Sophie Farooque Profile picture
Clinical Lead in the UK's oldest allergy clinic. Elected member BSACI Council. #DrugAllergy #FoodAllergy #FOAMed #PerioperativeAnaphylaxis.
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29 Aug 19
#FOAMed

Today I saw a pat who presented in A&E with life-threatening asthma.

MET call. Hypoxic & acidotic & with a hx of asthma. They weren’t compliant with preventative inhalers.

@DrLindaDykes @drrobgreig @jfdwolff @iceman_ex @GongGasGirl @bagheera79 @MDaware
They were treated with back-back nebs, Mg2+, steroids etc.

Hx an hour after eating they had vomited & then went on to an asthma attack. An urticarial rash was also noted. Anaphylaxis was considered but dismissed as a differential. They were reviewed by ICU.
Anaphylaxis & Adrenaline (& this is documented) were discounted as i) No hypotension ii) 1 hour between the ingestion of food & onset of symptoms.

So certain were the teams this was *not* anaphylaxis the pat. was not sent home with Adrenaline. No tryptase was checked.
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13 Aug 19
Thread: perioperative anaphylaxis is a crime scene (analogy I give to patients).

Imagine a serious crime scene. Usually the person (drug) closest to the scene of the crime will be responsible (eg NMBA) but stimes it will be the person furthererest away who did it (eg Chlorhex).
Under cross examination some will deny being involved even though they are responsible (eg Teicoplanin). Some will falsely confess even though it wasn’t them (eg Atracurium). And some will usually own up (eg Co-Amoxiclav).
I am like a detective & have to figure out who (aka which drug) is telling the truth & which isn’t. That is why I need a full description from the policeman (the anaesthetist) who was there at the time about what went on (AAGBI form/chart).
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