A 34-year-old male complains of dizziness and feels like he is going to pass out. He tells you he just took naproxen for the first time for joint pain. You observe urticaria and angioedema. His vital signs are P 104, R 20, BP 78/58, and SpO2 is unobtainable. You should:

• A. administer oxygen and transport.
• B. administer an epinephrine autoinjector.
• C. assess for orthostatic hypotension.
• D. apply cold packs to the affected areas.

Answer: (B)

Anaphylaxis is a life-threatening allergic reaction that requires immediate epinephrine to reverse airway edema, vasodilation, and bronchospasm. In this patient, the combination of dizziness with near-syncope, urticaria, angioedema, and severe hypotension after taking naproxen points to anaphylaxis with shock. Epinephrine is the treatment of choice because it provides rapid alpha-adrenergic vasoconstriction to raise blood pressure and reduce mucosal edema, plus beta-adrenergic effects that improve airway patency and bronchodilation. Administering an epinephrine autoinjector promptly directly addresses the underlying danger and improves survival odds, making it the best immediate action. Oxygen and rapid transport are important supportive steps, but they do not treat the reaction itself. Cold packs won’t help, and assessing orthostatic changes doesn’t address the acute airway and circulatory compromise. After epinephrine, continue monitoring, provide oxygen if available, start IV fluids per protocol, and transport urgently.