At 88, Fred lived independently in a small apartment and took meticulous care of himself. On mild days, he donned a dress shirt and tie and used his cane to walk to the newsstand a block from his home for the morning paper. He then walked another block to a local pancake house for a late breakfast and a “bottomless” cup of coffee.
One particularly warm day, Fred found the restaurant door propped open because the air-conditioning was not working. It was hot inside, but Fred occupied his usual seat and rolled up his sleeves. Without warning, he slumped over. Fred was eased to the floor by one waitress, while another called 911. Within minutes, an emergency medical technician (EMT) and a paramedic assessed Fred and called me at the hospital emergency department for medical advice.
Fred was only semiconscious and could not answer any questions. His pulse was weak, and his blood pressure was so low that it was almost unmeasurable. He was flushed and covered in sweat. At first, we suspected heat exhaustion, but we then realized that Fred hadn’t been inside the very hot pancake house long enough for that to be a strong possibility. Then, as the paramedic began to prep Fred’s arm for an IV site, he noticed a medical alert bracelet that said “bee sting allergy.” At that moment, the paramedic remembered that he had seen a few yellow jackets swarming around inside the restaurant—no doubt attracted by the maple syrup just beyond the open door. The paramedic promptly ruled out two other possible problems that could have led to Fred’s partial loss of consciousness—a quick check showed that Fred’s cardiac rhythm was slow but normal, and his blood sugar level was OK.
We had enough evidence at this point to treat Fred for a severe reaction to an insect sting—anaphylactic shock (a life-threatening allergic condition). The paramedic gave him an injection of epinephrine, hydrating fluids, a steroid and an antihistamine intravenously. The EMT administered oxygen to assist Fred’s breathing. Remarkably, before they had time to get Fred out to the ambulance, he was wide awake! And before regaining full consciousness on the ambulance gurney, Fred had said that the last thing he recalled was a “prick” in his left forearm—that’s when he was stung. Fred arrived at the hospital with normal vital signs, saying he felt, “100% normal.” I made Fred promise that he would add “yellow jacket stings” to his bracelet as soon as possible.
Fred’s experience should encourage anyone who has a serious allergy—be it to insects, food or medication—to get and wear a medical alert bracelet, pendant or other form of jewelry at all times. These relatively inexpensive pieces of jewelry, available at drugstores and online for as little as $7.99, can speak volumes when you cannot. Moreover, epinephrine self-injectors are available by prescription and should be carried by patients with serious allergies after their doctors explain how to use them. Oftentimes, there is time for the patient to administer his/her own injection…and the medical alert jewelry is a great backup.
Source: Richard O’Brien, MD, is an attending emergency physician at Moses Taylor Hospital and an associate professor of emergency medicine at The Commonwealth Medical College of Pennsylvania, both in Scranton. He is also a spokesperson for the American College of Emergency Physicians. www.acep.org