Patient comes to the hospital, 45 minutes after a wasp stung his finger.
History:
- a few years ago he had hypotonia and bronchospasm after a wasp sting, cured ambulatory and since that time he wasn't diagnosed nor treated
- hypertension, uses drugs but can't say which ones
- prostate hypertrophy
- smokes a lot of cigarettes for many years, now days smokes 10 cigarettes a day
On admission: Blood pressure (140/90), HR 90/min, respiration rate 16/min, dry rales on right lung. Local oedema and flare.
Procedures: Fenazolina and Dexaven (i.v.).
After 20-30 minutes: The patient starts to sweat, HR 110/min, increase of dyspnoea and bronchospasm, reddening of trunk, increase of local oedema, visible face swelling and big swelling of the tongue.
Oxygen therapy was ordered.
Epinephrine 0,3 (1:1000) (IM)
intensive parenteral hydration
nebulisation with Salbutamol
Calcium 10% (i.v.)
After above therapy, there was regression of the symptoms and the patient felt much better. The 24 hours hospitalization passed without the second stage of anaphylactic shock.
Discharged with following orders:
- Buy Epinephrine in ampule-syringes,
- oral and written instruction of using Epinephrine and course of injections with placebo in ampule-syringes
- using antihistaminic drug and oral cortycosteroid in medium dose 3 times a day
Short comment:
The dynamics of development of a anaphylactic shock can be various. First symptoms don't have to occur immediately, they can occur even after 2-3 hours, furthermore apart from first stage of the shock, the second stage may occur, and it's necessary to be prepared by observing the patient.
