Relationship Between Symptoms and Diagnosis
For the purpose of this assignment a paramedic working on a rapid response vehicle is called to a 46-year old female who is experiencing breathing difficulties. It is immediately apparent that the patient has a urticarial rash and a gross swelling to the lips, tongue and face. Whilst the patient is alert, it is clear that she is dyspenoeic. Primary observations confirm that the patient is tachycardic, tachypnoeic, hypoxic, and hypotensive. The patients’ blood glucose and temperature are within normal range. Due to the dyspnoea, it is
impossible to record a peak flow. Upon obtaining a thorough patient history, the paramedic discovers that the patient has just been prescribed Amoxicillin for a chest infection, she has no known allergies.
Whilst anaphylaxis seems likely, the initial differential diagnosis includes acute asthma, syncope and anxiety/panic attacks as many of the presenting symptoms are the same (Resuscitation Council 2006). For this reason, a more definitive guideline on rapidly diagnosing
References: ABBAS, A.K (2005) Diseases of immunity, 7th ed. Pilidelphia, Elsevier Saunders AACE, ASSOCIATION OF AMBULANCE CHIEF EXECUTIVES (2013) ANAPHYLAXIS CAMPAIGN (2014). Use of adrenaline inhalers http://www.anaphylaxis.org.uk/what-isanaphylaxis/knowledgebase/adrenaline-inhalers ANDERS, Diane, TRAUTMANN, Axel (2013). Allergic anaphylaxis due to subcutaneously injected heparin. Canadian Journal of Allergy and Clinical Immunology, 9 (1) ANDREAE (2009) http://www.bmj.com/content/339/bmj.b2489 BROWN SG (2005) http://www.priory.com/med/adrenaline.htm CAROLINE, Nancy (2008) CHOO KJL, SIMONS FER, SHEIKH A. (2009) Glucocorticoids for the treatment of anaphylaxis. Cochrane Database Syst Rev. 2009;1:CD007596. http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2010.02424.x/full FLOCKTON, Ruth (2007). Use of nebulised adrenaline in the management of steroid resistant stridor. Palliative Medicine, 21 (8) http://pmj.sagepub.com/content/21/8/723.extract GREAVES, IAN, et al. (2006) ‘Emergency Care’. A Textbook for Paramedics’. 2nd Edition. Saunders Elsevier. London GREGORY AND WARD 2010: Sanders Paramedic Textbook KEMP SF, LOCKEY RF (2002). Anaphylaxis: a review of causes and mechanisms. J Allergy Clin Immunol 2002;110:341-348 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683407/ KOBRYNSKI, Lisa (2007). Anaphylaxis. Clinical Paediatric Emergency Medicine, 8 (2), 110 – 116 http://www.clinpedemergencymed.com/article/S1522-8401(07)00027-4/fulltext LAXENAIRE MC. Epidemiology of anesthetic anaphylactoid reactions. Fourth multicenter survey (July 1994-December 1996)]. Ann Fr Anesth Reanim 1999;18(7):796-809. http://www.ncbi.nlm.nih.gov/pubmed/10486634 LEE, J.K., VADAS, P., (2011). Anaphylaxis: mechanisms and management. Clinical and Experimental Allergy, 41, 923 - 938 LONG A (2002) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC286326/ MULLER and HAERBERLI (2009) PUMPHREY RS, GOWLAND MH. Further fatal allergic reactions to food in the United Kingdom, 1999-2006. J Allergy Clin Immunol 2007;119(4):1018-9. http://www.ncbi.nlm.nih.gov/pubmed/17349682 RESUSITATION COUNCIL (2008) Emergency treatment for anaphylactic reactions: guidance for healthcare providers http://www.bmj.com/content/312/7023/71 SAMPSON et al, (2005) http://www.jacionline.org/article/S0091-6749(05)00032-1/abstract SHEIKH, A., et al (2007) SIMONS, F E, PETERSON, S, BLACK, C D. (2001b) Epinephrine dispensing for the out of hospital treatment of anaphylaxis in infants and children: a population based study. Ann Allergy Asthma Immunol. 86(6) 622–626. http://www.priory.com/med/adrenaline.htm SOUTH, MIKE, WILLIAMS, KATRINA (2012) http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2012.02436.x/full STONE, SHELLEY AND BROWN, SIMON (2011) http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002326 SNOWDEN, RACHEL (2009) WALKER, Tracey (2013). Study highlights need to study anaphylaxis prevention. Formulary, 48 (11) http://connection.ebscohost.com/c/articles/92036256/study-highlights-need-address-anaphylaxis-prevention http://www.ncbi.nlm.nih.gov/pubmed/24008815 ZHOU et al (2011)