allergic reaction or anxiety attack???

[usalsfyre]

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.

It's done on a regular basis here. That said, no service around us does it.

 

[crazycajun]

Alkyl dimethyl benzyl ammonium chloride is a major ingredient in Clorox wipes. Most people allergic to bleach are allergic to the high concentrations of Sodium and Ethyl Chlorides. Because both of these products are found in raw chlorine PT's allergic to bleach are often allergic to other cleaners containing chlorides. My diagnosis would be Anaphlaxis but I would be interested in the meds administered.

 

[Aidey]

Alkyl dimethyl benzyl ammonium chloride is a major ingredient in Clorox wipes. Most people allergic to bleach are allergic to the high concentrations of Sodium and Ethyl Chlorides. Because both of these products are found in raw chlorine PT's allergic to bleach are often allergic to other cleaners containing chlorides. My diagnosis would be Anaphlaxis but I would be interested in the meds administered.

2 hour onset time.

 

[medicsb]

Based on the information provided it sounds to me like a panic attack. I would've tried to coach the patient to control their breathing and then coach BLS to coach the patient as I'd release to BLS. Though, I have stuck around and treated a panic attack or two with ativan in extreme cases.

 

[TxParamedic]

My wife used to present just like this. Sensitivity to some chemical paired with anxiety and yehaw! She has since learned to control her anxiety to the point she can avoid hyperventilation and hasn’t landed in the ED since. She still can have SOB if she gets around some chemicals but she gets away from them and doesn’t panic and recovers quickly. Only took about a decade of coaching from her Doc and myself!

 

[addictedforever]

Alkyl dimethyl benzyl ammonium chloride is a major ingredient in Clorox wipes. Most people allergic to bleach are allergic to the high concentrations of Sodium and Ethyl Chlorides. Because both of these products are found in raw chlorine PT's allergic to bleach are often allergic to other cleaners containing chlorides. My diagnosis would be Anaphlaxis but I would be interested in the meds administered.

I'd tell you if I could, but I don't remember the meds. But that's the chemical that was in it. I couldn't remember, but that's it!

Based on the information provided it sounds to me like a panic attack. I would've tried to coach the patient to control their breathing and then coach BLS to coach the patient as I'd release to BLS. Though, I have stuck around and treated a panic attack or two with ativan in extreme cases.

Well, maybe they would've done BLS to, if they hadn't all been ALS providers But that's basically what they did.

My wife used to present just like this. Sensitivity to some chemical paired with anxiety and yehaw! She has since learned to control her anxiety to the point she can avoid hyperventilation and hasn’t landed in the ED since. She still can have SOB if she gets around some chemicals but she gets away from them and doesn’t panic and recovers quickly. Only took about a decade of coaching from her Doc and myself!

A decade??? Oh boy! Hope I'm a quicker learner than that! LOL Nope, I avoid chemical cleaners now, especially in tight closed areas.

 

[ZombieEMT]

I want to ask, does it matter. The problem is not whether its anaphylaxis or anxiety attack, the problem is that she is having difficulty breathing. From a BLS end, if all you can do for anaphylaxis is an epi-pen, its only temporary relief. An epi-pen can also help in anxiety attack. Treat the patient and not the disease. If they can not breath fix that. The fact that the patient is not breathing adequately is more pressing than why.

I also want to address statements by flyfisher and fireflite. Fireflite, a pulse ox is not always accurate, there are things that can give false readings. I would never deny a patient oxygen because a pulse ox says 100, especially if they need. Flyfisher, why go with a non-breather, where is the BVM. Both of you should stick to your standards of care and scope of practive. If someone is breathing at 44bpm, they should have a bvm to assisst with ventilations until they are at a normal level, even if they are unfomfortable on conscious patients. If you do not feel they really need it, just think again because it does not matter. Thats what you were trained to do, that is your standard of care, and that is what should be done.

 

[Aidey]

Epi helps in anxiety? Huh?! Epi is the exact wrong thing to give a patient with an anxiety attack. You want to give more epi to a patient who is having an overload of endogenous epi? Why?

All clinical signs indicate this patient has more than adequate gas exchange. More oxygen will cause further decrease in her CO2, which in turn will make her feel worse. Part of training is using good judgement, and using a BVM on this patient IS NOT good judgement. You can try it, but be ready to get punched by the patient.

 

[abckidsmom]

I want to ask, does it matter. The problem is not whether its anaphylaxis or anxiety attack, the problem is that she is having difficulty breathing. From a BLS end, if all you can do for anaphylaxis is an epi-pen, its only temporary relief. An epi-pen can also help in anxiety attack. Treat the patient and not the disease. If they can not breath fix that. The fact that the patient is not breathing adequately is more pressing than why.

