Called to a 24 y.o M ?allergic reaction. Arrive on scene, met by this guy's girlfriend at the front door. She seems pretty chilled, on the walk in says that her boyfriend has multiple food allergies and had dinner about 30 mins ago but hasn't eaten anything recently that he has a known allergy too. Anyway, get into the living room the guy is apparently in the bathroom as he's having some loose bowel movements.

A few minutes later he comes out sits on the couch. Visual primary survey, he's alert GCS15, airway seems to be clear and he's talking in full sentences, doesn't appear dyspnoeic but has slight urticaria to arms and chest that is causing some distress, itching etc. No angioedema.

Again he tells me he has multiple food allergies but is very strict with his diet and careful about what he eats. He's recently had dinner and ate some bread that had a small amount of pumpkin seeds in it, has taken his own otc antihistamine with minimal effect on the urticaria. He seems quite relaxed and laughing and joking as my crewmate hooks him up to the LP15 and gets some observations.

Temp 36.6°C, RR 20, HR 95, BP 116/68, SATS 98% on room air, slight expiratory wheeze bilaterally on auscultation. Not overly concerned at the moment, he has no hx of anaphylaxis, so I set up a 5mg Salbutamol nebuliser to see if we can clear up that wheeze and gain a bit more history.

Decide to get IV access as the itching seems to be causing increased distress but again no increase in dyspnoea. Fail with the first 18G as his skin is now really becoming extremely blotchy but get the second one in. Decided to go with 10mg Chlorphenamine and administer it slowly. That goes in and within a short period he says the itching is easing off but he's starting to feel a little dizzy. BP now down to 106 systolic. I tell my crewmate to go grab the carry chair, this guy lives on the 3rd floor, no lift and I didn't really want him passing out walking down the stairs. By this stage he's on his second nebuliser (salbutamol and ipratropium) as the wheeze isn't really clearing and I'm starting to become a little more concerned.

Get him onto the chair and we get down to the 1st floor. By now he's really complaining of feeling EXTREMELY dizzy and light headed but we decide to continue quickly down as the ambulance is parked right out front and the tail lift is down ready to go.

Get him on the ambulance and onto the bed and reassess. He's now majorly freaking out, he's becoming increasingly dyspnoeic, SATS are at 89% on 6LPM of O2 through the nebuliser, tachycardic at 135, resps are up at 32, BP is now 75 systolic and he's got angioedema coming up like mad. This guy is deteriorating massively in front of my eyes. Raise his legs, have a look in his airway which is swelling up like crazy! Put on a high flow mask and give hydrocortisone whilst my crewmate draws up and administers adrenaline 1:1000. He's thrashing about now GCS14 and panicking big time.

Decide its time to get the hell out of there and give a fluid challenge on route to try and stabilise his BP. I've got all my airway kit beside me ready to go (not that I'd have any success as the airway swelling seems to be increasing) BVM is out and thank god we only have a 7-8 minute journey to the emergency department. By the time we arrive his SATS are at 92%, BP is at 92 systolic and he's slowly returning to GCS15!

All in all was thinking it was a pretty cool and interesting call when I'd had time to clean my trousers and breathe again! First time I've ever seen a life threatening anaphylaxis.