In the ED, their vitals/exam are as above. IM epi (0.01mg/kg, max dose 0.5mg) in anterolateral thigh/IV H1 blocker/IV H2 blocker were given immediately, in addition to steroids, IV fluids, and pain medication. Given history, I doubt an active PNA or infection as patient afebrile. I doubt PE as patient without pleuritic CP, no LE signs of DVT including edema/unilateral swelling or calf pain. Also, low likelihood of PE by Well’s criteria. Doubt imminent airway compromise on exam today as patient without change in voice, without change in O2 saturation and without tachypnea, able to verbalize without complications. Given this, will plan for tele/airway watch x4-6 hours and intubation should patient acutely decompensate.
– Labs/Tests: None
– Imaging: None
– Treatments: See above, already given. IVF, antiemetics, albuterol as needed for symptoms. Epinephrine gtt if refractory symptoms. If continues to be refractory, consider glucagon 1-5mg (especially if on beta blockers), methylene blue 1-1.5mg/kg IV x1 (thought to be due to inhibition of NO-cGMP, avoid if G6PD or on other serotonergic agents), and ECMO
– Consults: None
– Dispo: Likely discharge with EpiPen/PO steroids after 4-6 hours of observation but pending clinical resolution