45 year female presents 4 hours post central chest pain suggestive of
myocardial ischaemia.
12 lead ECG shows inf.lateral infarction.
P-70
BP-110/60
Decision is made to thrombolyse with streptokinase
Patient not given B blockers at any stage
10 min after start of thrombolysis
Complains of
1. tightening of throat
2. SOB
3. Tongue swelling
4. Hoarse voice.
Examination confirms
patient in distress and fearful
slight wheeze
hoarse voice
P-90
BP 105/60
RR up
No rash
Anaphylaxis suspected.
Strep is stopped.
Hydrocort (200) and chlorpheniramine (10) given
tPA was started in place of strep
There was a question of what to do next
1. Watch and wait
2. Adrenaline
a. IM
b. neb
c. IV
Any thoughts?
Simon
Simon Carley
SpR in Emergency Medicine
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Evidence based emergency medicine
http://www.bestbets.org
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