# I'm confused.



## Frozennoodle (Apr 3, 2011)

I was dispatched to a patient for distended abdomen and severe bilateral lower extremity swelling.  When I arrived on scene the patient was found seated in a wheel chair with ABC's intact and a GCS of 15.  Patient advised that he had been feeling ill since Friday but that the swelling had gotten worse today and so had the pain.  Patient advised that his pain was 10/10 from mid-abdomen down to his feet.  Patient advised that he did go to dialysis the day before and had not urinated since 0530 (the time of the call was 1840).  

Patient had a patent airway and complained of some SOB.  He was on 2lpm PRN at home but currently not on it,  I applied 2LPM via nasal cannula and transferred the patient to the stretcher.  Gastric sounds present in all 4 quadrants with pain on palpation and the abdomen was hard warm and rigid to touch.  Patient's legs were severally swollen with fluids draining from his legs.  His legs felt extremely hard and warm to the touch.  Patient's v/s: 144/68 mmhg, 83 BPM regular and strong, 22 RPM, 143 CBG, 97%SPO2 on 2LPM, Skin Warm Pink Dry, no cyanosis or accessory muscle use noted.  

Patient advised increasing shortness of breath while en route and his speech began to slur.   I noted that severe swelling of the tongue was impeding his speech (When I picked him up there was no swelling to his tongue total transport time was 13 minutes).  I placed patient on 15 LPM NRB.  The patient advised me that the last time he had swelling of his tongue like that he stopped breathing.  

Patient has a history of CHF, HTN, COPD, ESRD, DM and Depression.  Patient denied any allergies.

I'm confused by the swelling of the tongue.  Why would this happen?  It seems like some sort of reaction but it doesn't make sense to me at all.  I can't think of anything that can explain both the lower extremity swelling and the tongue swelling.  Thoughts?


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## Veneficus (Apr 3, 2011)

Frozennoodle said:


> I was dispatched to a patient for distended abdomen and severe bilateral lower extremity swelling.  When I arrived on scene the patient was found seated in a wheel chair with ABC's intact and a GCS of 15.  Patient advised that he had been feeling ill since Friday but that the swelling had gotten worse today and so had the pain.  Patient advised that his pain was 10/10 from mid-abdomen down to his feet.  Patient advised that he did go to dialysis the day before and had not urinated since 0530 (the time of the call was 1840).
> 
> Patient had a patent airway and complained of some SOB.  He was on 2lpm PRN at home but currently not on it,  I applied 2LPM via nasal cannula and transferred the patient to the stretcher.  Gastric sounds present in all 4 quadrants with pain on palpation and the abdomen was hard warm and rigid to touch.  Patient's legs were severally swollen with fluids draining from his legs.  His legs felt extremely hard and warm to the touch.  Patient's v/s: 144/68 mmhg, 83 BPM regular and strong, 22 RPM, 143 CBG, 97%SPO2 on 2LPM, Skin Warm Pink Dry, no cyanosis or accessory muscle use noted.
> 
> ...



Sounds like anaphylactoid reaction for the tongue. 

Not enough info on the swelling, but if I had to guess I would say he is albumin deficent.


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## JPINFV (Apr 4, 2011)

Veneficus said:


> Not enough info on the swelling, but if I had to guess I would say he is albumin deficent.



I'm thinking something along the same lines. Definitely a case that needs some labs drawn quickly.


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## ZombieEMT (Apr 4, 2011)

Allergies seem like the obvious. He stated no allergies, oh well. Sometimes people do not know of allergies until they effect them. Did you ask if he ate anything new or different? Possible come in contact with anything abnormal? Whats the weather like, any insect bites?


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## Veneficus (Apr 4, 2011)

HaleEMT said:


> Allergies seem like the obvious. He stated no allergies, oh well. Sometimes people do not know of allergies until they effect them. Did you ask if he ate anything new or different? Possible come in contact with anything abnormal? Whats the weather like, any insect bites?



If I could help?

oid is the medical suffix for "looks like but isn't."

Anaphylactoid. 

_"anaphylactoid [an″ah-fi-lak´toid] 
resembling anaphylaxis.
anaphylactoid reaction a reaction resembling generalized anaphylaxis but not caused by IgE-mediated allergic reaction but rather by a nonimmunologic mechanism."_


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## tacitblue (Apr 4, 2011)

Was the patient taking ACEis?


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## Cawolf86 (Apr 4, 2011)

The dependent edema and abdominal distension could be related to his CHF (right sided). Distension of the abdomen would be a likely cause of the pain and SOB.


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## usafmedic45 (Apr 4, 2011)

Veneficus said:


> Sounds like anaphylactoid reaction for the tongue.
> 
> Not enough info on the swelling, but if I had to guess I would say he is albumin deficent.



Maybe angioedema.....what meds?


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