ALLERGIC REACTION

PATIENT PARTICULAR
Name : Mr xXx
Age : 33 years old
Race : Kadazan
Sex : Male
 TRIAGE
C/O :
Patient came to etd complaint of chest pain and
rashes whole body. History, after eating maggie
ayam last night started rashes and itchiness over
body.
 TRIAGE
Primary
Airway Airway clear, open, no shortness
of breath
Breathing Not Tachypneic, breathing
pattern, RR : 18/min
Circulation Good pulse volume, CRT < 2sec,
Disabilty Able to walk, conscious, alert
 MANAGEMENT AT RED ZONE
Put patient at red zone bed, put on cardiac monitor
Patient vital sign
BP : 142/105 mmhg
PR : 116 bpm
RR : 18/min
SPO2 : 98% under room air
Given medication stat
o IV Hydrocortisone 200mg stat
o IV Ranitidine 50mg stat
o IV Piriton 10mg stat
o MMT 30ml stat
Taken blood investigation such as FBC, ABG, BUSE
Serial ECG for assessment due to chest pain
 SECONDARY SURVEY
History
Chief complaint
Patient claim rashes whole body and itchiness, associated
with chest pain. Patient denied no tightness neck. Airway
open not shortness of breath

Past Medical History

No known case of medical illness

Past Surgical History

No known case of surgical illness
Family history
Patient was the eldest son of four siblings.

Social History
No history of drugs abuse
Heavy smoker 1 packs perday
Alcoholic
 VITAL SIGN
BP : 121/69 mmHg
PR : 101/min
SPO2 : 100% ( RA)
TEMP : 37.3C
PS : 4/10
RR : 17/min
 PHYSICAL EXAMINATION
Body Examination
Chest = symmetrical chest movement
Lung = air entry equal
Abdomen = soft, not distended, not
tenderness
Upper extremities = no abnormalities
Lower extremites = No abnormalities
Impression : Allergic Reaction
 DISCUSSION
Definition
Allergic reactions are sensitivities to substances
called allergens that come into contact with the
skin, nose, eyes, respiratory tract, and
gastrointestinal tract. They can be breathed into
the lungs, swallowed, or injected.
 SIGN AND SYMPTOM
Itching
Nasal congestion
Rashes
Watery, red eyes
Abdominal pain
Anxiety
Chest discomfort or tightness
Cough
Diarrhea
Difficulty breathing, wheezing
Difficulty swallowing
Dizziness or light headedness
Flushing or redness of the face
Nausea or vomiting
Palpitations
Swelling of the face, eyes, or tongue
Unconsciousness
Management

1. For a mild to moderate reaction:

Calm and reassure the person having the reaction. Anxiety can
make symptoms worse.

Try to identify the allergen and have the person avoid further
contact with it.

If the person develops an itchy rash, apply cool compresses and

an over-the-counter hydrocortisone cream.

Watch the person for signs of increasing distress.

Get medical help. For a mild reaction, a health care provider

may recommend over-the-counter medications, such as
antihistamines.
2. For a severe allergic reaction (anaphylaxis):

Check the person's airway, breathing, and circulation (the ABC's of Basic Life Support). A
warning sign of dangerous throat swelling is a very hoarse or whispered voice, or coarse
sounds when the person is breathing in air. If necessary, begin rescue breathing and CPR.

Call 911.

Calm and reassure the person.

If the allergic reaction is from a bee sting, scrape the stinger off the skin with something
firm (such as a fingernail or plastic credit card). Do not use tweezers -- squeezing the
stinger will release more venom.

If the person has emergency allergy medicine on hand, help the person take or inject the
medicine. Avoid oral medicine if the person is having difficulty breathing.

Take steps to prevent shock. Have the person lie flat, raise the person's feet about 12
inches (30 centimeters), and cover them with a coat or blanket. Do not place the person
in this position if a head, neck, back, or leg injury is suspected or if it causes discomfort.
 REFERENCES
Lieberman P, Nicklas RA, Randolph C, et al.
Anaphylaxis -- a practice parameter update
2015. Ann Allergy Asthma Immunol.
2015;115(5):341-384. PMID: 26505932.

Wasserman SI. Approach to the patient with

allergic or immunologic disease. In: Goldman L,
Schafer AI, eds. Goldman's Cecil Medicine. 25th
ed. Philadelphia, PA: Elsevier Saunders;
2016:chap 249.