🥺 Anaphylaxis patient 💥

Recorded in memory 🥺. Anaphylaxis patient. 💥

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A 32-year-old woman has done this operation once (in another clinic), has never been allergic to a drug before.

... the previous time I gave you the record that one needle hole had a red rash, but I thought I had an allergy, probably a skin allergy, and the marks healed.

... personally before the injection thought it was more about wound hygiene, so I suggested any cleanliness.

📌 before the operation, we talked about taking care of the wound again.

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There are two concurrently used drugs: PLLA, one brand, mixed with 2% Lidocaine without adrenaline 9: 1, including 20 ml (Lidocaine 2 ml) and 2% Lidocaine with adrenaline 2 ml as local anesthesia + infraorbital nerve block.

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So we do the operation, ml at 19-20, and then notice, there's a urticarial rash on the left elbow fold, just one point.

... asked the patient if, uh, the patient had hives.

... and the last CC in his hand is gone, turned to ask the brother who helped me if it's all gone.

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The case starts at 15: 00. The cause is expected to start around 15: 30-15: 40 (around 15: 30).

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The patient said it used to be, but it's been a long time.

We quickly asked if we had ever lost anything and what we had today.

... the patient said, allergic to raw shrimp, ripe shrimp, and eat simple noodles today, no shrimp.

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We were sure it was allergic. 💊

And at the same time, a rash from a single point starts to pop all over the body, starts to have eyebrows, and then all over the face.

... we began to think in ourselves, "This urticaria or anaphylaxis," while telling the younger to prepare 4 mg of Dexamethasone.

... while preparing, we ask the patient all the time, how to breathe, how to feel (but the eye also sees the patient holding his neck... at that time, in my heart, yes, < 1% is definitely right)

... Measure BP 85 / 58 mmHg 📉

... We quickly tell you to prepare Adrenaline and Chlorpheniramine (deduct amp, draw yourself)

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Butterfly in hand is ready first. Let Dexamethasone go to the right arm because the drug is ready first. While waiting for Adrenaline and IV.

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In my heart, the hoarse patient admitted that in my head I thought a lot about what to do if I couldn't fix the upper airway, even though I don't have a stridor yet.

(Hoarseness indicates swelling of the vocal cords, which, if swollen, the patient cannot breathe and can be life-threatening)

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With an emergency doctor for over 10 years, 🚑

• Adrenaline (1: 1000) 0.5 mg IM anterior thigh

• 0.9% NaCl 1000 ml IV free flow (open by yourself, because the nurse who is usually with can't come today)

• Chlorpheniramine 10 mg IV

• Dexamethasone for a total of 8 mg

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And told the owner to call an ambulance

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Patients say they're better at breathing, but we're not comfortable with the hoarseness.

... order Repeat BP and run out to coordinate the ambulance.

... usually the clinic has a private ambulance to put the number on it, so he called first and sent it to talk.

... 2 The company says I'm a Basic - > No, I don't need an Advance car.

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Call 1669. < < (The owner called) 📞 > > > Wait 2 minutes.

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In the meantime, I don't know what I'm thinking. Call Paramedics, honey.

... Do you know who is today?

Nong replied: Master, I'm at the command center.

🙋🏻‍♀️ J: Do you need a dispatch to call again, or do you accept it?

... you asked, the commander said. Take it.

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Hurry up and report the case. Interlock the landing site.

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BP at the time 16: 08 90 / 55 MAP > 65, and then we got a little humid, but we were still watching the patient, observing the sound of breathing, and preparing that Adrenaline might be repeated.

(The patient confirmed it was better. The rash looked collapsed.)

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16: 20 Tell him to take the BP meter and measure it again while waiting for the car.

... and the car called, ran out to the clinic itself. 🏃‍♀️

... the team put the motorlance in before the van arrived.

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The team came in exactly 16: 25. Saw that BP went back to drop another 85 / 51 mmHg.

So I told Para that if you don't get in the car, you'll have to give me another adrenaline and get in the car.

