allergic reaction or anxiety attack???

addictedforever

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Here's a scenario that got conflicting views from the four paramedics who responded. Some tho't an allergic reaction, others tho't just an anxiety attack. I'm curious what your take would be on this one. (I have the right to post this info as I was the pt.)

S-19 y/o f. CC: difficulty breathing. Pt. was cleaning at her work w/ Clorox wipes at 1030 when she had minor SOB then approx 1230 the breathing became a lot worse to what she has never experienced before. Pt states she can't take a deep breath. Pt denies cardiac cx/pn (side note I tried to tell them that my chest did hurt, but I could barely breathe, let alone talk), swelling of throat or tongue. Pt also c/o dizziness, tingling of face, arms, and legs (my hands, feet, and face were spasming at this point). PMHX: none

O-Arrive on scene to find pt. sitting in chair with severe difficulty breathing. Airway) open, clear. Breathing) Labored, rapid. Circ) Good. EKG) Sinus Tach. CBG) 155. Lungs) clear x 4. Skin) Pink, warm, dry. No rash, hives noted on hands or arms or face.

VS at time of arrival: T-97.5 F, P-150, R-44, B/P-118/30, SaO2-100/RA, ETCO2-11
VS in 15 min: B/P-153/77, P-125, R-45, SaO2-100/2L via NC, ETCO2-12
VS at ER: B/P-130/76, P-106, R-37, SaO2-100/2L via NC, ETCO2-12
 

MrBrown

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No cardiovascular, respiratory or integumentary symptoms and an increasing blood pressure leads Brown to say this is not anaphylaxis.

Could have been a panic attack but Brown does not see any sort of stimuli

Most likely cause is the bleach

... and why in the bloody hell where there FOUR IC's at this job? :rolleyes:
 
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addictedforever

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Only thing is Mr. Brown the Clorox wipes had no bleach in them. I am allergic to Bleach. It was some other chemical in them that triggered it. And it happened again, now I avoid them at all costs.

As far as the four paramedics...I have absolutely no clue!!! I was quite shocked! Two came in the ambulance and two on a firetruck. I really don't know, unless they were all bored and this was the most exciting thing that day. LOl :)
 

abckidsmom

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I wouldn't call it a panic attack or an allergic reaction. Sometimes chemical stimuli can trigger a reactive airway, and then the anxiety of that feeling can spin the drama right out of control.

I believe I could sit here and breathe 44 times a minute, shallowly as if my airway feels tight and burns, and could approximate those vitals.

I'm not saying you were faking it, or there wasn't an actual problem, just that all of those vital signs can be explained by the hyperventilation, and they don't look like an allergic reaction at all. It is extremely uncomfortable, and anxiety-provoking to have a reactive airway thing going on, and I would say that the problem was related to something along those lines.
 
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addictedforever

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Thanks! I am just curious and trying to learn what all I can. I honestly still don't know for sure what happened that day, just that it did happen again when I was exposed to the same thing. I honestly did not feel any anxiety until my supervisor started freaking out, other than that I felt perfectly calm. But by the time I got to the ER I was mad that I couldn't control my breathing. Cuz I tried everything from ignoring it to holding my breath :) nothing worked so I got mad :)
 

DesertMedic66

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Is there a reason why they did not go non-rebreather @ 15L per minute? Just curious.

Her O2 stats were at 100% on room air. O2 isn't going to help her stats because they are already at 100%
 

Aidey

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Here's a scenario that got conflicting views from the four paramedics who responded. Some tho't an allergic reaction, others tho't just an anxiety attack. I'm curious what your take would be on this one. (I have the right to post this info as I was the pt.)

Only thing is Mr. Brown the Clorox wipes had no bleach in them. I am allergic to Bleach. It was some other chemical in them that triggered it. And it happened again, now I avoid them at all costs.

As far as the four paramedics...I have absolutely no clue!!! I was quite shocked! Two came in the ambulance and two on a firetruck. I really don't know, unless they were all bored and this was the most exciting thing that day. LOl :)

Um, it is against the rules to ask for medical advise, and asking us to diagnose you is pretty much the same thing.


Is there a reason why they did not go non-rebreather @ 15L per minute? Just curious.

Because that would have been totally unnecessary and probably made her worse? The use of ANY supplemental oxygen in a patient with those vital signs could be questionable.
 
