ANGIOEDEMA

Question 1

DDX

Answer 1

Allergic (Histamine Mediated) Angioedema
Non-allergic (Bradykinin Mediated) Angioedema
Anaphylaxis
Trauma / Hematoma
Foreign Body
Peritonsilar Abscess
Retropharyngeal Abscess
Epiglotitis
Superior Vena Cava Syndrome

Question 2

MANAGEMENT

Answer 2

HISTAMINE MEDIATED
IM (0.5 mg) or IV epinephrine (5-15 mcg/min infusion)
IV methylprednisolone 125 mg IV
Diphenhydramine 50 mg IV or Citirizine 10 mg IV
Famotidine 20 mg IV

BRADYKININ MEDIATED
1 g TXA IV
ACEi induced: FFP 2 U
Non ACEi induced: C1-inhibitor concentrate

Question 3

DOCUMENTATION

Answer 3

ALLERGIC MEDIATED
Allergic Trigger
Rapid onset
Diffused Distribution
Associated with Urticaria, pruritis
May involve anaphylaxis
Responds to epinephrine, antihistamine, steroid

NON-ALLERGIC MEDIATED
ACEi / ARB common
Sometimes trauma
Slower onset
Focal / asymmetric Distribution
NO Urticaria, flushing
No anaphylaxis
No Response to epinephrine, antihistamine, steroid