> Anaphylaxis suspected.
Has at least two of the 4 features of anaphylaxis -
Wheezy yes, leaky maybe, itchy not mentioned, 'Feeling of impending doom'
yes.
BP no change, pulse and RR changes may just be related to feeling of
anxiety, but RR rise is an early indicator of hypovolaemia. Sao2 not
mentioned.
> Strep is stopped.
> Hydrocort (200) and chlorpheniramine (10) given
> tPA was started in place of strep
All very reasonable (lack of beta blocker use makes diagnosis and action
appear more simple)
> There was a question of what to do next
> 1. Watch and wait
> 2. Adrenaline
> a. IM
> b. neb
> c. IV
I would not give iv adrenaline unless there was imminent signs of cardiac
arrest (too much risk of dysrhythmia).
If there was hypoxia from the broncospasm, or I thought the airway was being
compromised, I would consider a neb as a holding measure, but if the
symptoms were more hypovolaemic then this would not be much use.
If this was a shelfish/peanut situation, and the symptoms were getting
progressively worse (even after removal of the allergen), I'd give early im
adrenaline
I've not given adranaline to an AMI with a normal rhythm before - I'd think
that would tip the risk/benefit ratio towards more watching and waiting.
However, any reduction in cardiac perfusion from hypovolaemia is going to
potentially extend the area of infarction and increase the risk of
dysrhythmia.
In this case, I think I'd be tempted to watch and wait for a bit longer
while I "Seek expert help" (quick mobile phone call to A&E consultant from
the scene/ambulance) .
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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