Anaphylaxis

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Epinephrine 1:1000


I was having a good day, its been a relatively chill shift.  I couldn’t have asked for better, I’ve got great partners, we’re having a good time together, and it was a beautiful day.  We got about an hour and a half left of our shift before home time.  We were going routine to a residential area when dispatch suddenly tells us to turn around.

Dispatch:  “99Alpha.  Take instead, 123 Sunny Hill Complex, code 3 for an allergic reaction, 10-Delta-2 under 323346.  98Alpha1.”

Partner:  “10-4.”

The lights flicker on, and the sirens yelp out in urgency as we make a U-turn heading back the way we came.  Hmmmm allergic reaction, a delta call.  I wonder if this one would be the real meal deal or just a local allergic reaction.

In my head, I wasn’t really expecting a full anaphylaxis, partly because it’s rare and partly because I’ve heard many paramedics having only done one or two anaphylaxis calls in their 20 year career, if at all.  As for me?  Well I guess you can say I’m still in my diapers.

Security was waving us down when we got to the site.  The patient was a ways away as they lead us into the building.  We strolled along with a quick stride to our gait as I cracked a couple of jokes with my preceptor.  When we get to our patient, Fire was already on site, they had a worried look on their face (which is usually not a good sign).  I can see our patient sitting on the floor with a face mask on, but more importantly I noticed that he’s blossoming with hives.  Hives were all over his face, and arms, he didn’t look good at all.  So this is the real deal!

Me:  “Hello!”

I greeted Fire with a smile, trying to lighten the atmosphere.

Fire:  “Hi, this is John Doe, 21 year old male, having an allergic reaction with difficulty breathing…”

Me:  “Okay…Hi John, have you had this allergic reaction before?”

JD:  “Yeah…2 days ago…they gave me benadryl and epinephrine…and took me to the hospital.”

Two days ago!?  I was not expecting that.

Me:  “Do you know what you’re allergic to?”

JD:  “No idea…it just started all of a sudden…”

I lifted up his T-shirt.

Me:  “Are you having trouble breathing?”

Hives were all over his chest and back as well.  I’ve never seen so much hives in my life.

JD:  “Yeah…my throat is really tight…”

Ohhhh this is not good.

My partner quickly started getting a set of vitals as I grabbed the box of medicine from our jump kit.

Me:  “Do you have an epi pen?”

JD:  “No, I wasn’t given one.”

I flipped open the medical kit and took out the alcohol wipes.  I wiped my patient’s arm.

Me:  “Just going to give you some medications.”

I looked back and could see Fire breaking down our cot.  I then turned looking for the vial of epi.  Ahh there it is!  The clear one!  I take it out, reading the label, making sure it was the right drug.  It read:  Epinephrine 1:1000.  Perfect.  Wait!  How much do I give again?  My mind drew a blank.  Not the right time for a brain fart!  I then grabbed a syringe and ripped the plastic open.  I could feel my adrenaline going.  Crap!  How much do I give?  Stupid adrenaline was blocking my brain from thinking properly.  Okay calm down and think!  I can see my preceptor beside me opening the packages of Benadryl.  I looked at the syringe I opened and realized it was the wrong one, I had opened the 10cc syringe with the plastic end, there’s no way I can jam that through his skin.  I picked up the 1cc package and rip that open.  Common!  Calm down you silly goose.

Preceptor:  “So what are you going to give him?”

I replied in a calm voice:  “Epinephrine.”

Preceptor:  “How much?”

I knew he was gonna ask me that question!  It’s not the time to look like an idiot!  I looked at my 1cc syringe and the number 3 jumped out at me.  Without missing a beat:

Me:  “0.30mg.”

Phew!  That was close.  I knew my protocols backwards and forwards, but in the heat of the moment I almost forgot my dosages.  That’s not cool, not cool at all.

Preceptor:  “Good.”

I held up the vial and drew the drug, flicked the syringe just like they do in the movies to get the bubbles to the top and squirted out the excess drug out.  I can feel the eyes of the crowd that had gathered, along with Fire, on me.  Heh no pressure right?  Looks like we’re putting on a nice show for them.  I showed my preceptor that 0.30mg of epi was in the syringe.  He nods his approval as he continued popping benadryl into my patient’s mouth for a total of 50mg.  Pinching my patient’s shoulder I pushed the needle in, pulled back seeing no flash and delivering the medication.  I gave his shoulder a nice rub with the alcohol wipe to get the circulation going.  Vitals, epinephrine, benadryl, that was all done within a minute.  I tossed the medications back into the kit and cleaned up my garbage.

Me:  “You think you can stand up without feeling too dizzy?”

