anaphylaxis

The summary and a few nitbits:

Anaphylaxis is a medical EMERGENCY.

In anaphylaxis, death occurs through respiratory arrest. Forget intubation or tracheostomy^*. The airway blockage is at the level of the bronchi below the larynx.

The first thing to do is yell for the ADRENALINE (epinephrine).

Then, in order:

1. lay the patient down and raise the feet
2. ensure the airway is free
3. monitor blood pressure
4. give adrenaline 1ml of 1 in 1000 intramuscularly or intravenously
5. give antihistamines and/or hydrocortisone
6. if hypotensive, give intravenous infusion of fluid (colloid better than crystalloid)
7. if still hypoxic, oxygen and/or assisted ventilation may be necessary (this is when you can consider the intubation or trachy)

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^*There might be a place for intubation/tracheostomy if CPAP (continuous positive airway pressure) is available.

There are several common signs of anaphylaxis:

• Sneezing, coughing, wheezing
• Shortness of breath
• Tightness and swelling of the throat
• Tightness in the chest
• Rapid pulse rate
• Swelling of the mucous membranes (mouth, tongue, nose)
• Blueness around mouth and lips
• Dizziness
• Nausea
• Vomiting

So here I sit, having read mentions and notes and definitions of others on the subject of anaphylaxis, wondering at the straight list of possible symptoms. Really clinical. Very succinct and to the point. But everything I’ve read here so far has been of a third person nature, like reading the insert of an EpiPen. Here’s what it’s like, at least what I’ve experienced…

To start off, though, you need to understand that this is not like being allergic to carrots or honey or wheat. Yes, yes, yes, I know you’ve just read all about how serious this is already. But still. There’s a difference between getting hives or having a mild problem breathing, and having to make a trip to the hospital. If you or someone you know is allergic to crustaceans or peanut butter, this is NOT something to dick around with. Yeah, it might be funny to see someone blimp up and turn red because they had some carrots in their salad, but it’s an entirely other thing to have to explain to the doctor on call at the emergency room, "well, yes, she told us she was allergic to that stuff, but it was less than half a shrimp, we didn’t think it’d be enough to hospitalize her."

First, it feels like something’s sticking in the back of your throat. Like you didn’t quite swallow something all the way. You drink some water, you eat some bread, you try to ignore it. Itchy palms. Then your sinuses start to close up, fast. Not instantaneous, but it feels like the cut-away shown in the hay-fever medication commercials. Meanwhile, the throat thing has gotten no better, and as a matter of fact, swallowing’s getting pretty interesting at this point, since there’s not that much room any more. But it’s ok, you can still breathe...through your mouth...and even that’s becoming questionable.

This is about the time that you notice that you’ve broken out in a sweat, as the room temperature has jumped 20-30 degrees. Your eardrums start to tickle, but you’re already rubbing your hands together in an effort to scratch the insane itch on both palms. Hopefully, by this time, you are positioned near a trashcan (read: within 5 feet if your aim is good), because here comes what seems to be everything you’ve eaten for the past three days.

If it hasn’t been administered yet, the EpiPen should be used NOW. Pull out the gray cap on the end. Put the black tip to the outside of your thigh—-no need to strip, they’ll go through jeans, just not on the seams-—and with one quick motion, push until it clicks. Small pin prick, but it’s nothing compared to everything else that’s going on. Keep the needle tip in your leg for a count of ten, then remove. Massage the area for a good 10 seconds, and call the hospital. The adrenaline shakes will arrive soon, so get others to fill out paperwork for you, and don't worry about sleeping any time soon. ^_^