Sunday, August 21, 2011


I love a rewarding case - looking at a patient and knowing that my intervention and the care of my technicians saved its life. It is one of the things that is most awesome about ER medicine. One of my favorite things to treat - hands down - is anaphylaxis. I see this at a minimum of once a month. I am kind of an anaphylaxis magnet at work, for some reason. Maybe I'm just good at recognizing it, who knows? It took me a long time to realize that anaphylaxis was out there and to start looking for it in my inexplicably collapsed and poorly responsive patients.

Around 6am this morning, a medium sized dog named Lily presented to us. She had been normal that evening, then jumped on her owner's bed, collapsed, defecated and urinated on herself, and then proceeded to start vomiting.

When she got to us, Lily had barely palpable pulses. Her gums were a muddy grey-pink color. Her heart rate was 240 (normal 90-120). She was breathing hard and seemed very weak. Her blood pressure would not register. She had a rash along her ventral abdomen, and her body temperature was low.

Her owner was a disabled, elderly lady with $250 to her name. This is certainly not enough to treat a nasty anaphylaxis. On a weekend, these cases run into the $1200-2000 range. I was not hopeful when she applied for CareCredit, as she was on disability. I was decidedly wrong, as she was approved for $1800. We had already started working on her dog at that point anyway.

Within an hour of administering epinephrine and Benadryl, starting aggressive fluid therapy to bring her blood pressure up, administering dextrose for her low blood sugar, and re-warming her, Lily's heart rate was down to 120, her gums were pink and moist, and she was standing in her cage and showing interest in her surroundings.

When I left her this morning, her vitals were stable, her blood pressure was 120, her blood glucose was normal, and she was maintaining her body temperature on her own.

It is always immensely satisfying to take a dying dog and raise it Lazarus style from near-death. It really makes my job worth it (despite being up all night last night due to patients and having nearly constant Braxton-Hicks contractions all morning).

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