JD:  “Yeah I think so…”

Me:  “I just need you to sit on the stretcher here.”

Within another minute, we were ready to roll.  We took about 10 steps when we met ALS.  We briefed them on our patient’s status as we continued out to our ambulance.  Fire had left earlier when we thanked them and said they were good to go.  As we rolled past them on our way to our ambulance, I noticed a firefighter posing and taking photos with a lady in front of their fire truck.  I couldn’t help but smirk as their fire captain shook his head with a grin.

We all clambered into the back of our ambulance as ALS asked my preceptor if they needed me.  My preceptor looks at me.

Preceptor:  “It’s up to her.”

I look at my patient and back at ALS.

Me:  “I think I’ll be okay.”

ALS:  “I think so too.”

With that they hopped out.  John Doe had massive lovely veins, I attempted two lines, but it’s always the massive juicy veins that elude me.  I decided to get rolling and do an intravenous on him at the hospital, his pressure’s doing okay at the moment and the hospital wasn’t too far away.

Just as we were pulling into the hospital, I re-checked his hives, to my amazement, my patient’s hives had gone down significantly.  There were still some hives on his face and arms, but the ones on his chest and back were gone, leaving only flushed skin.  I asked how his throat feels and he says it’s fine now.  Amazing.

At the hospital, I placed an 18g catheter into his hand and started an IV line and went to the counter to finish my paperwork.  I had nothing written down except for the times when we had given benadryl and epinephrine.  It was then that I noticed myself sweating and felt my face hot and flushed…damn, what a call.  As I’m filling out my patient care report, my preceptor’s partner walks by and gives me a pat on the shoulder.

Partner:  “Good job, that was a good call.”

I looked at him, thinking I must be hearing incorrectly.

Me:  “Uhh…thanks…”

It didn’t feel like all that great of a call, I almost forgot my drug dosages (thank goodness he couldn’t hear what was going on through my head), and I missed two starts…but then I looked at John Doe and saw him smiling and talking to his girlfriend…hmmmm… maybe it was a good call.

Before I left the ER, I checked on John Doe again.  Looking at him now, you would have never have guessed that 15 minutes earlier, he was in anaphylaxis.  All his hives had gone down now, he’s still a little flushed, but other than that, he looked like any other normal person on the street.  Amazing, just amazing.

It was the first time I’ve seen such a drastic improvement in a patient directly from the actions and treatments we had done on scene.  Needless to say, I left the hospital with a big smile on my face.  

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Comments
9 Responses to “Anaphylaxis”
  1. K says:

    Awesomeee!!! So glad you got to make such a huge difference for someone. I haven’t seen anyone with anaphylaxis yet but 3 years later I still remember DH’s little jingle “Epi, beny, go, IV vitals bo.” 🙂

  2. Drew says:

    Wait until you get a good hypoglycemic call and see a patient going from unconscious and being BVMed with an OPA in to completely alert and denying transport after a single bolus of D50.

  3. Brad says:

    I enjoyed reading this. John Doe needs an epi prescription. 🙂

  4. Evelyn says:

    I had an almost fatal anaphylaxis attack 32 months back and almost died from it. Allow me to share my story with you:

    http://therighttobealive.blogspot.com/2011/09/day-i-met-death.html

  5. Mirjam says:

    Interestingly enough did I experience anaphylaxis first hand when my friend got stung by a wasp. She is highly allergic and always carries an epi pen. I am not a paramedic (just a wannabe ;)).
    I dialed 911 and stayed with her whilst on phone with dispatch. She had trouble breathing immediately and got flustered in her face. Another neighbour and friend rushed to get her epi pen which she managed to administer to herself before collapsing and convulsing on the ground. It was an interesting sight to see to say the least. She couldn’t speak anymore, but knowing she had the epinephrine in her and paramedics on the way I was surprisingly calm.
    Paramedics arrive, I hang up with dispatch and answer a bunch of questions whilst they quickly check her out, get her on a cot and in the ambulance we go. She had to be monitored at the hospital for the next 3 hours and was discharged after that.
    I have received many comments on how calm I was in the situation. I actually was mesmerized by all the buttons in the front of the ambulance as I got to sit there whilst en route to the hospital. ‘Oooooh, what does this button do???’ I didn’t ask any questions about the paramedic job as it wasn’t the place and the time, but boy did I want to!
    Because she had her epi pen administered so fast and the paramedics showing up in 5 minutes and giving her Benadryl and monitoring her breathing and swelling it all went smooth from my perspective. Yes, a bit scary as she definitely could have stopped breathing (which has happened to her before after being stung earlier this summer), but a very interesting event to be part of.

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