Immunologic Emergencies

Immunologic Emergencies

Part 1 You and your partner are dispatched to Pioneer Park, a local recreational area where residents frequently picnic and enjoy a variety of outdoor festivities, especially during the spring and summer months. The nature of the call is possible allergic reaction for a 25-year-old man.

Part 1 You arrive to find a crowd of onlookers who frantically motion for you. As you move through the crowd, you see a man sitting on the ground. He appears to be very anxious and has hives all over his chest and arms. In fragmented sentences, he explains that was playing Frisbee when something stung him on his back. He also says that it s hard to breathe and he feels very dizzy. You see that his breathing is very labored and note the presence of wheezes.

Part 1 1. How can you discern between a mild or moderate allergic reaction and anaphylaxis? 2. Assuming this person is having a severe, lifethreatening allergic reaction, what would you expect his vital signs to indicate? Given his presentation, would you call for other resources?

Part 2 You immediately request ALS assistance as you ready your EpiPen. You expect to see vital signs that indicate an increased vascular container (hypotension) and the heart s attempts to compensate for that larger container (tachycardia). You also expect to see a subsequent decreased oxygen level secondary to the swelling of the airway and the problems with the circulation.

Part 2 Your partner takes initial vital signs and reports that the patient s blood pressure is 94/56 mm Hg, pulse is 130 beats/min, respirations are 42 breaths/min, and the pulse oximetry reading is 90%. You explain to the patient that you need to administer epinephrine to reverse the effects of the insect bite. You tell him that the injection may sting but that he should not pull away.

Part 2 You place your knee along the inside of his leg to prevent his moving, and you administer the EpiPen. Your partner gives the patient high-flow oxygen and removes the stinger by scraping it off with a tongue depressor. You then have him lie down, and you prop up his feet on your airway bag.

Part 2 3. In some states, EMTs have kits that contain multidose epinephrine and antihistamines they can administer by mouth. Is an EpiPen a multidose preparation?

Part 3 A few moments after you administer the EpiPen, you notice that the patient is breathing more easily. His blood pressure and pulse oximetry values have risen, and pulse and respiration counts have decreased. The paramedics have now arrived.

Part 3 4. What treatment would you expect them to provide?

Part 4 You assist the paramedics in moving the patient to the ambulance. There you see one paramedic has already prepared to initiate intravenous fluids, administer Benadryl, and give a breathing treatment.

Part 4 5. What can the delay of epinephrine do to a patient who is in anaphylaxis?

Summary Anaphylaxis, in simple terms, is the body s attempt to rid itself of an allergen that it perceives as harmful. This normally benign substance (such as pollen or insect sting), causes the body to have leaky capillary beds (the body s attempt to remove the allergen from the bloodstream) and inflammation of the airway (the body s attempt to prevent further exposure of the air passages to this substance). What the body does to help or protect itself, in this case, actually causes great harm.

Summary Mild and moderate allergic reactions are localized. They do not involve entire body systems. In a mild to moderate allergic reaction, you could expect to see itchy, watery eyes, runny nose, sneezing, and, possibly, hives. Although these signs and symptoms are uncomfortable, they do not cause harmful effects to the cardiovascular and respiratory systems.

Summary In cases of anaphylaxis, the delay of epinephrine administration can cost the patient his or her life. You must immediately recognize the situation, know how to correctly administer the epinephrine, and do so in a timely manner. You must be familiar with local protocols because many differ. Some areas have standing orders for EMTs to administer EpiPens when anaphylaxis is expected (history of events with hypotension and breathing difficulty), whereas other localities require EMTs to obtain permission via online medical control.