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“EMS
6, allergic reaction, at 123 Main Street.”
At 7:40 Christmas night, my partner and I flip on
the lights and sirens and race our ambulance toward 123 Main Street. En route,
my partner reads off details of our dispatched call on our dashboard laptop.
“Twenty-year-old female. Respiratory arrest.”
I grab the radio. “This is EMS 6, requesting assistance on our anaphylaxis call. Copy?”
“Twenty-year-old female. Respiratory arrest.”
I grab the radio. “This is EMS 6, requesting assistance on our anaphylaxis call. Copy?”
“Copy EMS 6. FD 14 is en route.”
Once we roll up on scene, several people wave us
into the two-story home, their faces contorted in panic. As we hear sirens from
an approaching fire truck, we rush our loaded stretcher inside the front door
and toward the young lifeless body lying on the tiled kitchen floor, cyanosis
around her lips.
I notice our patient’s chest is motionless, and I
don’t feel or hear any air moving out of her mouth or nose.
“What is her name?” I ask no one in particular in the crowd of about a dozen surrounding us.
“What is her name?” I ask no one in particular in the crowd of about a dozen surrounding us.
“Ally,” several voices answer.
“Ally?” I rub my knuckles over her sternum.
“Unresponsive,” I inform my partner, who’s yanking out a BVM (bag-valve mask), other airway equipment, and the med box.
“Ally?” I rub my knuckles over her sternum.
“Unresponsive,” I inform my partner, who’s yanking out a BVM (bag-valve mask), other airway equipment, and the med box.
I feel for a carotid pulse on her flushed neck. “Rapid
and weak,” I say to my partner. We share a look of understanding—our patient is
headed for cardiac arrest. Our interventions must be quick and efficient.
“What happened here?” I again ask the room full of people as I press the mask over my patient’s mouth and nose with my left hand in the E/C formation. With my right, I squeeze the football-sized bag every five seconds to oxygenate the young woman’s system. Her chest rises and falls with every squeeze, indicating her airway isn’t blocked by swelling or any foreign object.
“What happened here?” I again ask the room full of people as I press the mask over my patient’s mouth and nose with my left hand in the E/C formation. With my right, I squeeze the football-sized bag every five seconds to oxygenate the young woman’s system. Her chest rises and falls with every squeeze, indicating her airway isn’t blocked by swelling or any foreign object.
“She was eating and started coughing, and said her
chest is all tight,” a hysterical woman answered, suddenly kneeling next to me.
“She was itchy all over, had trouble breathing, hives on her back.”
I face the middle-aged woman, tears flowing out of her eyes and down her cheeks. “Are you her mother?”
I face the middle-aged woman, tears flowing out of her eyes and down her cheeks. “Are you her mother?”
“Yes. She was severely allergic to peanuts when she
was little but out grew it or whatever.”
As I continue bagging, my partner pushes epinephrine
IM (intermuscular) then inserts an IV into our patient’s left arm for med access
and fluid replacement. A fire crew of four men darts into the house.
Without an exchange of words, I hand one of the firefighters the BVM, and two of them take over bagging. One presses a tight seal over the mouth and nose, the other squeezes the bag.
Without an exchange of words, I hand one of the firefighters the BVM, and two of them take over bagging. One presses a tight seal over the mouth and nose, the other squeezes the bag.
“Hand me our monitor,” I ask the firefighter closest
to our cardiac monitor. He and the fourth guy assist me in hooking up a twelve
led ECG to our patient’s four limbs and chest.
I study the monitor for our patient’s vital signs, looking for indications of imminent anaphylactic shock and cardiac arrest. “BP 80/52. Pulse 134. SPO2 86%. Normal sinus heart rhythm.”
“Uh-huh,” my partner says, letting me know he heard my report of the grave vital signs.
I study the monitor for our patient’s vital signs, looking for indications of imminent anaphylactic shock and cardiac arrest. “BP 80/52. Pulse 134. SPO2 86%. Normal sinus heart rhythm.”
“Uh-huh,” my partner says, letting me know he heard my report of the grave vital signs.
I hand him diphenhydramine and methylprednisolone to
administer into the IV line.
“Does Ally have any medical conditions or take any
medications for anything?” I ask the mother.
“No. Nothing.”
We add Benadryl to the line then attach a little bag of Pepcid to the IV set up. Following up with those meds, we add Solu-medrol.
We add Benadryl to the line then attach a little bag of Pepcid to the IV set up. Following up with those meds, we add Solu-medrol.
In scanning the kitchen, I spot several whole pies
ready to be served, remnants of T-Bone steaks and empty lobster tails on multiple
dirty plates. “Did she eat any nuts tonight?” I ask the mother to keep her
occupied.
“Nothing any of us ate tonight contains nuts.” The
mother points over her shoulder. “We haven’t eaten any pie yet, but none of
them has nuts.”
“Has she ever eaten lobster before tonight?” I ask
while digging into our airway bag.
“Once. Couple of months ago and loved it.”
“It was probably the lobster. The second encounter
with an allergen is when an allergic reaction occurs.” I turn to my partner. “Let’s
intubate.”
“Uh-huh.”
I’m readying the intubation equipment when Ally jerks
to a conscious state, coughing and rolling on to her side, shoving the mask
away from her face.
“Guess she didn’t want to be intubated,” one firefighter
whispers near my ear, not out of humor but relief, a feeling I share.
“Ally? Hi.” I grab a non-rebreather mask. “You
suffered a severe allergic reaction. You need oxygen.”
She nods, rolling to lie on her back again. Her
mother squeezes her hand, pats her forearm.
“Bummer, I know, but we gotta take you to the
hospital to be monitored overnight.” After turning the portable O2 tank on to
15 liters per minute, I strap the non-rebreather to Ally’s face. “Just breathe
normally and relax. You’re doing fine. We’ve got you, Ally.” I smile at her.
The firefighters lift her weak body onto our
stretcher; I study the monitor. “BP 96/60. Pulse 118. SPO2 92%,” I say to my
partner.
“That’s what I want to hear,” he responds in a
relief matching my wide smile.
You can read more posts done on allergic reactions/anaphylaxis here, here, and here.
You can read more posts done on allergic reactions/anaphylaxis here, here, and here.
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Dianna T. Benson is the award-winning and international
bestselling author of The Hidden Son and Final Trimester. Persephone’s Fugitive
is her third release. An EMT and a HazMat and FEMA Operative since 2005, Dianna
authentically implements her medical and rescue experience and knowledge into
all her suspense novels. She lives in North Carolina with her husband and their
three children. www.diannatbenson.com
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