Immediate Questions

A. Is this anaphylaxis? If anaphylaxis is present, assess airway, breathing, and circulation (ABCs) while administering epinephrine, 0.01 mL/kg of body weight. Consider other causes if anaphylaxis is not present (Table I-5).

B. What are the vital signs? Tachycardia is a common finding in children and is most often due to hypoxia, fear, or a compensatory

TABLE I-5. CONDITIONS TO CONSIDER IN DIFFERENTIAL DIAGNOSIS

Aspiration of foreign body Asthma exacerbation Flushing syndromes Hereditary angioedema

Mastocytosis (high tryptase level when child is well) Panic attack Septic shock Vasovagal syncopea

" Lack of pruritus in presence of slow pulse rate and low BP distinguishes vasovagal reaction from anaphylaxis.

response to evolving hypotension. Hypotension is an ominous sign, although normal BP does not rule out anaphylaxis.

C. Is patient well oriented and able to communicate? Mental confusion suggests poor cerebral perfusion. Inability to speak, dysphonia, hoarseness, or stridor could indicate upper airway obstruction from laryngospasm or laryngeal edema.

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