Q: 23 year old female presented to ER with severe anaphylaxis reaction after eating shrimp. Airway seems compromised. As you prepare and proceed with intubation, you encounter severe vocal cord edema with no inlet visible. What should be your next step? 

 Answer: Administration of Epinephrine 

 The 2010 Joint Task Force anaphylaxis parameter update, the 2011 World Allergy Organization anaphylaxis guidelines. It recommends cardiopulmonary monitoring, administration of oxygen and placement of a a large-bore IV, resuscitation with isotonic crystalloid, placing the patient in a supine position with the legs elevated and Epinephrine injection. 

Special and prompt attention should be paid to Airway. If severe vocal cord edema is encounter, repeat administration of epinephrine usually reverses the edema. Dose is 0.1-0.5 mg SC q10-15min. If edema persists, difficult airy protocol should be initiated.