crotchitymedic1986 Posted January 26, 2009 Share Posted January 26, 2009 You are called to the home of an 8 year old who has chicken pox. The mom had just administered the child's first dose of Benadryl (liquid, gave the proper dosage). A few minutes later the child was screaming that the itching was worse, she noticed the child's face was swelling and called 911. You arrive to find a 30kg child that is in obvious anaphylactic shock. B/P 50 palp, Sinus Tach at 140, Pulse ox 90% with obvious respiratory distress, externally audible wheezing in both lungs, using accessory muscles. Child is still conscious and breathing, but is lethargic, and has that "I'm fixing to die look". There is no trick here, it is a reaction to the benadryl. How do you treat this patient, with what you have in your drug-box right now. Obviously, some will have more options than others. Link to comment Share on other sites More sharing options...
spenac Posted January 26, 2009 Share Posted January 26, 2009 Immediate IM of EPI 1:1000. O2 IV Prepare for intubation or even RSI if no relief from EPI. Also prepare Quik-cric. Just for starters. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted January 27, 2009 Share Posted January 27, 2009 SQ EPi or even in the veins of the area under the tongue High flow oxy Intubate I suspect that the allergic reaction is really to something that is in the cream rather than the benadryl itself. Is it truly the benadryl she's allergic to. Link to comment Share on other sites More sharing options...
spenac Posted January 27, 2009 Share Posted January 27, 2009 SQ EPi or even in the veins of the area under the tongue High flow oxy Intubate I suspect that the allergic reaction is really to something that is in the cream rather than the benadryl itself. Is it truly the benadryl she's allergic to. Ruff has your service not gone over to Epi IM rather than SQ? Link to comment Share on other sites More sharing options...
mobey Posted January 27, 2009 Share Posted January 27, 2009 Epi 1:1000 IM (I also like the sub lingual tissue in extreme cases! 5.0 mg Ventolin (Albuterol) 2mg/kg Solu-Medrol RSI if needed Oh ya.... wash off the cream!! Link to comment Share on other sites More sharing options...
CBEMT Posted January 27, 2009 Share Posted January 27, 2009 O2 0.01mg/kg SQ Epi to a max of 0.3mg, or 0.005-.020mg/kg IV "for patients with severe respiratory distress or hypotension." If by ET tube, 0.1mg/kg in 3-5ml of saline. 1-2mg/kg Solu-Cortef IV. Dopamine is an option with MC consult and a pump at my level. (If I get that far into the protocol, the ambulance broke down and every ambulance within 20 miles is unavailable.) Dose per order. Paramedic option: Epi and/or Dopamine drips (MC consult for epi, not necessary for Dop). Epi is 0.05-0.20mcg/kg/min. Dop is 2-20mcg/kg/mine, titrated to achieve a systolic BP of 85 for this age group. Link to comment Share on other sites More sharing options...
akflightmedic Posted January 27, 2009 Share Posted January 27, 2009 Did I miss something? What "cream" do you keep referring to?? I read it as the child ingesting LIQUID Benadryl. Link to comment Share on other sites More sharing options...
mobey Posted January 27, 2009 Share Posted January 27, 2009 Did I miss something? What "cream" do you keep referring to?? I read it as the child ingesting LIQUID Benadryl. pfft... that is funny!!! ya... there is no cream! Link to comment Share on other sites More sharing options...
unknown Posted January 27, 2009 Share Posted January 27, 2009 pfft... that is funny!!! ya... there is no cream! Where as it is kinda funny- due to the scenario clearly states Liquid Benadryl- Moby points out a very sad statistic: Most GP would not have done the obvious in situation like this. If cream was used they wouldn't wash it off. If the child is running a fever of 102.5- they call 911 or rush them off to the ER with out trying Tylonal or Ibuprofen first........How many of you have griped about the calls you go on with complaints of flu like symptoms? The ones where you just want to say Chicken Noodle soup REALLY DOES make you feel better....try it next time before you call 911!! Sometimes I wonder if the Common Sense of the World got tossed out like the Baby with the Bath water........ OK no more 3:30 AM rants.... Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted January 27, 2009 Share Posted January 27, 2009 Ruff has your service not gone over to Epi IM rather than SQ? I mis-read that it was liquid benadryl rather than cream, but my question still stands, are we sure its an allergy to benadry itself or is it something in the benadryl liquid? And NO we have not gone to IM epi yet. Our protocols do allow for SQ or IM though. Link to comment Share on other sites More sharing options...
Recommended Posts