Around 40's male admitted for antibiotics and debridement of his wound infection at right leg. Nurse started Vancomycin drip since 8:30pm last night. Patient was well and did not have any history of allergy or significant medical diseases.
Patient complained of bilateral eye redness and dry coughing around 9:20pm. On arrival after being called, i noticed he had injected bilateral conjunctiva. Patient was subjectively comfortable with breathing. Quite easily linked to Vancomycin allergy, i stopped the drip and gave him an antihistamine shot.
However, his symptoms did not subside and progressed to dyspnea with SpO2 down to 95%. Hoarseness was also noted. So i ordered Hydrocortisone shot hoping that it could suppress the allergic reaction soon enough before his larynx became obstructed. I explained to family and patient that emergent intubation is expected if his symptoms progress.
Things kept stuck when his symptoms persisted without obvious progression. To prevent laryngeal edema progressing to complete obstruction and cause difficult intubation, I requested otolaryngologist to come over with his fibro-optic laryngoscopy to prepare for intubation. Meanwhile, i ordered epinephrine shot which was my last resort. After 2 mins, his symptoms subsided and his voice became much louder. But there was still increased lacrimation from his eyes and edematous changes of bilateral conjunctiva.
ENT doctor evaluated his larynx and confirmed edema of larynx. But there was no emergent compromise of upper airway. And the patient now is doing alright.
PS: when to perform intubation? and give epinephrine? Still need to think about them!
I've learnt and grown up through this incidence and i am glad that i did SAVE a life !!!
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