|
|
Post by Bjs04f on Aug 9, 2015 5:43:35 GMT -5
 Hey man I snorted some cocaine an hour ago and I cant swallow, habing hard time breathing and throat feels tight. Guy is tachy and hypertensive due to cocaine. Clearly having a reaction, uvula obstructing any view of the aiway. Management go! |
|
|
|
Post by tyson on Aug 9, 2015 21:33:10 GMT -5
First of all, are you allowed to come into the ER complaining of an allergic reaction to cocaine? Is that in the rulebook? Excellent photograph.
I think with this guy my first thought would be to try and avoid epinephrine in the setting of cocaine. I'd likely give him some Ativan and shot of decadron. Treat him as a uvulitis/bonehead. .
If symptoms worsen or there were systemic symptoms like shortness of breath, flushing, hives then I would consider further steps like Epi, Benadryl, Pepcid, tube etc.
|
|
|
|
Post by kemple on Aug 9, 2015 22:28:31 GMT -5
Amazing! That's one for the EM Resident magazine. That being said agree with Tyson avoid epi unless absolutely necessary. Go with the other tx options aggressively.
|
|
|
|
Post by Bjs04f on Aug 10, 2015 1:12:19 GMT -5
yeah was quite the dilemma, the guy looked like an epiglottitis, sitting in tripod drooling everywhere, with zero airway to be seen. Decision was to cardiac monitor and try IM epi with repeat ekg after each. 4 rounds in he was able to sit back and breath comfortably. Decided to be agressive with him based on how difficult airway management would be in him if things went wrong
|
|
|
|
Post by Bjs04f on Aug 10, 2015 1:13:09 GMT -5
also related made a dirty epi drip for a pt in anaphylatic shock from bee stings. 1 cardiac epi in NS bag wide open. awesomeness
|
|
|
|
Post by kemple on Aug 10, 2015 13:46:59 GMT -5
also related made a dirty epi drip for a pt in anaphylatic shock from bee stings. 1 cardiac epi in NS bag wide open. awesomeness Who did you do that with? |
|
|
|
Post by pbruss on Aug 11, 2015 18:41:11 GMT -5
dont forget about glucagon in thses situations.
|
|
