possible allergic reactions?

[jotond]

Hello everyone, long time reader, thanks in advance for your input! I had two situations this week that I'd like some feedback on.

First, was administering two units of platelets to a cancer patient. First one was infused and shortly after, before I hung the second, patient stated that she felt a nasal congestion all of a sudden, with a slight sinus type of headache. Her vitals were unchanged, temp remained in the 36 C range, no shortness of breath or other symptoms. I asked another nurse what she thought and she didn't think it was a reaction. I researched blood transfusion reactions in our policies, and headache was listed as a possible reaction, but I didn't think on its own it was truly a reaction without VS change, or other symptom. However with the stuffy nose? At any rate, the second units of platelets was infused and her symptoms remained the same. I reported off to the next RN and went home, end of story. Also, she had been premedicated with tylenol and benadryl.

Second situation, working in the ED and patient definitely did have an allergic reaction to IV contrast following return from CT scan with profound angioedema. No SOB, difficulty swallowing, VSS, patient seeming ok. MD notified and rec'd orders for solumedrol 125, benadryl 50 and zantac 150 - IV for all 3 of course. Shortly after I gave solumedrol and benadryl (was waiting on zantac from pharm but that's another story...) patient became very agitated, tachy up to 148, yelling she can't breathe, diaphoretic. We put her on a nonrebreather, no other meds given, her heart rate returned to NSR and her anxiety lessened after a couple of minutes. No stridor or wheezing, SaO2 never less than 95%. Do you think this was an escalation of sorts of the allergic reaction? It seemed to happen RIGHT AFTER I gave benadryl and solumedrol. Perhaps a reaction to either of these medications?

Also, this ED situation was happening concurrently while I had a crying baby in another room (who was fine but still, the crying...), another patient needing to go to OR.... my coworkers were helping me obviously but I could feel my stress level shooting through the roof. Any suggestions on how to physically calm myself, any techniques you may utilize to stay focused and not feel like it is all on you? I know it can't be good for me to get so wound up and stressed out, nor is it good for my patients!

Thanks so much!

[Asystole RN]

The first patient could have had a sensitivy or maybe an environmental allergy not related at all. There are reactions and sensitivity to blood products and then there are full on allergic reactions. I am guessing environmental from the lack of any other corresponding S&S.

The second patient sounds like she had a anxiety attack. IV benadryl can make you VERY intoxicated, esp if pushed fast. She may have possibly felt the sudden rush from the benadryl and panicked.

Sounds like you had a very busy day, kudos to you.

[lckrn2pa]

The solu medrol induced the anxiety, common SE of steroids

[kids]

Shortly after I gave solumedrol and benadryl (was waiting on zantac from pharm but that's another story...) patient became very agitated, tachy up to 148, yelling she can't breathe, diaphoretic. We put her on a nonrebreather, no other meds given, her heart rate returned to NSR and her anxiety lessened after a couple of minutes. No stridor or wheezing, SaO2 never less than 95%. Do you think this was an escalation of sorts of the allergic reaction? It seemed to happen RIGHT AFTER I gave benadryl and solumedrol. Perhaps a reaction to either of these medications?

Having been both on the giving and the recieving end of IV solumedrol & benedryl...it was a side effect of the meds. Either of them alone can induce anxiety but benedryl seems to be the worst of the two.

[Isabelle49]

Jotond, my hair would have been standing end! You did well. To stay calm, stay focused and you seemed to do this well. Remember no one ever died from crying or complaining. Take frequent deep breaths and hum in your head for a few moments, or say a little prayer (mini-meditation) ,will help bring your anxiety/stress level down.

[resumecpr]

Benadryl and Solumedrol will cause a very hot feeling over the face and chest, sometimes cause the patient to feel like they can't breathe. Next time, ensure you push slowly and dilute well.

[jotond]

Thanks everyone. Never saw such a reaction to these meds before and I've been an RN for several years. Although mostly in ICU before ED so maybe I'm just used to my patients being sedated!

[Burnt Out, ASN, RN]

If you push Benadryl IV too fast, you can also cause a patient to go into bronchospasms: I've personally had that happen twice and it is a very scary feeling.