Lip swelling
Tachypnoea
Tachycardia (marked)
Potential +/- actual A+B+C compromise of likely allergic aetiology (as the paramedic may have seen it)
Most deaths from anaphylaxis occur pre-hospital and in 30 minutes of the onset of symptoms don't they?
I would have congratulated the paramedics for giving adrenaline in this case.
If the patient had decompensated in the time in took to get her to hospital would they have been criticised for NOT giving adrenaline? Probably. Are you 100% SURE that adrenaline didn't save the patient's life?
It's worth bearing in mind the criticism we get in emergency medicine from our colleagues in other specialties when they use the retrospectoscope to conclude we were barking too aggressively up the right tree. We don't like it, and then we find ourselves doing the same thing to paramedics. It's hard to get it right all the time in pre-hospital care and often you're 'damned if you do, damned if you don't'. In ?anaphylaxis, I'd go for sensitivity over specificity everytime, and avoid discouraging paramedics from administering potentially life-saving treatments.
I anticipate arguments about on scene time and side effects of adrenaline, but I'd still support their action.
I also wouldn't have discharged her from the ED, particularly as the adrenaline may have modified her ED presentation, and wonder what the rationale was for IM chlorpheniramine (as opposed to PO or IV).
Cliff
Patient has "urticaria all over" and some swelling of the lips. Pulse 133,
> BP 157/83, RR 25, GCS 15, Sa O2 not recorded. Treatment is Adrenaline
> 1:1000 0.5ml IM. Arrives at hospital 15 mins after injection and 28
> minutes after ambulance arriving on scene. Travelling time 11 minutes. She
> was discharged home after 1 hour having had IM Chlorpheniramine here.
> Would any of us have used adrenaline?
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