A-Typical anaphylaxis

[MacBook]

I do not have a lot of info for this pt but I will post what I can. I am thinking Anaphylaxis.

21 y/o female. Helping friend move when suddenly got very hot and short of breath. Walked into hospital with audible wheezes and stridor. Stridor on inspiration, acc muscles very involved, resps around 36 maybe more. Very pale, unable to speak.
BP 102/68 P98 Spo2 79.
Air entry silent in bases, obvious wheezes in apex's, upper airway stridor.

That's it, no edema, no swollen anything, no uticaria, no nothin!

No PMHx. No asthma, No known allergies.

Tx, epy (unknown amount), ventolin 10mg, a steroid. There may be more, but this is all I was told.

So anaphylaxis? Please clue me in.
(originally I thought first asthma attack, but the stridor and the rapid onset and speed of progression threw me off)

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[pianoman511]

I do not have a lot of info for this pt but I will post what I can. I am thinking Anaphylaxis.

21 y/o female. Helping friend move when suddenly got very hot and short of breath. Walked into hospital with audible wheezes and stridor. Stridor on inspiration, acc muscles very involved, resps around 36 maybe more. Very pale, unable to speak.
BP 102/68 P98 Spo2 79.
Air entry silent in bases, obvious wheezes in apex's, upper airway stridor.

That's it, no edema, no swollen anything, no uticaria, no nothin!

No PMHx. No asthma, No known allergies.

Tx, epy (unknown amount), ventolin 10mg, a steroid. There may be more, but this is all I was told.

So anaphylaxis? Please clue me in.
(originally I thought first asthma attack, but the stridor and the rapid onset and speed of progression threw me off)

Well, from the sound of things, the treating physician thought that it was an anaphylactic reaction due to the epi administration. Due to the rapid onset it does sound plausible.

Secondly, upper airway stridor means that edema was present. I can't think of anything else that could cause stridor other than an object in the airway.

 

[leviathan]

I do not have a lot of info for this pt but I will post what I can. I am thinking Anaphylaxis.

21 y/o female. Helping friend move when suddenly got very hot and short of breath. Walked into hospital with audible wheezes and stridor. Stridor on inspiration, acc muscles very involved, resps around 36 maybe more. Very pale, unable to speak.
BP 102/68 P98 Spo2 79.
Air entry silent in bases, obvious wheezes in apex's, upper airway stridor.

That's it, no edema, no swollen anything, no uticaria, no nothin!

No PMHx. No asthma, No known allergies.

Tx, epy (unknown amount), ventolin 10mg, a steroid. There may be more, but this is all I was told.

So anaphylaxis? Please clue me in.
(originally I thought first asthma attack, but the stridor and the rapid onset and speed of progression threw me off)

There is a rare phenomenon called exercise-induced anaphylaxis, which has something to do with lowering of the threshold point for mast cell degranulation. It could also have been a severe case of exercise-induced asthma. Epi is not given solely for allergic reactions and is a useful drug for severe bronchospasm refractory to ventolin, so the physician wasn't necessarily thinking this was anaphylaxis.

 

[MacBook]

Sometimes feel I'm not thinking outside the box, enough to really figure out whats going on. Appreciate the well thought out replies folks.