I also want to address statements by flyfisher and fireflite. Fireflite, a pulse ox is not always accurate, there are things that can give false readings. I would never deny a patient oxygen because a pulse ox says 100, especially if they need. Flyfisher, why go with a non-breather, where is the BVM. Both of you should stick to your standards of care and scope of practive. If someone is breathing at 44bpm, they should have a bvm to assisst with ventilations until they are at a normal level, even if they are unfomfortable on conscious patients. If you do not feel they really need it, just think again because it does not matter. Thats what you were trained to do, that is your standard of care, and that is what should be done.

This is very sweet, but have you ever even SEEN an adult person with a little bit of anxiety breathing 44 times a minute? I dare ya to get them to sit still on the stretcher, much less let you stand over them, hold a mask to get a seal on their face, and then the *real* fun begins...you try and time your squeezing of the bag to their breathing.

Good luck.

Keep reading around here, there is a lot for you to learn. It's interesting how in one paragraph you promote freelancing with using meds that are not indicated, and in the second paragraph you promote mindlessly sticking to "what you were trained to do." Nothing like a little paradox to mix your message. :blink:

 

[Smash]

I want to ask, does it matter. The problem is not whether its anaphylaxis or anxiety attack, the problem is that she is having difficulty breathing. From a BLS end, if all you can do for anaphylaxis is an epi-pen, its only temporary relief. An epi-pen can also help in anxiety attack. Treat the patient and not the disease. If they can not breath fix that. The fact that the patient is not breathing adequately is more pressing than why.

I also want to address statements by flyfisher and fireflite. Fireflite, a pulse ox is not always accurate, there are things that can give false readings. I would never deny a patient oxygen because a pulse ox says 100, especially if they need. Flyfisher, why go with a non-breather, where is the BVM. Both of you should stick to your standards of care and scope of practive. If someone is breathing at 44bpm, they should have a bvm to assisst with ventilations until they are at a normal level, even if they are unfomfortable on conscious patients. If you do not feel they really need it, just think again because it does not matter. Thats what you were trained to do, that is your standard of care, and that is what should be done.

I think we just got trolled. Well, I hope we just got trolled...

 

[usalsfyre]

An epi-pen can also help in anxiety.

Something tells me you've never seen a patient post-epi administration.

Fireflite, a pulse ox is not always accurate, there are things that can give false readings. I would never deny a patient oxygen because a pulse ox says 100...

True, but it's FAR more common to get falsely low readings than falsely high. Despite what's taught in every EMT-B class in the country, SpO2 does have value (esp if it displays a waveform) you just have to know how to take it in context.

especially if they need.

The problem is determining need. Respiratory rate in isolation is as poor a determinate as SpO2

Flyfisher, why go with a non-breather, where is the BVM.

As abckidsmom notes...good luck.

Both of you should stick to your standards of care and scope of practive.

"Standard of care" being a little squirley here.

If someone is breathing at 44bpm, they should have a bvm to assisst with ventilations until they are at a normal level...

Which isn't going to happen on this patient with you holding a BVM to their face...

...even if they are unfomfortable on conscious patients.

...for at least the reason of the workout they are going to get stomping a mudhole in your existence while you try this.

If you do not feel they really need it, just think again because it does not matter. Thats what you were trained to do, that is your standard of care, and that is what should be done.

I withhold treatments I was "trained to do" all the time. Daily in fact. Why? Because it was not medically indicated at that moment in the patients course of care. That's what medical practice is. Anyone who tells you something is an absolute in medicine is full of crap. The important thing is having a sound reason for everything you do, or don't do.

 

[addictedforever]

this thread gets more interesting as it goes along. I love being able to hear from different paramedics and how they would treat it. I'm learning so much!

And if anyone had tried to put a bvm or nrb on me, i think i truly would've panicked then

 

[addictedforever]

I want to ask, does it matter. The problem is not whether its anaphylaxis or anxiety attack, the problem is that she is having difficulty breathing. From a BLS end, if all you can do for anaphylaxis is an epi-pen, its only temporary relief. An epi-pen can also help in anxiety attack. Treat the patient and not the disease. If they can not breath fix that. The fact that the patient is not breathing adequately is more pressing than why.

I also want to address statements by flyfisher and fireflite. Fireflite, a pulse ox is not always accurate, there are things that can give false readings. I would never deny a patient oxygen because a pulse ox says 100, especially if they need. Flyfisher, why go with a non-breather, where is the BVM. Both of you should stick to your standards of care and scope of practive. If someone is breathing at 44bpm, they should have a bvm to assisst with ventilations until they are at a normal level, even if they are unfomfortable on conscious patients. If you do not feel they really need it, just think again because it does not matter. Thats what you were trained to do, that is your standard of care, and that is what should be done.

You sound like a very compassionate person. I think it truly would've been interesting to have you treating me, but I may have truly panicked had you tried a BVM even tho' I would understand what you were doing. I would've just grabbed the rails so tight they woulda popped off

 

[addictedforever]

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 think they were mostly worried because I have a brother with a rare heart murmur that's genetic.

 

[shfd739]

Im agreeing with the others here.

