. Repeatedly examine oropharynx, watching for edema (may be subtle swelling of lip or tongue just on one side).
. If angioedema is suspected, immediately call for personnel experienced in intubation and airway management. Do not wait until airway obstruction occurs.
. Choose from the following medication options:
- Epinephrine 0.5 ml via nebulizer or 0.3 ml of 0.1% solution subcutaneously (may repeat 2x as tolerated).
- Diphenhydramine (Benadryl) 50mg IV followed by 25mg every 6 hours x 4 doses.
- Methylprednisolone (Solumedrol) 100mg IV; may follow with 20–80mg IV daily for 3–5 days depending on degree and course of angioedema.
- Famotidine 20mg IV followed by 20mg IV every 12 hours x 2 doses.
. If further increase in oropharyngeal angioedema is seen, or if there is airway compromise:
- If tongue is edematous, but oral intubation is possible, perform urgent orotracheal intubation.
- If tongue is too edematous for orotracheal intubation, perform fiberoptic nasotracheal intubation.
- If there is severe stridor or impending airway obstruction, perform tracheostomy or cricothyrotomy and consider reversing TPA.
Always resolves spontaneously within 24 hours without sequelae.
