Allergic Reaction: Dianna Benson

I always love it when friend and author Dianna Benson stops by! Dianna is a talented writer and has two treats for you today-- a new novel, Persephone's Fugitive, is releasing. I was blessed to have the opportunity to read and endorse this novel. Two, she is giving a factually based fictional account of an EMS call dealing with a severe allergic reaction called anaphylaxis.

Welcome back, Dianna!

“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?”

“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.

“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.

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.

“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?”    

“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.
   

“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 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.

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.

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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

Author Question: Facial Disfigurement

Dianna Asks:

I have some ideas of my own plus other medical professionals’ input but would also like yours – what would you suggest for this:

My character has some sort of facial….disfigurement is too strong a word, but what facial features could’ve been damaged via trauma two years ago enough to change a 16-year-old’s appearance (so now she’s 18-years-old)? What ideas come to mind for you?   

Jordyn Says:

I heard a talk once on facial disfigurement and the surgeon stated that we basically identify people via a small triangle of their eyes, nose and cheeks. Even though it may not be overtly obvious, even the slightest offset to the eyes will put people off. So, maybe she was in a car accident that caused this kind of disfigurement and she mostly looks all right but just slightly off and people sense that but don't say anything. And yet, she knows they are distant for this reason.

From a pediatric perspective, there is always cleft/lip palate repair as well that generally leaves scarring as well.

Hope this helps and good luck with your novel!

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Dianna Torscher Benson is a 2014 Selah Award Winner, a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. She’s the author of The Hidden Son, her debut novel. Final Trimester is her second release. After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Dianna lives in North Carolina with her husband and their three children. You can connect with Dianna via her website.

   

          

Fall Call: Dianna Benson, EMT

I love these posts from author and EMS expert Dianna Benson where she weaves medical detail into a fictional piece. 

Welcome back, Dianna!

I shake my head to full awake from my cat-nap, and gear up for the trauma call less than a minute drive away. Once my partner and I roll on scene, I note the three cop cars arriving.

Additional information regarding the call flashes across our ambulance laptop screen.

Proceed with caution. Law enforcement dispatched.

“What’s the deal?” my partner yells out the driver window at a cop rushing toward the building.

“Another worker pushed the guy.”

“Ah,” I say with a nod. “Attempted homicide.”

“Or homicide, but if the guy’s not already dead, he’s gonna need us.” My partner jumps out of our ambulance.

We grab a C-collar (cervical collar) and a backboard, and toss it onto our stretcher already loaded with EMS equipment and supplies.

“Remember caution?” I remind my partner.

“Yeah, yeah. Guy was pushed not shot or stabbed. Let’s go.”

I really didn’t want to hang back either. Our patient’s life may be over if we wait.

Inside the building, we push through a crowd of gawkers. I notice three cops drawing their guns at a man choke-holding some young woman, her wide eyes glossed-over.

“Let her go,” the cop at the left yells out. “Now.”

I’m hoping the guy follows the demand or we’ll have more than one patient. As I rest my hand on my radio in case I need to request additional EMS crews, I scan the area for an injured man on the ground. I spot our patient on the other side lying supine and lifeless in a pool of blood on the cement, his attacker in the middle and blocking us from our patient. I glance up and see the catwalk and assume our patient was pushed off of the suspended walkway about twenty feet above.  

The guy fell twenty feet? I think to myself.  If he’s alive over there, he’s in critical condition.

“Clear out,” the cop to the right shouts. “Everyone. Out of this room. Now.”

The crowd scampers away. My partner and I hold our position behind the cops. The perpetrator doesn’t have a weapon, so there’s no danger to us.

After a few drawn-out minutes of the cops warning the perp to let the woman go, and our patient remaining lifeless and out of my reach on the ground in the near distance, I somehow dig up my most gentle tone and interject, “Sir, I don’t think you want to hurt her. Do you?”

The perp jerks his head in my direction. Ten seconds tick by with him just staring at me as if pleading me to help him out of this. “Ah…no. No, not really.”

“I didn’t think so. How about letting her go and we’ll talk?” Stop blocking me from my patient. If he’s not already dead, he needs me now. Needed me minutes ago.

 “Talk? Yeah, yeah,” he nods, “I just need to talk.” Chest panting, arms shaking, the perpetrator shoves the woman aside and drops on the ground. All three cops pounce on him and drag his arms behind his back.

I roll the front of the stretcher around the chaos on the ground; my partner pushes from the back. As I pass the perp, I ignore his insistent yells to talk with me since my focus is on my patient.

“Sir?” I say to the lifeless man as we approach him.

No answer. No movement of any kind.

