Reaction to Platelets

[island emt]

My sister in law has a Benedryl allergy.

It IS NOT the dye in the liquid and the capsules.

She has quite a few food allergies and medication allergies also.

True allergies with hives and swelling of the airway, not just the common itching feeling or naseua that many pt's report.

I'm with Ruff on not giving a documented medication allergy without Dr's orders, I'd be heading for Epi if something is really needed .

Edited May 29, 2013 by island emt

[1EMT-P]

I followed up on this patient 24 hours later. It turns out that the infusion center staff had increased the rate at which her platelets were running. They also double checked everything, the platelets were fine. After arriving at the ER she developed increased hives, itching & swelling of the face & throat. She was given an additional dose of 0.3mg IM Epi, along with 25mg IV Phenergan & 20mg IV Pepcid. Then transfered to a larger facility for further evaluation.

[scubanurse]

That's crazy! I've usually seen s/s of fluid overload with increased rates of infusion, not anaphylaxis. Very interesting case, sorry I didn't chime in sooner!

Thanks for sharing!!

[Eydawn]

I've seen this... it can be a reaction to antigens left in the platelets or FFP (I've seen it more with FFP than with platelets, but it's a risk with any blood product I would think).

Our protocol says for mild urticarial to give antihistamines and steroids... if she were truly allergic to Benadryl you bet I'd be calling for a stat promethazine order. The claritin PO is good to have on board, but we need the old school fast acting stuff here...

For anaphylactic our protocols call for epi, steroids and oxygen (and a stat page for a rapid response team).

For this chickie, steroids and a run to the ER, watch the airway, be ready to hop on the epi if it looks like she's becoming more compromised. For the fellow who said bag her or put 15 LPM NRB- dude, she just got a neb tx, of course her resp rate will be elevated (along with her heart rate). Ever had one? She's fine. Her sats are fine. She's compensating well. We just need to support her and watch her carefully lest she decompensate on us, in which case we've got a mess on our hands.

Wendy

CO EMT-B

RN-ADN

[uglyEMT]

For the fellow who said bag her or put 15 LPM NRB- dude, she just got a neb tx, of course her resp rate will be elevated (along with her heart rate). Ever had one? She's fine. Her sats are fine. She's compensating well. We just need to support her and watch her carefully lest she decompensate on us, in which case we've got a mess on our hands.

Wendy

CO EMT-B

RN-ADN

Thanks Wendy. Didn't realize the neb treatment did that. No I have never had one nor a patient that had one. Most I have had was handheld inhalers. I did say i would be ready to bag, as you said in case she decompensates I want to be ready thats all. The 15 NRB was because of the shallow resperations but again I didnt realize the neb would do that. I was just going by my inhaler treatment protocol which is after treatment if patient doesnt respond with normal full breaths give 15 lpm NRB, call for medics, meet in route, load and go. Just fell back on my stuff thats all.

Thats why I love this place, I get exposed to things I haven't had before and get to know from others experience what to look for and what treatments are advised.