The anaphylactic shock

A patient is admitted with suspicion of appendicitis. Never has he been admitted into ward before, and never would he think this can be fatal.

He was just a young boy working as a sales, and just like any other people with appendicitis his RLQ pain made him highly on list for surgery. Blood tests showed positive for infection, and all he needed is some radiological report to suggest the diagnosis.
He was scheduled to have ultrasound, but later the radiologist contacted us that a contrast Computed Tomography (CT) may be better for diagnosis. He was then transferred to the CT room.
Approximately the examination took 20 minutes and he was transferred back. When I saw him back his first response of seeing me is ‘My hands are so hot’.
I felt something was not going right.
The sense of hot may be due to vasodilation. The possible cause for vasodilation after CT appeared the only one to me at that time.
Allergy.
I soon applied all the vital signs machines to him, the cardiac monitor, the blood pressure monitor, the saturation of oxygen monitor (SaO2 mon). And within 1 mins he was sitting in bed I saw his whole body turning red.
And within a further 20 seconds I noticed rash.
To my experience and knowledge I knew I had to rush or he is going to collapse in front of me real soon. I informed houseman officer and later he informed his seniors.
Intravenous piriton, steroid is given soon after they arrived.
It seemed things didn’t worsen in the next 1 minute, so I decided to click a automatic check up button to monitor his blood pressure. Yet that was not right – the blood pressure dropped, and his mouth was so edematous and pale when I came back.
Oxygen, high flow, 100%, via facial non-rebreathing mask. More intravenous fluid was given, and all I was thinking at that moment was giving him adrenaline and be prepared for intubation, and bed-side cricothyrotomy.

With seconds passed away the doctors available and me was standing in front of him wishing the worst would not happen, the good time comes. The medication given started working. Rashes started subsiding.

He was transferred to ICU later, with my escort.

Some facts about anaphylaxis
Anaphylaxis is a severe allergic reaction that is rapid in onset and may cause death. There are usually prominent dermal and systemic signs and symptoms – sudden onset of skin rash, hypotension, bronchospasm (shortness of breath). The anaphylactic shock actually refers to the hypotensive stage in anaphylaxis.

The most common inciting agents in anaphylaxis are parenteral antibiotics, IV contrast materials and certain food such as peanuts, though it can also be idiopathic, which is no cause.

Anaphylaxis is a medical emergency that needs prompt, intensive and accurate management. The medical management includes oxygen, cardiac monitoring, intravenous access. Medication such as Piriton, Adrenaline and steroid are the first line medication for reversing the anaphylaxis. Adequate fluid is to be given if the person is in shock. 1 litre of normal saline is a must usually.

The worst scenario of anaphylaxis is inability to breathe due to airway edema, one of the presentations of allergic reaction. If intubation of advanced airway is not possible or prompt enough to be done, cricothyrotomy is the only option – make an incision to the neck and insert an airway for ventilation.