Sunday, 21 December 2008

Puffy eyes

All night long we had been dealing with people with high temperatures and nothing much else. A quick assessment including obs and all were referred to the out of hours GP (OOH GP). We had just finished our break when right on time the station alerters went off. We checked the MDT to see what the job was, it was an allergic reaction. So many times we get to these jobs and find that some one just feels sick and nothing more. But this turned out to be the real thing. A few minutes later we arrived on scene to met by the patients mother who was grinning. 'Here we go again' I thought. On entering a small bedroom we were faced with a wriggling mass on the bed. Some where underneath was an 18 year old girl who was supposedly having an allergic reaction. Some swollen & puffy eyes popped up from the duvet. Eventually a whole head appeared and it soon became apparent that the young girl was genuinely suffering from an allergic response to something. We went through the usual checks like checking her tongue for swelling and listening to her chest etc. They were fine but both eyes were completely swollen and her top lip was about three times its normal size. Her face was flushed and she had urticaria (hives) all over her neck and arms. I checked her pulse and BP which were 100 bpm & 100/60 BP. She was a tiny thing in fact my eleven year old son was bigger than her so I wasn't overly worried by the BP reading however she was tachycardic. I asked of any known allergies, the answer was none. I also asked if she had started any new meds or had been in contact with any shellfish or dodgy plants, again the answer was no. The only thing they could think of that could have possibly caused the reaction was maybe an orange jelly that she had eaten earlier but without the proper testing we wouldn't know. I decided to administer some antihistamines to counter act the reaction. Everyone including our young patient were in good spirits but you could see she was uncomfortable with her symptoms. I had a look at her arms & hands for a vein, nothing! Great! I could have given it via IM injection but really wanted a line so the meds would act quicker and also in case her BP dropped suddenly enabling me to get fluids into her. I spotted a tiny one on her right hand so I tried to get a blue 22g cannula in, I got the flashback but it wouldn't advance. Out it came and into the sharps bin. Last try. I put the tourniquet on her right arm and waited patiently and within a short while a nice vein came up in her ACF. I opted for a pink 20g and got it in straight away, my crew mate then handed me 10mg of Chlorphenamine (Piriton) which I administered slowly.

'OK then let's get some shoes on and we'll pop you over to the hospital.'

Her boyfriend came with us and sat holding her hand on the way. I was busy doing more obs and filling in the paper work. The rash had now started to subside although her eyes were still really puffy and her top lip still swollen. I constantly checked to make sure her breathing was OK and that her tongue wasn't swelling. All was well until we pulled into the road leading to the hospital. Her boyfriend grabbed my arm and said that he thought she was struggling to breath. I asked her and sure enough her chest was getting tight and she was complaining of a feeling like there was a lump in her throat. I put her on some O2 and quickly administered 500mcg of adrenaline 1:1000 intramuscularly. I didn't have time to give any Hydrocortisone so I left that to the hospital. By the time we got into the dept her breathing was now easier.
Job done!

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