Anaphylaxis in a patient boarding in the emergency department

Scenario overview A 5-year-old boy has been sent as a “direct admit” to the hospital. The pediatric unit was full and admitting doctor sent the patient to ED for evaluation and admission. The boy was initially seen by his PMD for cellulitis and the PMD sent the child for admission because of the extensiveness of the infection. Patient had a “bug bite” on the right calf, which has become infected. Most of the boy's lower extremity is red, swollen and tender and he has streaks running above the knee on his upper leg. You are the ED team and have just reached sign out at shift change when the nurse tells you about the patient. He has developed a rash with itching and is suddenly very short of breath and wheezing after getting a medication. She has tried to page the intern but has not had a response to the pages for about 5 minutes. She is asking you to evaluate the patient because the father is getting upset and was already angry that they have been forced to sit in the ED all night waiting for a bed.