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Clinical Opal - Marty presents with throat tightness following an insect bite

08 August 2023 - Grace Larson

Marty has presented to the local urgent care clinic with their mother. Marty is 10 years old and had been on a bush walk with their family when they were bitten/stung by something.

Marty has been waiting for approximately 13 minutes prior to you reviewing them. Marty has some angioedema and is complaining of a feeling of throat tightness. There is no visible rash or any audible stridor or obvious increased work of breathing. 

Observations are documented as follows;

HR 120

RR 21

Sp02 96% 

BP 88/52 (65)

Temp 37

Weight 40kg

Marty has no known medical history and is up to date with all vaccinations.

 

What intervention is most appropriate for Marty?

  1. Oral antihistamine 

  2. Nebulised Adrenaline

  3. IM Adrenaline

  4. IV Adrenaline

 

Yes it is crucial that Marty receives an IM dose of Adrenaline.

As there has been exposure to a common allergen, and symptoms of anaphylaxis including throat tightness and angioedema.

Marty can receive 10 mcg/kg of Adrenaline in Marty’s case this is 400mcg or 0.4mL of 1mg in 1mL solution.

Marty could also receive an Epipen if there is one available as she is over 20kg.


References:

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jpc.16006

Grace Larson
Grace Larson

Grace Larson, RN, BN, CertIV(TAE), GradDipClinNurs(PaedCritCare), MAdNursPrac(PaedCritCare), has extensive experience in paediatric nursing, with 13 years in Paediatric Intensive Care Units (PICU). She’s published journal articles in the specialty area of pain and sedation in PICU, and has presented at national and international conferences on the area of pain and sedation in paediatrics. Grace has previously worked with the ACCCN delivering Paediatric Advanced Life Support in Victoria, bringing a wealth of experience into her clinical teaching on paediatric resuscitation. She has also consulted with NSW Health on quality and safety delivering within PICU, and has been contracted with the ANMF to develop nursing programs for nurses who require additional education as part of their practice requirements.

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