I slide my fingers to his neck and find a thready carotid pulse. His chest is rising and falling in steady rhythm bi-laterally.

My partner holds his head in an in-line spinal stabilization position as I strap the C-collar around his neck. I slip a towel underneath his head for hemorrhage control and feel for trauma. I find an open skull wound, crepitus bone, and flesh.

Two firefighters appear at our side and assist me with log rolling the unconscious patient onto a spine board and strapping his body down. I secure the man’s c-collared head to the backboard with head blocks, straps and tape, allowing my partner to finally release the manual c-spine stabilization.  

“What do you need from me?” some guy asks. “I’m his supervisor.”

“How old is he?”

The manger answers that pertinent question as well as all my others, as I connect my patient to our cardiac monitor. Less than a minute later, I’ve assessed all vital signs and the heart rhythm, as my partner performs a rapid trauma examination. Our patient remains unconscious. I’m thinking internal bleeding is the main cause and he’s headed to hypovolemic shock, and if that’s the case, surgical interventions are vital. No more time to waste on scene.

“Femur fracture,” my partner says.

“Among other things,” I say. “Let’s go.”

All of us lift the backboarded man onto the stretcher, and roll it out to my ambulance.

As one of the firefighters drive, my partner and I attend to our trauma patient in the back with the assistance of another firefighter. Our patient remains unconscious. In order to protect his airway, I slide a lubricated oropharyngeal airway down his throat. With a curved laryngoscope, I lift the epiglottis and gain a visual of the glottic opening and white vocal cords. I drop the orotrachael tube between the cords, down the trachea. I connect a bag valve mask over the tube opening. To keep him oxygenated, I squeeze the football-size bulb every five seconds.  

“Take over bagging,” I say to the firefighter, and he grabs the bag valve mask from my hands.  

I spike an IV bag as my partner slides in an eighteen-gauge IV needle into our patients left arm. Since the patient is unconscious, there’s no point to administer pain meds.

I grab the radio mic. “Wake Med ED, this is EMS 16.”

“Go ahead EMS 16.”

“We are en route with a thirty-three year old male. Trauma patient. Twenty-foot plus fall onto concrete. Unconscious. Intubated. Open head trauma posterior. Fractured femur.  Normal sinus cardiac rhythm. BP 95/52 and falling. 182 heart rate. ETA 5 minutes.

Even if this man’s body survives, his brain will probably never be the same. I swallow the sadness clogging my throat, hoping he doesn’t have any children, and I re-focus on finishing my job on this trauma call.

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Dianna T. Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book, The Hidden Son, released in print world-wide March 1, 2013. 

After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. Dianna lives in North Carolina with her husband and their three athletic children. Learn more about Dianna at www.diannatbenson.com.

Motor Vehicle Collision: Dianna Benson, EMT

I love this post by Dianna Benson, EMT written in first person about the treatment of a patient involved in a MVC. A lot of information presented in such an interesting way.

Dianna's debut novel, The Hidden Son, released in March.

Welcome back, Dianna!

EMS #16 and #22 MVC at Park Avenue and Green Street.

I toss the rest of my sandwich into a trashcan, and rush out of the fast food joint toward my ambulance, my partner behind me.

Less than five minutes later, we roll up on scene behind an arriving ladder fire truck. I slip mybright orange reflector EMS vest over my head and lurch toward two cars mangled together in a huge intersection, their hoods now one. The EMS #22 crew heads to the one patient in one car, so my partner and I bolt for the two patients in the other.

A civilian is leaning inside the driver’s door.

“Sir?” I say, approaching.

He looks at us, eyes wide, face pale. “Glad you’re here. I’m a doctor, an urologist, but I see patients in my office. I don’t deal with emergency—”

“It’s okay. We got it.”

Blowing out a sigh, he backs away.    

Unconscious, the driver’s face is buried in the deployed air bag, arms dangled around it in a laxhug.

“Sir?” I feel his pulse. It’s thready and rapid. Blueness surrounds his mouth and colors his lips, his chest not rising and falling. “Respiratory arrest,” I say to my partner who’s assessing the unconscious passenger, the lifeless patient’s head caught in the shattered door window.

Frowning, my partner shakes his head. “Cardiac arrest over here. Facial skin ripped away. Neck twisted 180 degrees and split open. Bled out.”

Code for: We can’t do a thing for her.

My partner rushes our equipment-loaded stretcher around the trunk to the driver door, as I wave a firefighter over to climb into the backseat. With both hands, the firefighter stabilizes the patient’s head straight against the headrest as I assess the minor facial wounds caused by flying glass. Another firefighter grabs the airbag, punctures it and rips it out of my way.  

