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Facial Swelling in a Patient With Penicillin Allergy
Case Study
The bedside nurse initiated a rapid response event after the patient was found to be in acute respiratory distress. Upon the arrival of the rapid response team, the patient was found to be a 34-year-old male with a history of alcohol abuse admitted a few hours ago for suspicion of aspiration pneumonia. He was receiving his first dose of ampicillin-sulbactam when he developed dyspnea and significant facial swelling.
Vital Signs
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Temperature: 97.6 °F, axillary
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Blood Pressure: 90/60 mmHg
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Heart Rate: 110 beats per min (bpm)
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Respiratory Rate: 32 breaths per min
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Oxygen Saturation: 80% on room air, 96% on 15 L/min non-rebreather mask.
Focused Physical Examination
The patient was a young male in severe respiratory distress, tachypneic using accessory muscles of respiration. Appropriate personal protective equipment was established, and the patient was examined. Visible pitting edema was noticed around the eyelids, lips, and throat. There was minimal air entry in bilateral lung fields with inspiratory and expiratory wheezing. The remaining examination was unremarkable.
Interventions
A cardiac monitor and defibrillator pads were attached to the patient. He was emergently given epinephrine 0.5 mg intramuscular with methylprednisolone 125 mg IV on suspicion of allergic angioedema and possible anaphylaxis. The patient was emergently intubated via the nasotracheal route and transferred to the intensive care unit (ICU) for further management.
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