PBL 1

Trigger 1:
A 55 year old female called her family doctor complaining of pain in her shoulder. She was
administered 40mg diclofenac IM injection at 17:40. After 15 minutes of administration,
patient felt her throat beginning to swell, developed rashes, and felt dizzy and weak.
Emergency call is made at 18:00. Patient developed anaphylactic reaction to diclofenac IM
injection. She was collapsed and semi-conscious upon arrival of ambulance crew at 18:25.

Trigger 2:
On physical examination, airway was partially obstructed (laryngospasm). Breathing was
20/min, shallow with audible wheeze. Heart rate – 102/min, regular, and blood pressure was
80/55 mmHg. Obvious urticaria, cyanosis of lips and angioedema were observed.
Patient was placed on 100% O2. Epinephrine (1:1,000 solution) 0.5 mg IM injection was
administered. Salbutamol 5 mg/2.5 ml nebuliser was also commenced. Angioedema, urticaria,
peripheral cyanosis and laryngospasm were fully resolved after the second dose of
epinephrine 0.5mg IM injection. Further management was done according to the anaphylaxis
algorithm.

Learning Outcomes
At the end of this PBL session, students must be able to:
1. Discuss the types of hypersensitivity reactions.
2. Define anaphylactic shock and its causative agents.
3. Discuss the pathophysiology of anaphylactic shock.
4. Describe the clinical manifestations of anaphylactic shock.
5. Discuss the drugs used in anaphylactic shock.
6. Outline the management of anaphylactic shock.