You are called to the ward by a nurse because a patient is hypotensive. The patient is a 76 year old man admitted 3 days ago by your colleague because of pneumonia. He has a history of dementia and type 2 diabetes. The pneumonia was a clear-cut infiltrate on chest x-ray, and he has been treated with azithromycin and ceftriaxone.
The nurse says that when she gave the ceftriaxone dose (his 3rd), the patient was doing well. 20 minutes later she returned to check on the IV, and found that the patient had facial, lip and hand swelling, tachycardia (120/min), tachypnea (26/min) and a BP of 80/40.
What is your approach?
The Learning Issues:
1. How to react to unstable vital signs being given over the phone?
2. How to do a rapid initial assessment?
3. How to do a rapid secondary assessment?
4. When and how to react before you have full information in this situation?
5. What additional information do you need?
6. What is the emergency response to suspected anaphylaxis?
7. What precautions need to be taken for airway management?
8. What subsequent actions should be taken after emergency management?
Resources:
A very good full text reference from the CMAJ can be found here.
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