and hives but do not prevent or reverse laryngeal edema or distributive shock. Corticosteroids have a delayed onset of action of 4 to 6 hours and do not treat acute airway obstruction. Inhaled albuterol relieves bronchospasm but does not treat laryngeal edema or hypotension.

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