A 45-year-old male with PMH of alcohol abuse and hypertension was admitted to emergency department (ED) with anaphylactic shock. He was working on his house when he was attacked by bees. He was stung twice and subsequently experienced generalized body hives and decrease in systolic blood pressure (SBP) to the 80s per the emergency medical system (EMS) responders. The patient denied shortness of breath (SOB), nausea or vomiting (N/V), or tongue swelling on admission. There was no prior exposure or allergic reaction. Diphenhydramine 25 mg IV and bolus IV fluids were given by EMS.
Physical Examination: Drowsy but following commands. VS: BP 100/50, HR 99, RR 18, SpO2 92% on RA. HEENT: bilateral swollen upper eyelids, no tongue swelling, posterior oral pharynx visualized. Chest: CTA (B), no respiratory distress, no crackles or wheezing. CVS: no murmurs, rubs or gallops, regular rate and…
