Racemic epi in allergic reaction

[DFIB]

Dwayne: I will indulge as devil's advocate. (Sorry chbare)

When looking at a bp as a make or brake on diagnosis (don't defend yourself here... just being general) I think it is important to take it to the next level.

If systolic is a representation of LV output and Diastolic is a representation of vascular resistance, we can put this into better context.

Typically, a low systolic is a result of poor preload, or poor LV function.

Typically a low diastolic is representative of poor vascular tone.

So in this patient we see a slightly low systolic, and perhaps a lack of hypertension.

It can be argued that this could be a result of poor preload, as a direct result of hypovolemia caused by the tachypnea.

With the diastolic of 75 we could accept that her vascular tone is intact and working normally, which does not fit with the vasodilation caused by histamine in anaphylaxis..

In essence we could say that this patient has a narrowing pulse pressure that would indeed point toward decompensation. Is this a correct statement?

EDIT: Would we not think she is at least slightly vasoconstricted?

Edited July 26, 2012 by DFIB

[Kiwiology]

This little girl is not critically unwell with anaphylaxis but has a moderate systemic allergic reaction that will certainly not be getting better on its own. Without treatment it will continue to get worse and lead to a point where she is.critically unwell.

I think any hypovolaemia is relative rather than actual and is being caused by the vasodialatory effect of the mast cells releasing histamine.

Treatment in my book? fluid loading and a very conservative dose of IV adrenaline