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Between them, the BP hospital isn't really up yet.

... so we got on the ambulance to adrenaline the patient another 0.5 mg and the car went out. 💨

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Meanwhile, the clinic was cleared, thanks to the owner, who canceled every case after that, and the husband picked us up and him to the hospital together.

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The concern in my heart is, "What we give, he loses, the likelihood is that 1.PLLA is anesthetic, but the heart wants to be more anesthetic, with a greater incidence, and should degrade more quickly."

... because everything has already entered the patient's skin. Can't be removed.

... allergen will also trigger further allergies. This is why adrenaline must be given round 2 too (bad heart at all). 💔

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To the ER hospital (which we used to take on duty), good luck 2 is the elder who took the case for the same EP, studied in Khon Kaen, and we know each other best.

... He turned and said, "Well, who is managing Mawa, why is it so cruel... Oh, my brother, why is it so bad?"

... we're like OMG from bad heart, a lot more comfortable. 🙏

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The other person on duty came to help comfort (comfort the doctor, not the patient)

... You're so awesome. A case like this. What would someone else do?

It's a patient's luck to see an ER doctor.

... fully managed the equivalent of a hospital.

This case is very dignified, ER doctor. This is Anaphylactic shock.

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J: A lot of heart. (Talk to the patient. The patient smiles. Looks very understandable.)

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Thank you for taking the case for the patient until the time of duty and reporting that it has begun to resolve.

🍊 Because really, ER doctors look at each other, not just afraid of the initial management.

🍊 worry about when the allergic to degrade, can it be an anesthetic or a preservative of an anesthetic?

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The pharmacists who came to evaluate it had to actually write two allergies, both Lidocaine (prepared for branding and preservative) and PLLA, which, according to the history, could not really be separated.

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The patient and we talked about what happened, and told the patient, "The doctor thinks more about it is an anesthetic, because from the previous history, there was a rash that only came up, the hole was open, maybe it stimulated the local anesthesia, and this is the second time, the landscape is ready, but because of the severe allergies, it is recommended not to inject both."

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Strengthen the 📚

1.Anaphylaxis does not need to be born when first taking that substance. The second time, more severe allergies are possible. According to the mechanism of immunology.

2. It is impossible to predict who will happen and what will cause it many times.

3.Local anesthetic anesthesia can be allergic, but in general anesthesia has amide type with ester type (used to be read as a resident ER). Normal amide type rarely causes allergic reactions, but however, preservative in the drug can cause it, and can choose to use other ones, such as switching groups from amide - > ester and choosing no preservative.

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📝 This case is exactly the book. 📚

... the patient touches an allergenic substance within minutes to hours and a BP drop (which the patient has everything).

... has a history of exposure to this substance and may even trigger allergies. It may not be the wound hygiene we think about, but the local reaction (Parsimony - if it is the language of Decision Making... is to combine all scattered reasons to explain with assumptions and minimal variables, because it should not be diagnosed that way, this way, for example, the previous infection was lost, this time lost, just lost, started again, not at all.)

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The last 👩🏻‍⚕️ that ER doctors want to leave for other Aesthetic doctors who don't use ER ⚠️

1. Regularly check emergency medicine

2. Anaphylaxis can happen, and if managed in danger (the ER level still screams because we don't have a tube in the clinic, and the last time we met like this, a very large male patient, we put a tube at no.6).

3. Don't keep blaming it for us if it's time to admit that one in a hundred thousand is in our hands. 🥹

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And finally wanting to ginger is ✨ thanks to his own merit points and the patients who met.

... the clinic has all the medicine, not far from a good hospital.

... We choose to press the phone to find the right person.

... meet the brothers and sisters who make it a lot more comfortable.

... The case is really very prestigious for ER doctors like us, but I would like to take an ER break first. I only accept teaching. I call teaching often. I don't have to do it often. I understand. Above, thank you. 🙏

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# Doctor Cicada tells a story # Doctor Er # Drug allergies # Severe allergies # Anaphylaxis# anaphylacticshock