how would you handle this?

[Anonymous]

Your on scene of a medical call in a public place and someone walks up to you and says they have a rash from eating peanuts and wants to know if they should go to the hospital? Patient took benadryl earlier, rash is across the chest and no difficulty breathing. Do you advise them to go, call 911 or do you attempt to treat this patient as well?

 

[SSwain]

How taxing is the medical call you are currently on?
Can you spare the manpower to further assess the new pt?
Is the new PT a probable anaphalaxis or just allergic reaction?
If the latter, offer to call for a second Ambo for them, or recommend they go to a walk in clinic or their personal physician.
If the former, and you can spare the manpower, assess and treat as needed.

just my $0.02

 

[Veneficus]

What do you think is wrong. If the pt already took his benadryl, what are you planning to do to help?

Are you comfortable sending him away?

What instructions would you give if you did?

It seems like this person is asking you to decide if he needs medical treatment or not.

Your call.

 

[Anonymous]

Patient stated the food was eaten a few hours earlier, also stated antibiotics were recently finished and had been allergic to the sulfer, no previous peanut allergy. Rash was diffuse across chest. Patient was asking if they would be okay or should go to the hospital. I was standing outside a security room with gurney while partner and ALS were inside. I asked the person if they had any trouble breathing they said no, I said I would advise going to the hospital just to be safe and monitor for signs of airway swelling/difficulty breathing. Patient asked if I thought they could wait to go to the urgent care by their house an hour away, I said i would advise going to the nearest (3 miles away). Patient walked away.

Now my gut instinct says this person was fine and just had a rash, however vitals were not assessed and I am worried I may have sent a patient away that could have benefited from our help or deteriorated after speaking with me. How should I have handled that differently? As far as how taxing the medical call was, we ended up cancelled on that call.

 

[NYMedic828]

Patient stated the food was eaten a few hours earlier, also stated antibiotics were recently finished and had been allergic to the sulfer, no previous peanut allergy. Rash was diffuse across chest. Patient was asking if they would be okay or should go to the hospital. I was standing outside a security room with gurney while partner and ALS were inside. I asked the person if they had any trouble breathing they said no, I said I would advise going to the hospital just to be safe and monitor for signs of airway swelling/difficulty breathing. Patient asked if I thought they could wait to go to the urgent care by their house an hour away, I said i would advise going to the nearest (3 miles away). Patient walked away.

Now my gut instinct says this person was fine and just had a rash, however vitals were not assessed and I am worried I may have sent a patient away that could have benefited from our help or deteriorated after speaking with me. How should I have handled that differently? As far as how taxing the medical call was, we ended up cancelled on that call.

You sure the patient was allergic to sulfer, not sulfa?

What would you do exactly that would benefit their condition other than take them to the hospital as they could on their own? If it was hours ago, odds are type 1 hypersensitivity reaction like anaphylaxis is not taking place.

 

[VCEMT]

Tell him to go see his doctor, he just has a rash. Not my problem.

 

[epipusher]

Just call for another rig.

 

[Veneficus]

odds are type 1 hypersensitivity reaction like anaphylaxis is not taking place.

Consider a type IV hyper senstivity or anaphylactoid reaction.

 

[firetender]

In the midst of handling another call in which another person is in good enough shape to walk up to me and ask, the name of the game is to assess as quickly as possible if there is an immediate danger to the person asking.

In this case, nothing life-threatening. two hours since eating and in the absence of the rash spreading while you're looking at it, and in the absence of any respiratory symptoms I'd say the advice you gave was sound.

Anaphylaxis, which is the only thing you'd have to worry about here as a real emergency, comes raging down the pike, not trickling.

 

[Veneficus]

In the midst of handling another call in which another person is in good enough shape to walk up to me and ask, the name of the game is to assess as quickly as possible if there is an immediate danger to the person asking.

In this case, nothing life-threatening. two hours since eating and in the absence of the rash spreading while you're looking at it, and in the absence of any respiratory symptoms I'd say the advice you gave was sound.

Anaphylaxis, which is the only thing you'd have to worry about here as a real emergency, comes raging down the pike, not trickling.

But it can also come several hours post incident.

 

[Anonymous]

But it can also come several hours post incident.

trying to put my mind at ease here

 

[Veneficus]

trying to put my mind at ease here

The reason i asked those questions in my original post was to spur you to research the topic so that you could make better informed decisions in the future and not have to worry after the fact.

knowledge + experience = the best outcomes.

experience without knowledge sets you up for a fail later.

 

[Anonymous]

The reason i asked those questions in my original post was to spur you to research the topic so that you could make better informed decisions in the future and not have to worry after the fact.

knowledge + experience = the best outcomes.

experience without knowledge sets you up for a fail later.