Im still surprised by the NRB comment. I was taught 10 years in emtb to interpret the spo2 and also assess the patient. And EpiPen? Wow.

I wouldn't hand off to BLS though. Vitals are too out of norm to feel comfortable doing so or be able to justify it.

 

[ZombieEMT]

So maybe the epi statement was off, and do not get the wrong idea because its not something I would do. However, I have heard stories of epi being used to treat respiratory ending positive when not an allergic reaction. Someting that might seem like an allergic might not actually be an allergic reaction, does that mean that the epi is completely ineffective? Right or wrong, but the epi is treating problems the body is having and not removing an allergen from the body? Is that not why we still transport after epi has been administered.

As for the BVM, I do not feel that I am wrong there. Again, there is a standard of care. How they feel compared to how they actually are is something that we have to considered. I have multiple times bagged a patient in severe respiratory distress and done so successfully. You base your input on what? Have you tried more than once to bag a conscious patient? Have you tried at all or just went with what other people tell you. Talk to your patient, convince them its best, if they really need it. Do you frequently attempt to bag or just always go straight to NRB and ignore the standard. There are standards for a reason. You want to bust on me, but if you havent really tried more than once, you dont really know.

 

[ZombieEMT]

Usalsfye, I do agree with nothing in medicine being definite. 100% true, you treat as the patients needs, its all based on the patient. So for that same reason, shouldn't you treat individual you run into as a new patient rather than what you normally do. If the standard is to treat with a bvm, why not make an attempt. If unsuccessful for any reason at all, even if just incomfortable, feel free to make the decision to remove but why deny from the beginning. Isnt always going against the standard and not bagging, saying there is a definite in that situation. On the same topic, don't we normally treat most analphylaxis with epi, because thats the standard. Again dont get me wrong, I agree 100% that there is no definite, I just do not see why to always sway from standard rather than see where it takes you.

 

[shfd739]

Usalsfye, I do agree with nothing in medicine being definite. 100% true, you treat as the patients needs, its all based on the patient. So for that same reason, shouldn't you treat individual you run into as a new patient rather than what you normally do. If the standard is to treat with a bvm, why not make an attempt. If unsuccessful for any reason at all, even if just incomfortable, feel free to make the decision to remove but why deny from the beginning. Isnt always going against the standard and not bagging, saying there is a definite in that situation. On the same topic, don't we normally treat most analphylaxis with epi, because thats the standard. Again dont get me wrong, I agree 100% that there is no definite, I just do not see why to always sway from standard rather than see where it takes you.

What standard says you have to use a BVM on this patient?

 

[Aidey]

There are other things to try in allergic reactions besides epi. Especially if there is not strong evidence of anaphylaxis, which there is not in this case.

I also want to know what standard you are talking about. Everything I have read says consider assisting ventilation if respirations are below 8 or greater than 30 and signs of inadequate oxygenation are present. I do not recall ever hearing it was the standard to bag pts breathing more than 30 times a minute.

For the record I have bagged a conscious patient. I don't do it very often because it isn't often necessary.

 

[IAems]

BLS is BLS, and ALS is ALS

From a BLS perspective, Do Not Withhold Oxygen For Any Reason (just like you were trained). From a BLS level of training, a RR of 44 and HR of 150 of course requires high flow oxygen. If an EMT-B withheld O2 from a patient and something happened to that patient, that EMT-B would be completely at fault. That being said, even an EMT-B can monitor how a patient responds to an intervention and adjust treatment accordingly. The damage to be done by withholding oxygen is far greater than the damage to be done by applying it. However, for a Paramedic, interventions and treatments are different and correspond to that level of training. To those of you who are Paramedics, unless you're on scene, and it's your patient, please don't tell a Basic to provide your level of care without your level of training. And those of you who are Basics stating you would withhold oxygen, best of luck explaining in a courtroom why you withheld oxygen from a patient C/O SOB, possible anaphylaxis (in and of itself an indication of high flow O2), RR 44, and HR 150. I have always taken the approach of treating for the worst case scenario of present symptoms. That being said, if the throat and tongue are actually swelling (not just reported that way by a panicking patient), I'm going to be a lot more worried about anaphylaxis than anxiety. To my knowledge, anxiety does not cause swelling. I've always thought its better to look stupid for doing too much than look stupid for doing to little. Just in theory, how much higher do you let the RR and HR go before applying oxygen and, I am admitting ignorance in this one, short of minor vasoconstriction, an immediate diagnosis of pulmonary fibrosis, or a chronic history of COPD, what would be the detrimental effects of high flow O2 on this patient? By the way, how did you get an accurate SaO2 reading anyway? As I understand, the best we can do in pre-hospital is SpO2 which has a + or - 4% accuracy of the actual SaO2 (especially without a pleth wave), and is further called into question by the fact that agitation and patient movement reduce accuracy (like for example "hands . . . spasming"). I guess what I'm saying is, you're all probably right and the patient doesn't need oxygen, but if the patient did and an EMT withholds it, wouldn't that be much worse?