October 22, 2010
A man awoke in the early hours of October 22, 2010 experiencing chest pain and struggling to breathe. He had been suffering from trouble breathing the previous day, but it became worse during the night. When he woke, he also found his skin flushed and the presence of hives on his face, neck and shoulders.
He called 911, and Bethesda-Chevy Chase Rescue Squad Medic 741 and Bethesda Fire Department Engine 706 (the latter staffed by a Department of Fire and Rescue Services crew) were dispatched to render aid for “a male patient experiencing an allergic reaction.”
The crews arrived on the scene simultaneously and found the patient standing in his living room leaning against a sofa trying to catch his breath, wheezing and displaying all the signs and symptoms of a moderate allergic reaction. The patient wasn’t aware that he had any allergies, but he had started taking approximately six new medications several days earlier and thought he might be allergic to one or more of them.
Working with the paramedic assigned to the engine company, the Rescue Squad medic assumed control of patient care and began quickly assessing the patient. He directed the crews to take vital signs and administer high-flow oxygen to the patient. Upon placing the patient on a cot in the back of the medic unit, the crew connected the patient to an ECG monitor to assess the patient’s cardiac rhythm and vital signs.
They also began administering medications. The medic administered Albuterol and Atrovent medications through a nebulizer in an effort to counteract the effects of the patient’s allergic reaction, open his airway and lung passages, and reduce his work of breathing. Then the medic injected the patient with Benadryl (diphenhydramine) and Epinephrine. Once these medications were administered, the crew turned their attention to establishing an IV, monitoring the patient’s airway, and checking the patient’s response to these interventions provided.
The crew continued supportive patient care on the way to the hospital. The patient began to improve and commented that he felt that it was becoming easier to breathe.
Allergic reactions are not uncommon, but moderate to severe reactions must be treated quickly and aggressively. Rapid recognition of the signs and symptoms of a life-threatening allergic reaction and speedy activation of the Emergency Medical Services system – i.e., calling 911 – can greatly improve a patient’s outcome when he or she is experiencing a life-threatening allergic reaction.