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addictedforever

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I'm sorry, Aidey, I did not mean to ask about medical advice. Since I have seen an MD about it, I just wanted to know what other paramedics would do if presented with this same scenario.
 

18G

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Nothing rings out an allergic reaction. It sounds like what ABCkidsmom had said about maybe a SOB feeling instilling some anxiety which spiraled out of control.

Looking at the vital signs the HR was initially 150, resp rate of 44, EtCO2 of 11 plus "c/o dizziness, tingling of face, arms, and legs (my hands, feet, and face were spasming at this point)" this all equals hyperventilation syndrome. By the time you arrived at the ED HR was 106. An allergic reaction would not present with a spontaneously decreasing HR.

So yeah, anxiety induced hyperventilation.

flyfisher151... this patient did not require ANY supplemental oxygen let alone 15lpm by NRB.
 
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flyfisher151

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Thanks for the answer firefite! I just learned something. Funny how when you are in school, all this info is jammed in your head, but it takes a real scenario to stick it there and glue things together.
 

johnrsemt

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4 Medics: I have been on runs that was dispatched ALS ambulance and Engine (chest pain, trauma, resp distress, allergice reaction all get engine crew also): and have had 2 medics on the amb and 4-5 on engine. Makes patient care easy if you talk about it in advance: IV person, Drugs, Airway, Cot, family care.

Why does everyone think that it is NOT an allergic reaction because the patient doesn't have hives? I get hives around cat dander: I have Never gotten hives with Anaphalaxys for my Nut Allergies. I have had dr's and Medic's tell me that I was NOT having an allergic reaction due to no hives: they changed their story when Epi and Benadryl fixed my problem after I stopped breathing. Also when the Staff Doc yells at them for not listening to the patient and letting me stop breathing.
 

Aidey

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No one is saying it wasn't an allergic reaction because of the lack of hives. There are other things, like the vital signs, that indicate it was not an allergic reaction.
 

sir.shocksalot

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No one is saying it wasn't an allergic reaction because of the lack of hives. There are other things, like the vital signs, that indicate it was not an allergic reaction.

What about the vitals leads you to believe it wasn't an allergic reaction? I wasn't aware vital signs necessarily changed in allergic reactions.
 

CaydenElizalde

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I'm not tempted really to believe it was initially an anxiety issue or an allergic reaction. I've personally attempted to clean things out like my shower or other such things with Clorox and after inhaling a bit too much of the chemicals that released into the air from the surface, I noticed that I was having some serious problems breathing and chest pain from coughing. Maybe it was just a bit of anxiety brought on by a "chemically induced" respiratory distress. :\
 
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addictedforever

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Nothing rings out an allergic reaction. It sounds like what ABCkidsmom had said about maybe a SOB feeling instilling some anxiety which spiraled out of control.

Looking at the vital signs the HR was initially 150, resp rate of 44, EtCO2 of 11 plus "c/o dizziness, tingling of face, arms, and legs (my hands, feet, and face were spasming at this point)" this all equals hyperventilation syndrome. By the time you arrived at the ED HR was 106. An allergic reaction would not present with a spontaneously decreasing HR. QUOTE]

It did not spontaneously decrease. I was given some sort of drug to make it decrease but I can't remember the name, and I can't read the spelling on the PCR.
 

18G

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It did not spontaneously decrease. I was given some sort of drug to make it decrease but I can't remember the name, and I can't read the spelling on the PCR.

The only drug you would have been remotely given to decrease your HR in this situation would be adenosine. And if they gave you adenosine with a sinus tach at 150 someone needs to go back to school.
 

Smash

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The only drug you would have been remotely given to decrease your HR in this situation would be adenosine. And if they gave you adenosine with a sinus tach at 150 someone needs to go back to school.

I presumed some kind of anxiolytic; the only hoofbeats I'm hearing belong to the anxiety horse, not the anaphylaxis zebra.

As an aside, I have no idea what a tho't is. Can someone enlighten me?
 

usalsfyre

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If there was any thought it might be a true allergy issue I might have considered diphenhydramine, covers that base and tends to have a bonus anxiolytic side effect as well. However, I agree with the above assessments, sounds like an acute anxiety issue best treated with a low dose of benzos.
 
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18G

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A benzo could be given but it would be a rarity to see a benzo given for someone hyperventilating pre-hospital. Not saying that is a good thing but it is what it is.
 
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