I insert an oropharyngeal down my patient’s throat to protect his airway. I cover his mouth and nose with a BVM—bag valve mask—connected to oxygen tubing and a D-tank running at 15 liters per minute. As I squeeze the football-size bulb every five seconds to oxygenate his system,I assess his legs. Right femur appears fractured, left is covered with bleeding abrasions and lacerations, but no hemorrhage threat.

I strap a C-collar around his neck. Keeping his spine in-line, my partner and two firefighters place his body on a backboard on top of the stretcher, as I continue to bag him. I check his pulse again. Still present. I check for spontaneous breathing. Still nothing, although cyanosis no longer blankets his lips. I brace his entire right leg in a traction split to assist with hemorrhage control.

Inside the ambulance, my partner hooks our patient up to the cardiac monitor via a 12-lead, a firefighter bags the patient, and I perform a rapid trauma assessment, head to toe. After I find no other significant trauma or issues, I spike a bag. Less than a minute later we have an IV bolus in place, running high fluids.      

Spiked and dipped lines display on the monitor screen. “Normal sinus rhythm,” I speak out loud. “But hypotension and tachycardic.” Meaning low BP and high pulse rate. I’m thinking it’s possible this patient is headed to hypoperfusion (shock) due to internal blood loss.

   

“Ready?” another firefighter asks from the ambulance’s driver’s seat.

“Yep, take off.” I listen to our patient’s chest. Heart beating rapidly but strong. Lungs sounds absent on the left side. Diminished on the right.

I eye my partner. “I’m thinking left pneumothroax. Right may be heading in that direction.” I read the monitor screen. “Severe hypotensive now. How about administering Dopamine?”

“Already on it,” my partner says, filling the IV catheter with the med. “He needs chest decompression. Let’s—”

“I’m having trouble bagging,” the firefighter says. “You wanna intubate him?”

   

“Do you have full resistance or only some?” I ask.

“Full.”

Blood quirts out of the patient’s mouth.

I gain my partner’s eye contact. “Cricoid intubation?”

“Yep. Chest decompression can wait.”

I locate the cricothyroid membrane, and prep the area with betadine. My partner punctures the skin with a needle while aspirating for air with a syringe, then slides a cannula along needle and syringe. I secure the cannula with a neck strap, and osculate for breathing with my stethoscope.

I hear solid breath sounds. “We’re good,” I say then eye the firefighter. “Continue bagging.”

I snag the radio and switch the channel to the number one trauma hospital.

“Wake Med? This is EMS #16. We’re en route with an MVC patient. Unconscious. Absent left lung sounds. Diminished in right. Surgical trach in place. O2 saturation 90% with BVM at 15lpm. Bolus IV in place. Dopamine dose administered. BP 90/50, pulse 162.  ETA 15 minutes.”

“Chest decompression,” my partner says as he arranges equipment.

To prep the site, I rub iodine to the patient’s second intercostals in the mid-clavicular line. My partner inserts a 14-guage catheter into the skin over the third rib. He advances the catheter through the parietal pleura.

“Pop,” he says indicating he felt a pop, which is the goal. He advances the catheter to the chest wall, then removes the needle, leaving the catheter in place.

I secure the catheter to chest wall with dressings and tape.

Six days later, I see the patient exiting the hospital in a wheelchair, his right leg casted. Two hospital employees assist him into an awaiting car. I smile huge and thank God.

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Dianna T. Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book, The Hidden Son, released in print world-wide March 1, 2013. 

After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. Dianna lives in North Carolina with her husband and their three athletic children. Learn more about Dianna at www.diannatbenson.com.

   

Cardiac Arrest in EMS Field: Dianna Benson, EMT

Dianna Benson writes a compelling first person account of a young woman in cardiac arrest.

Dianna's debut novel, The Hidden Son, debuts this coming March. Hope you'll check it out.

Welcome back, Dianna!

Our station buzzer and waist radios go off at midnight.

EMS 8. Cardiac arrest. Terminal C, near gate 34.

My partner and I rub the sleep from our eyes and restart our brains.

​

On scene in a near empty airport terminal, a middle-aged woman waves us toward her. Four airport security officers appear relieved by our arrival. All four scramble away from the unconscious patient’s side as I radio for firefighter assistance.  

“Help my daughter, please,” the woman begs in a panic. “She just fainted.”

The daughter appears to be in her early twenties. “Ma’am?” I say, touching her shoulder.

Unresponsive. I feel her carotid artery. Pulseless.

I begin chest compressions. “Does she have any health issues? Allergies?” I ask the mother.

