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29 March Ceftriaxone Anaphylaxis ShockYesterday, I heard a special case from our chief resident during lunch time. Last year, a male patient, 70y, Admission Diagnosis:Pneumonia. This patient had refuse any anaphylaxis of Penicillin G. AST(-). Therefore Ceftriaxone + Levofloxacin had been given along with fluid therapy and antipyretic treatment. Before long, the patient’s temperature was coming down gradually and his respiratory symptom relieved. But in the 3rd day after admission, the patient suddenly appeared bark coughing, hoarseness when Ceftriaxone iv drip, soon symptoms: aphonia, dyspnea, larynx wheezing and roaring sound were observed. First impression: Phlegm Blocking and Tracheospasm, so sputum aspiration, oxygen therapy and aminophylline iv drip were underwent ( no steroids use for the patient also have Diabetes Mellitus, and that was laterly proved it was our wrong doing), as well as Arterial Blood Gas Analysis. Situation deteriorating rapidly, the patient soon appeared ARF(Acute Respiratory Failure), emergency intubation for mechanical ventilation was immediately operating on, but in vain. Trachea Incision was too late…Few days later, body anatomy report: Allergic Caryngeal Edema Asphyxia. Although Anaphylaxis of Penicillin G is not unusual, Delay Allergic Reaction is rarely seen. So far only several cases reported worldwide. However, we have to learned our lesson well from this case for early prevention of Delay Allergic Reaction from now on. 22 March I admit I couldn't see the forest for the trees in this caseThis evening, an ambulance 120 took an unconscious patient to my ER. This patient, F,35y. Her relatives said: "She suffered vomit at home where they found a bottle of insecticides on the ground, then lost her conscious." PE: Vital T36℃, P90, R16, BP 110/88, in acute illness, with asthenia pallor, a cool skin, and strong garlic odor, pupils 3mm, react equally to light, no other abnormity found. Immediate treatment according to Diagnosis of Acute Organophosphates Poisoning was underwent: gastric lavage, Atropine 1mg iv each 15min. After gastric lavage, patient’s conscious partly regained. After iv Atropine 5mg, patient appeared crying:”I didn’t drink insecticides!, I just drank spirit!” Shortly she appeared Atropinized symptom:mydriasis,flush and dry skin, tachycardia. Suddenly I realized my Diagnosis maybe wrong and suspended Atropine using. After examined patient’s relatives about whether spirit bottle was also found, “There was indeed a spirit bottle on the ground as well!” the strong garlic odor probably cause by insecticides spatter when patient fell to the ground! in addition to previous PE: no miosis, no diaphoresis, no fasciculation. I had to admit I couldn’t see the forest for the trees in this case. Hours later Lab Center reported Blood Cholinedterase normal. Corrected Diagnosis:Acute Alcoholic Poisoning. |
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