Maintain pressure on reforms to protect NHSClinical Skills Challenge - case 5
This 24-year-old lady was admitted at 9pm with wheeze and shortness of breath. Can you make the correct diagnosis?
History of presenting complaint
She was at a restaurant having dinner with her partner. She had just finished her main meal of lobster when she felt generally unwell. Within 15 minutes she had become quite distressed with a wheeze and short of breath. She felt her lips tingling and become a little swollen.
On admission
This lady is terrified and distressed. She is very wheezy and has marked angio-oedema affecting her lips. Her skin is quite flushed.
Past medical history
Asthma as a child.
Appendicectomy 4 years ago.
Allergic to aspirin.
Table 1: Vital signs on admission
| Blood pressure | 84/60 mmHg in both arms |
| Pulse | Rate 120 per minute and regular |
| Respiratory rate | 45 per minute |
| Temperature | 36.4oC |
| Oxygen saturation | 86% on high flow oxygen |
Bloods
Her full blood count and U&E’s were all within normal limits.
- Arterial blood gas showed acute respiratory acidosis with hypoxia. PO2was 9.2 kPa on high flow oxygen.
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Readers' comments (84)
amanda Bushell | 2-Oct-2008 6:57 pm
It appears from the history leading up to the events that this lady is could be having an anaphylactic reaction. due to the angiodema to the lips & drop in BP and low sa02. her medical history shows she had asthma as a child & with allergy to asprin
indicates she is hypersensitive to some substances
1 of the common allergens is seafood & as she has consumed the lobster this seems to point to an anaphylactic reaction.
Anaphylactic reactions are potentially fatal , but can vary in severity.
she needs a anti-histamine & an injection of adrenaline 1:1,000
and repeated injection. if no improvement after 5-10 mins
Mandy Bushell Community staff Nurse
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Anonymous | 3-Oct-2008 5:34 am
anaphylactic shock
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angie perez | 5-Oct-2008 12:25 pm
severe allergic reaction to ? lobster, anaphylactic shock.
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magda jadczak | 5-Oct-2008 11:02 pm
in my opinion its model case of anaphylactic shock after food alergen
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Nicky Broadley | 6-Oct-2008 4:37 pm
The patient is suffering from anaphylactic shock from an allergic reaction to the lobster.
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Andrew Johnston | 6-Oct-2008 11:27 pm
From this ladies symptoms i am guessing shes having an Anaphylaxis reaction to shellfish. This would explain her tingling, wheeze and the angio-oedema affecting her lips. The Flushing would maybe be cased by the effort in trying to gain more oxygen through her breathing. Low blood pressure, high pulse rate, high respiratory rate and low 02 saturation are all common signs in anaphylaxis.
Treatment for this condition would be the administration of 1:1000 adrenaline an adult takes 500 micrograms IM (0.5 mL), This will be done via intramuscular injection, and reapeated after 5 minutes if no improvement. An antihistamine such as Chlorphenamine (Dose 10mg IV) and a Steroid like Hydrocortisone ( Dose 200mg IV) can be given to help reduce the reaction. Also as this lady has low blood pressure, fluids such as 0.9% saline solution could be given to titrate against low BP.
Once this lady is ready for discharge, a medi-alert braclet should be presented to the paitent to warn others of the allergen. As well as the use of an epi-pen incase of a secondary reaction. Finally allergen testing could be use to rule out other allergies, as she could be considered hypersensitive due to her history of asthma.
Andrew Johnston
Student Nurse
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NACHINGA KUNDA | 7-Oct-2008 12:57 pm
Was suffering from anaphylactic shock with some complications of airway obstruction (asthmatic rection and circulatory collapse with severe hypotension.
Treatment- intramuscular adrenaline, intravenous chlorpheniramine 10mg,high flow oxygen, intravenous fluids and intravenous hydocortisone.
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susan marston | 9-Oct-2008 3:17 pm
anaphylactic shock
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Caroline Taylor | 9-Oct-2008 8:51 pm
Due to this lady having eaten lobster and having angio odema, wheezing, shortness of breath, hypotension and tachycardia, I would suggest she is suffering from anaphylaxis.
Caroline T.
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Anonymous | 10-Oct-2008 4:08 pm
I have just enrolled on the Nursing Diploma at DMU University. Althiugh I have a limited knowledge I can identify 2 vital signs.
Based on the evidence I would diagnose antigalatic shock. Indicators being a swollen mouth and low blood pressure.
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Mary Saunders | 10-Oct-2008 7:59 pm
anaphlactic shock
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Anonymous | 13-Oct-2008 6:49 pm
As the lady had eaten seafood and developed the symptoms described, I thin it is suggestive of an allergy causing anaphylactic shock
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Anonymous | 14-Oct-2008 6:22 pm
the symptoms the young lady is experiencing would suggest that she is sufferong from a allergice reaction to the lobster she has consumed
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PAULA curtis | 14-Oct-2008 8:18 pm
allergic reaction to shellfish that may be developing into anaphylaxis
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Anonymous | 14-Oct-2008 8:39 pm
Diagnosis is of anaphylactic shock.
Needs intravenous antihistamine (chlorphenamine 4mg), IM adrenaline, salbutamol nebuliser and high flow oxygen (10 litres flow rate via non re-breathe mask).
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Anonymous | 15-Oct-2008 7:47 am
seafood allergy
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Anonymous | 15-Oct-2008 8:15 am
anaphylaxis due to shellfish
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debbie thomas | 17-Oct-2008 7:06 pm
Diagnosis: As this lady is short of breath and wheezy,she can be diagnosed as exacerbation of asthma and chest infection.
>As she has swollen lips and reddness and allergic to aspirin,she could have had an allergic reaction which could have led to anaphlactic shock .
Treatment: 100% oxygen, Use first line drugs like adrenaline,intravenous fluids,and when patient ismore or less stable give hydrocorttisone iv,and salbutamol nebulisers.
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Anonymous | 19-Oct-2008 9:33 am
This lady is suffering from anaphalaxis caused by an allergic reaction to shellfish.
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Anonymous | 20-Oct-2008 8:12 am
Anaphalaxis due to seafood
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