“No,” she cries out. “Nothing.”

My partner presses defibrillator pads to our patient’s chest—one under her right clavicle, the other on her side over her left lower ribs.

“What was she doing when she collapsed?” I ask the mother as I continue non-stop chest compressions.

“Walking to our gate.” The mother pants several quick breaths. “We’re catching the red eye to Paris. Help her. Please. She’s only twenty-four.”

I swallow the sadness clogging my throat. God, please give this mother strength.

The cardiac monitor assesses the heart rhythm. The wave pattern displays on the screen, and I interpret it. “Pulseless ventricular fibrillation,” I tell my partner as he whips out our IV kit.

We defibrillate the patient. A small crowd gathers near us as two firefighters arrive on scene to help us.

“Take over compressions,” I say to the two males, and one of them does so, as my partner drills a hole into our patient’s shin for intraosseous access, the preferred and more effective route over intravenous in cardiac arrest.

I dig into our airway bag for an airway adjunct, an oxygen tank, and a BVM—bag valve mask. Iinsert the oropharyngeal airway down the patient’s throat and connect the BVM to an oxygen line to oxygenate our patient.

“Bag her,” I say to the other firefighter, and he grabs the BVM from my hand.

I whip out our med box and spike a bag, as my partner finishes the IO (intraosseous) line. We push 1mg epinephrine and 40 unit vasopressin into the line; the firefighters continue with chest compressions and bagging.

I prick the patient’s finger and a run a BGL—blood glucose level—for possible hypoglycemia.“Does she take any medications?” I ask the mother for information as well as to engage her in hopes of keeping her calm. “87 BGL,” I say, telling my partner it’s at a normal level.

“No, she doesn’t,” the mother wails out, tears covering her face. “Why isn’t she waking up?” she screams, pulling on the jacket of the firefighter bagging the patient.

“Ma’am?” I gain her direct eye contact. “Let us do our job, okay? We’re here to help your daughter.”

“Yes. Sorry.” She releases her grip on the firefighter and backs up. “Not my girl,” she cries out. “Not my Hannah. God, take me instead.”

“Ma’am, take some deep breaths and keep on praying.”

She nods at me with the saddest smile I’ll never forget.

I check Hannah’s pulse. Carotid pulse still absent.

We repeat defibrillation then resume chest compressions and bagging. We add 300mg of Amiodarone to the line. Then sodium bicarbonate.

“I took a first aid class,” some male in the near distance says. “Do you want my help?”

“No, we’re good,” I answer loud enough for wherever he is to hear.

We start another line, this one IV in the left arm, and run cold fluids in it.

“Hey, you could use my help,” that male voice again says, although this time he sounds ticked.

“Sir?” One of the security officers rushes behind me. I hear scrambling. “Move on your way.”

“I’m trying to help.”

“That’s kind of you, but they’ve got it. Please walk on.”

A hand yanks on my shirt collar at the back of my neck. I squirm forward from it with no luck, but stay focused on the care of my patient.

“Let go of her. Now.” The grip on me releases. I hear more scrambling behind me.

“Hey. Hey. Hey.” The chaos behind me fads out.  

I apply new defib pads. We repeat defibrillation then resume chest compressions and bagging.

I check the carotid. Still no sign of life.

We add magnesium sulfate to the IO line. We push another 1mg of epinephrine and 150mg of Amiodarone. Then doses of Procainamide and Metroprolol.

We work the code for over twenty minutes, to no avail. I’m thinking Hannah possibly suffered acidosis, hyperkalemia or cardiac tamponade, or maybe she overdosed on some drugs. Maybe she has an undiagnosed heart condition.

“Astyole,” my partner says while viewing the monitor screen.

“What does that mean?” the mother wails out. “That’s bad? There’s only one straight line thingon the screen over there.”

“Keep praying,” I tell the mother.

“Let’s inject Narcan,” I say to my partner, thinking it could be some kind of overdose.

“You’re on my brain wave,” My partner says about the med I suggested.

We inject Narcan into the line. Unfortunately, a minute later there’s no change in the patient’s lifeless condition, and typically an overdose patient will jerk to life in seconds.  

“How about some Atropine?” my partner says, and I nod, reaching for the medication.

We continue to push additional med dosages and work the full code as the two firefighters continue with bagging and chest compressions, neither I nor my partner willing to call it.

Not yet.

I can’t yet let Hannah go, and the mother isn’t ready for it.

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Dianna T. Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book, The Hidden Son, released in print world-wide March 1, 2013.

After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. Dianna lives in North Carolina with her husband and their three athletic children. Learn more about Dianna at www.diannatbenson.com.