Anaphylaxis. It’s a life-threatening allergic reaction to any number of things…bees, shellfish, peanuts…and the reason that people carry “epi-pens” around with them.

Last night, a man in his 50s who’d never had an allergic reaction before was wheeled in unresposive, driven to the ED by his wife after eating at a chinese restaraunt. He was slumped in the wheelchair, red as a beet, with his lips swollen up tense like a puffer fish.

A surreal sense of deja-vu surrounded myself and my colleague as we and the nurses got him onto a stretcher, monitored and started treatment with epinephrine. That’s when things stopped running smoothly. Suddenly, everything became confusing, chaotic and time-consuming. I prepared intubation equipment and tried to look inside his mouth. His tongue was swollen beyond recongnition. His eyelids barely opened. He was given sub-q epi, as a temporizing measure while we obtained IV access and prepared other IV meds.

He slowly became more striderous. We called for the “cric-kit” which wasn’t anywhere close. (Remember the MASH episode where father Mulcahey sticks a pen into some guys throat to help him breath? That’s basically what’s in the kit, except it’s not a pen, and it’s sterile.)

We pushed the IV epi and slowly, his redness faded, his hives eased and his lips became less tense. He was awake and talking, blinking. He told us he felt better, but boy, he was still pretty scary looking.

THe entire time, we could not obtain a blood pressure so I finally put in an arterial monitoring line. We ultimately got him up to the ICU, unitubated, to be placed on an EPI drip among other things. I’m sure it’s not what he bargained for when he and his wife decided to have chinese for dinner.