I would be very cautious in using adrenaline in this case in any form. The
worry, as if you didn't know, is extending the infarct. True analphylaxis is
probably quite rare from streptokinase, while allergy is relatively common.
Watching and waiting is probably the most reasonable course of action,
particulary since the case you describe sounds quite mild. If things do
start going pear shaped, would this be a case for intubation rather than
adrenaline? An uncomplicated RSI would probably be less adrenergic than
adrenaline. Persuading an anaesthetist to do this might be the complicated
bit. My feeling is that all these allergy symptoms will just vanish with a
little time.
Adrian Boyle
----- Original Message -----
From: "s.carley" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, August 24, 2002 6:43 PM
Subject: catecholamine dilemma
> 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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