Yes well unfortunately all my learning is coming from my mistakes, in hindsight it is easy for me to see what I should have done/could have done.

Further assessment could have included a BP/HR and asked about any nausea, vomiting or abdominal pain. At the time I wasn't sure how to handle a "still alarm," if you will, when I was already on scene for another patient. I was not sure how fire would have received me interrupting them providing care for one person to tell them that this person had a question about "whether or not they should be worried"

Could have called for another ambulance, should have let ALS decide if transport by ambulance was needed or not.

 

[Veneficus]

Yes well unfortunately all my learning is coming from my mistakes, in hindsight it is easy for me to see what I should have done/could have done.

Further assessment could have included a BP/HR and asked about any nausea, vomiting or abdominal pain. At the time I wasn't sure how to handle a "still alarm," if you will, when I was already on scene for another patient. I was not sure how fire would have received me interrupting them providing care for one person to tell them that this person had a question about "whether or not they should be worried"

Could have called for another ambulance, should have let ALS decide if transport by ambulance was needed or not.

That was not my point.

You were asked to make a decision and you did.

This time it turned out to be a reasonable and acceptable decision.

Now that we got past that...

You could do some research on exactly what was happening with the person so in the future you are even better prepared to handle such a request and can do so with confidence.

 

[Anonymous]

That was not my point.

You were asked to make a decision and you did.

This time it turned out to be a reasonable and acceptable decision.

Now that we got past that...

You could do some research on exactly what was happening with the person so in the future you are even better prepared to handle such a request and can do so with confidence.

But I do not know exactly what was going on. I know what I THINK was going on, and I can explain the physiology behind it, but I cannot predict what the outcome of the reaction would have been, nor can I be certain if that was what was even going on in the first place or if it was something unrelated. Maybe it progressed to a more severe reaction after she left? I am not there to diagnose, as I am not a doctor. That is why I would have liked to ensured she was seen at a hospital (and had epi accessible until she was). therefore I think the more reasonable decision would have been to have her go by ambulance.

ps. I hope my post doesn't come off the wrong way, I am trying to learn, just have a million "what if" thoughts run through my head after each call. I am really having a hard time getting over calls when I feel like something could have been or should have been done differently.

 

[Veneficus]

But I do not know exactly what was going on. I know what I THINK was going on, and I can explain the physiology behind it, but I cannot predict what the outcome of the reaction would have been, nor can I be certain if that was what was even going on in the first place or if it was something unrelated. Maybe it progressed to a more severe reaction after she left? I am not there to diagnose, as I am not a doctor. That is why I would have liked to ensured she was seen at a hospital (and had epi accessible until she was). therefore I think the more reasonable decision would have been to have her go by ambulance.

ps. I hope my post doesn't come off the wrong way, I am trying to learn, just have a million "what if" thoughts run through my head after each call. I am really having a hard time getting over calls when I feel like something could have been or should have been done differently.

I think if you look up the 4 types of hypersensitivity reactions in apathophysiology text, your mind may be better at ease.

You cannot do your job if you do not diagnose

 

[Medic Tim]

I am not there to diagnose.

Actually you are. What makes you think otherwise?

 

[firetender]

But it can also come several hours post incident.

If you're referring to anaphylaxis which would be the Rule-Out in that case when it comes on it COMES ON!

http://www.ncbi.nlm.nih.gov

www.ncbi.nlm.nih.gov
Anaphylaxis is a life-threatening type of allergic reaction. Symptoms develop quickly, often within seconds or minutes.

http://www.ncbi.nlm.nih.gov

Does it not?

That is what the OP would have seen if it were a true emergency. At most, he saw an allergic reaction. And yes, of course I agree he needs to arm himself with understanding.

 

[NYMedic828]

If you're referring to anaphylaxis which would be the Rule-Out in that case when it comes on it COMES ON!

http://www.ncbi.nlm.nih.gov

Does it not?

That is what the OP would have seen if it were a true emergency. At most, he saw an allergic reaction. And yes, of course I agree he needs to arm himself with understanding.

O come on FT. You know better than to question whether Ven is right or not... Which happens to be always :glare:


But, I am a bit lost here Ven.

http://pathmicro.med.sc.edu/ghaffar/hyper00.htm

Anaphylaxis to my understanding was always considered to be a type 1 response?

As stated in the above link, he may have a delayed reaction from something "rash" inducing but it isn't necessarily an emergency in the context of anaphylaxix?

 

[Sandog]

Anaphylaxis does not always present itself upon first exposure of the allergen. The symptoms could have been a pre-cursor to the next exposure. Would have suggested the person get tested at a earliest convenience.