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ACEi Angioedema


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29 replies to this topic

#6 ERDoc

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Posted 02 October 2011 - 03:31 AM

There's not much you can do in the field.

http://www.medscape....rticle/484537_3
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#7 DFIB

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Posted 02 October 2011 - 03:55 AM

I would agree with Mobey as to giving Dex. I will let you medics and Docs hash out the Epi discussion. But if she is not presenting tachycardia why not administer Epi? I would like to know her breath sounds and labor of breathing are like.

Was her tongue the only location of swelling? What was the color and texture of the tongue like? Was there any evidence of trauma to the tongue or insect bites? Scorpions can cause glossitis?

Does she have a history of hyperthyroidism or symptoms suggesting undiagnosed thyroid disorder? If so, could her cardiac condition have precipitated Myxedema?

Would sedation and establishing a definite airway be a consideration in this patient?

Am I overthinking this scenario?

Edited by DFIB, 02 October 2011 - 04:02 AM.

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#8 ERDoc

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Posted 02 October 2011 - 04:15 AM

Would sedation and establishing a definite airway be a consideration in this patient?

Am I overthinking this scenario?


I would have a very low threshold for securing the airway in this situation.
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#9 Kiwiology

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Posted 02 October 2011 - 04:42 AM

Isolated angioedema in patients taking ACE inhibitors is a side effect, its well known within the realm of medicine and is not anaphylaxis. If her tongue swelled up and she was cardiovascularlly compromised and shut down to buggery it would be more of a problem

I mean granted her tongue swelling up is a bit of a bugger but I am not overly concerned by it; provided the patient is still oxygenating well her whole head can swell up to the size of a basketball and I'm not going to be any more concerned, sure it might be something to freak out the poor PGY1 House Officer at the hospital with while the Consultant laughs at him ...

It's been three hours and she hasn't deteroriated any so I am not worried she's gonna suddenly go poof, crash and get super crook

Put patient on stretcher and take to hospital

Edited by kiwimedic, 02 October 2011 - 04:45 AM.

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#10 jstalmm

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Posted 02 October 2011 - 06:15 AM

So is this truly an allergic reaction? Do they fall into a medical directive that is for "allergic reactions"?

I would argue no, atleast not anaphylaxis I would agree that IM adrenaline would be an overkill as the patient has no systemic effects, but would definitely agree with the others that a neb of adrenaline would be a good idea. The edema is being cause by leaking capillaries, and even if it's not an IgE mediated type reaction like in anaphylaxis, there's no reason why it wouldn't work.

Dex would be a good call as pointed out, however, the onest will be awhile and I'd be a bit more concerned about the amount of acute swelling/airway compromise

Good topic
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