رجل عمره ٤٨ سنة بدأ ليسينوبريل للضغط قبل أسبوعين، وجاء للطوارئ وشفتاه ولسانه متورمة وصوته متغير ويشعر بضيق في الحلق. التنفس ٢٤، والتشبع ٩٤٪، والضغط ١٥٠/٩٠، بدون طفح جلدي. ما أول إجراء؟

A 48-year-old man started lisinopril two weeks ago and arrives with swollen lips and tongue, a changed voice and throat tightness. RR 24, SpO2 94%, BP 150/90, no rash. What is the first action?

1. Give the next lisinopril dose and apply cold packs
2. Give an oral antihistamine and reassess in an hour
3. Assess the airway and prepare advanced help, as he may need airway support
4. Reassure him that this swelling only happens in the first week

Answer: C) Assess the airway and prepare advanced help, as he may need airway support. ACE-inhibitor angioedema can occur at any time and can obstruct the airway; a voice change is a danger sign. Airway comes first, then the drug is stopped permanently. Antihistamines alone often fail because the mechanism is bradykinin-related.