Samuel Smith is a 50-year-old male patient who presents in the emergency department with a temperature of 101°F (38.3°C)

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Samuel Smith is a 50-year-old male patient who presents in the
emergency department with a temperature of 101°F (38.3°C), a
productive cough, fatigue, and difficulty breathing. He has a
history of seasonal allergic rhinitis and mild asthma but no other
significant health history. He does not report any known medication
allergies. Initial orders include: • Chest radiography • Complete
blood count • Complete metabolic profile • Pulse oximetry • Sputum
for culture and sensitivity Mr. Smith's chest x-ray reveals
pneumonia. He is placed on IV penicillin. The nurse returns to
check on the patient and finds he is short of breath and extremely
anxious about his symptoms and states that his skin is "itching"
and he feels dizzy. Upon initial assessment, his pulse is rapid,
his lips are blue tinged, a rash is apparent on his chest and arms,
and wheezing is heard on auscultation of his lungs. The patient
expresses a sense of impending doom. Vital signs at this time are:
• Blood pressure – 85/50 mmHg • Heart rate – 130 bpm • Pulse
oximetry – 89% The nurse immediately discontinues the IV
penicillin. The IV tubing is changed, and normal saline is
initiated. Oxygen therapy is provided via a 100% high-flow
non-rebreather face mask. Oxygen saturation is monitored via pulse
oximetry, and ABGs are ordered. Arterial blood gases indicate
respiratory acidosis due to hypoventilation and retained carbon
dioxide as bronchial constriction increases with progressive
anaphylaxis. On auscultation, audible wheezing with decreased
breath sounds in the lower lobes is noted. Mr. Smith complains of
severe dyspnea and shortness of breath. Hoarseness is evident.
Itchy skin wheals or hives have spread over his body, forming
large, red blotches. Angioedema of his lips and mouth is visible.
Mr. Smith is placed on a cardiac monitor, which reveals a heart
rate of 130 bpm with occasional premature ventricular contractions
(PVCs). His BP is 85/50 mm Hg. His oxygen saturation improves to
90% after the initiation of oxygen. Epinephrine 0.5 mg and
diphenhydramine 50 mg are administered via IV push. Albuterol is
administered via nebulizer to relieve the bronchospasm. Emergency
equipment for endotracheal intubation and possible tracheotomy is
readied. Mr. Smith's condition begins to improve. His shortness of
breath lessens, and pulse oximetry indicates improved oxygenation
at 95%. Vital signs reveal: Blood pressure – 110/60 Heart rate – 90
1. What has happened to Mr. Smith? 2. Explain pathophysiology of
what has occurred, and the actions of the medications given
(epinephrine, diphenhydramine and albuterol).