We have a young (15) female patient in that has been diagnosed with Hereditary Angioedema. This Pt has had some severe episodes in the past and has required intubation and admittance into the ICU multiple times. I have completed interfacility transports with this patient from one hospital to another. Upon acquiring information from the sending Physician and his treatment in the ER was Epinephrine and Benadryl which he admitted does little to no help for the condition. He then told me that he was also treating with TXA because it inhibits bradykinin formation. My question is since we carry TXA and this is a known condition (HAE) for this Patient could the crew patch and ask for an order for TXA in the pre-hospital environment since the Patient does not fit into our moderate or severe allergic reaction protocol ? Since this is not an allergen based reaction and yet is still a life threatening.

Question is regarding dexamethasone in anaphylaxis. Scenario of a 50s M stung by a bee, known anaphylaxis reactions in past, no epi pen called EMS. Pt had angioedema, hives, and signs of bronchoconstriction. Pt treated with epi, followed by benadryl and some salbutamol for his bronchoconstriction. Pt has a history of asthma. Causative factor of bronchoconstriction likely being from anaphylaxic reaction to the bee sting, which the bronchoconstriction quickly resolved with epi, benadryl and salbutamol. Could this pt benefit from dexamethasone? Is this part of the expectation if you have anaphylaxis and the pt also has bronchostriction, with indications as described in protocol, that we should follow the protocol including dexamethasone? And while I’m on the topic, thoughts on dexamethasone in anaphylaxis in general, often steroids are given in hospital, could dexamethasone be beneficial?

If the patient has a mint allergy, is Ondansetron contraindicated? On the package for Ondansetron package it says it contains mint.

If a patient has self-administered benadryl prior to our arrival, should a paramedic re-dose under the Allergic Reaction Medical Directive? There appears to be no contraindication for this in the directive. As well, the direction per the Medical Directive in the OBHG Companion Document is, diphenhydrAMINE administration should always follow the administration of EPINEPHrine as outlined in the Medical Directive. However, I have heard from my more senior colleages that we should not re-dose the benadryl, like we can the epineprhine. Can you please clarify?