On the Other Side of the Gurney

On the Other Side of the Gurney
Anil Rickhi Emergency Physician

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I am a physician trained in Emergency Medicine and Psychiatry. 

I would like to open up this discussion called "Anaphylactic Shock Secondary to Peanuts, Lentils, Pine Nuts, Tree Nuts etc."

I have these severe allergies and would like to speak to you today how it feels to be on both sides as a provider and patient. 

It wasn’t too long ago that I was doing an Emergency Medicine shift at the Halifax QE2 Hospital. Upon my arrival, I usually stop be the pharmacy where I purchase a protein bar which is labeled "(may contain traces of peanuts)". This had been a monthly routine for me until one day. 

As I entered the elevators donned in my scrubs, lab coat, stethoscope etc and hit the first floor to the ER I opened my protein bar and took a bite while in the elevator. Within seconds, my throat started to close up and I could no longer breathe. As soon as the elevator doors opened, I proceeded my way to the ER where I was met with a horrified triage nurse.

Subsequently, within seconds, I was on a resuscitation bed with corticosteroids being injected into me nonstop for my breathing. I stayed the night in ICU.

These all too common experiences occur among patients presenting with Anaphylaxis.

As a physician, I recommend not only carrying around an Epipen, but Benadry, an H2 antagonist such as certrizine and perhaps 50mg of prednisone. This can be a life-saver and in today's society, I am concerned that peanuts are still being served on planes when someone could potentially die. Choosing between pretzels or peanuts vs. a human life should be more accommodating.

The reason I bring this up is because recently in elementary schools there has been some controversy if you're allowed to eat peanuts when there has been a reported case and documented doctors note of the danger. 

We never asked for this disease. We know you would not rather us die then having your peanut butter sandwich. Please educate yourselves more on how deadly this can be. I have personally have been waiting to receive a patient in an an ambulance bay over 10 times that I can recall. Despite our best attempts we could not resuscitate these patients who were mostly young children. 

Typically if you have anaphylactic shock, you should administer an Epipen to your thigh immediately. This will help your airways open, but it is only for a limited time window to get to the hospital. It is not a cure. Typically upon arrival you will be triaged and taken in right away. We insert two IVs in while taking your vital signs. Most people who are in anaphylactic shock are given other medications and may have a tube put down your throat to help you breath.

While this can indeed be very frightening and deadly. I suggest people put together an anaphylactic emergency kit to have close by. This should contain the following: An Epipen, Benadryl, Ranitidine 300mg (in most countries it is over the counter). You may also want to your physician about getting 50mg of prednisone. There is some evidence that this can be useful to prevent what we call post anaphylaxis.