Simon
it all hinges on the airway. Presumably this is taking
place in a good standard ED in the UK.
you haven't said whether there is visible rather than
simply reported tongue swelling though hoarse voice
noted. If this happened to me (or rather to a patient
of mine - Adrian) I would prepare for a difficult RSI,
prepare an adrenaline neb and observe carefully,
hoping to avoid both. If she progressed to clear
evidence of increasing airway compromise I would give
the adrenaline first. These intubations are not for
'fair weather' intubators like me, I would have an ITU
cons there also.
Ive never seen full anaphylaxis in 15 years of using
strep but I estimate over 40% have a significant
hypotensive reaction and in my view the drug should be
withdrawn and TPA/rPA/TNK used instead.
Steve Meek
Frenchay
--- "s.carley" <[log in to unmask]> wrote:
> 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
> [log in to unmask]
> Evidence based emergency medicine
> http://www.bestbets.org
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