Crew responded code 4 to possible allergic reaction. PT was a bad historian, who states he has a chest pain post being stung by a wasp. Pt had swelling on the left side of his lower lip where he got stung. PT complains of dizziness/lightheaded. PT had no adventitious sounds in the lungs. PT complained of mild nausea with no vomiting. No incontinence. PT complained of weakness as well. During the assessment, pt complains of chest tightness post the wasp sting, all the answers to CP questions were leading the crew to believe that patient was experiencing ischemic chest pain. Pt states he has hx of allergic reaction to bee sting. Vitals: 58, sinus bradycardia with LBBB in 12 leads noted. BP: 86/42, RR 22, Sat of 90%. 
 
In this case, pt is showing signs of anaphylaxis with multiple symptoms being affected and known allergen exposure, but complaining of ischemic sounding chest pain. Is the crew to be treating with Epi, or should the crew withhold the epi as patient may have ischemic chest pain and it can worsen the cardiac symptoms? 

If there is clinical uncertainty with regards to best treatment to provide, a consult to the BHP would be helpful in these unique situations. The BHP can then use all patient historical and physical exam findings to assist with decision making. Without having all the information at hand, in the setting of anaphylaxis this chest discomfort could be caused by ischemia due to the hypotension or may be secondary to bronchoconstriction.  Consideration may be that the hypotension is driving the cardiac ischemia, or thus treating the underlying cause (anaphylaxis) may alleviate this chest discomfort.  

Airway/Breathing,Cardiac Ischemia,Cardiac/Circulation,Moderate to Severe Allergic Reaction

Allergen, Anaphylaxis, Chest pain, Epinephrine

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