Tales of Anaphylaxis: Part III: How to spot it and The Worst Case Scenario
Sunday, September 7, 2008
Case 3: It's 9.55pm on a Sunday. The next closest hospital is twenty minutes away. In walks the last patients of the night; a couple.
He is stressed and sweaty, and talking very, very quickly. But he's fine.
She sits down. She is pale, sweaty, agitated, feeling a bit faint, short of breath and pregnant. Thirty three weeks pregnant. She's not fine.
About fifteen minutes earlier, they had been at dinner, having a wonderful time on a romantic getaway. It's all turned to custard pretty quickly. Before they left on holiday, she'd had a cold, and her doc had prescribed some antibiotics. She had taken the first dose with dinner. About fifteen minutes earlier. Within a minute or two of ingestion the lady (let's call her Sharon) had to bolt to the toilet with diarrhoea. Her initial complaint had been cramping abdo pain; the respiratory signs followed soon after.
I called the ambulance on the spot; this wasn't a case I was going to take lightly. The Ambos arrived within about eight minutes. In that time I dosed Sharon with some salbutamol and tried to extract as much of a history as possible.
When the ambos arrived, we arranged for a dose of antihistamine and they whisked her off to hospital.
The next day, Sharon's husband kindly returned to pay for the medication. I wasn't at work, but apparently Sharon had gone massively downhill on the way to hospital. Fortunately, the ambos managed the situation well and got her there in time. Both Mum and foetus were doing well.
Summary: For all of the cases in this series, diagnosis was based on several observations, including:
Timing - Anaphylaxis happens within 30 minutes of exposure. It's a fast reaction. Other allergies typically take a bit longer to manifest.
Presentation - the patients had several or all of the following signs:
Management - As in the cases above, the patient is best taken to hospital for care, especially for an initial attack. Dial 000 or 911 without delay! Adrenaline is the cornerstone of treatment; this should be given by a trained practitioner where available. Other treatments used in conjunction with adrenaline include bronchodilators, steroids and antihistamines. Some patients whom have known anaphylaxis may be supplied with an Epi-Pen; this should be used as soon as anaphylaxis is suspected, and an ambulance called.
Conclusion (in three sentences) -
For more information, have a look at Wiki's guff, or talk to a doctor or pharmacist in person.
Disclaimer: This website is provided for entertainment purposes. Anaphylaxis is a complex medical situation and this post has provided a brief overview only. If you think you have anaphylaxis right now, call an ambulance immediately.
He is stressed and sweaty, and talking very, very quickly. But he's fine.
She sits down. She is pale, sweaty, agitated, feeling a bit faint, short of breath and pregnant. Thirty three weeks pregnant. She's not fine.
About fifteen minutes earlier, they had been at dinner, having a wonderful time on a romantic getaway. It's all turned to custard pretty quickly. Before they left on holiday, she'd had a cold, and her doc had prescribed some antibiotics. She had taken the first dose with dinner. About fifteen minutes earlier. Within a minute or two of ingestion the lady (let's call her Sharon) had to bolt to the toilet with diarrhoea. Her initial complaint had been cramping abdo pain; the respiratory signs followed soon after.
I called the ambulance on the spot; this wasn't a case I was going to take lightly. The Ambos arrived within about eight minutes. In that time I dosed Sharon with some salbutamol and tried to extract as much of a history as possible.
When the ambos arrived, we arranged for a dose of antihistamine and they whisked her off to hospital.
The next day, Sharon's husband kindly returned to pay for the medication. I wasn't at work, but apparently Sharon had gone massively downhill on the way to hospital. Fortunately, the ambos managed the situation well and got her there in time. Both Mum and foetus were doing well.
Summary: For all of the cases in this series, diagnosis was based on several observations, including:
Timing - Anaphylaxis happens within 30 minutes of exposure. It's a fast reaction. Other allergies typically take a bit longer to manifest.
Presentation - the patients had several or all of the following signs:
- The hallmarks are a combination of urticaria, erythema, pruritus, or angioedema. Laryngeal oedema, bronchospasm, cough, sneeze, wheeze and nasal secretions are also likely.
- Patients may complain of a generalized warmth, tingling of lips and tongue, a lump in the throat, tightness in the chest or a feeling of impending doom.
- Gastro symptoms are quite common; diarrhoea, vomiting and particularly cramping abdominal pain.
Management - As in the cases above, the patient is best taken to hospital for care, especially for an initial attack. Dial 000 or 911 without delay! Adrenaline is the cornerstone of treatment; this should be given by a trained practitioner where available. Other treatments used in conjunction with adrenaline include bronchodilators, steroids and antihistamines. Some patients whom have known anaphylaxis may be supplied with an Epi-Pen; this should be used as soon as anaphylaxis is suspected, and an ambulance called.
Conclusion (in three sentences) -
- Anaphylaxis is a life-threatening, multi-system allergic reaction.
- Patients will present within 30 minutes of exposure with respiratory and/or gastro signs.
- As soon as anaphylaxis is suspected call an ambulance and use an Epi-Pen, if you've got one.
For more information, have a look at Wiki's guff, or talk to a doctor or pharmacist in person.
Disclaimer: This website is provided for entertainment purposes. Anaphylaxis is a complex medical situation and this post has provided a brief overview only. If you think you have anaphylaxis right now, call an ambulance immediately.
hi captain atopic,
im a pharmacist just about to start medical school and I have found your blogs interesting and highly entertaining! keep up the awesome posts! i especially like this one =)
Erros