Author: William Burkhalter, MD
Co Author #1: Michael M. Linder, MD Director of Primary Care Sports Medicine University of South Alabama

Patient Presentation:
unresponsive

History:
The patient is 22 year old African American female university track athlete. She presented to the athletic training room after having taken ibuprofen 400mg PO one dose for muscle soreness. Before arriving in the training room she developed shortness of breath, akathisia, and pruritis. With a past medical history of asthma, she thought she was having and asthma exacerbation and used her albuterol inhaler multiple times without relief of dyspnea. She began to develop a generalized rash with associated pruritis when she appeared in the training room. She was given Benadryl 50mg PO and observed. Approximately fifteen minutes later she developed stridorous dyspnea, diaphoresis with pallor and an urticarial rash. She then became unresponsive. She was found to be pulseless but still breathing agonally. An automated external defibrillator was applied and no shockable rhythm was recognized. She was immediately given epinephrine 0.3 mg intramuscularly (into the thigh) and immediately regained consciousness with prompt resolution of dyspnea. EMS was activated and she was transported to a university hospital for further evaluation.

Physical Exam:
Vital signs BP 124/76 HR 102 RR 18 progressing to pulselessness agonal breathing. Gen- Young adult African-American female anxious appearing progressing to unresponsiveness.
HEENT NCAT OP normal.

Cardiac: Tachycardic, regular rhythm, 2+ pulses progressing to pulselessness. Lungs Clear to auscultation bilaterally.
Abdomen soft, nontender, nondistended, normal bowel sounds.
Extremities no cyanosis or edema.
Skin diffuse erythematous confluent raised patchy rash.

Physical exam in emergency department: Vitals: BP 130/85 P 80 RR 18 T 98.2 SPO2 99% room air.
Gen - anxious appearing.
HEENT no orpharyngeal swelling noted.
Cardiac. Regular rate, rhythm.
Lungs clear bilaterally.
Skin global hives.

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