There is a reason that I came off the FRU, I don't like sitting on scene with patients that (for whatever reason) I can't transport. Sick patients need to be in hospital, not in their houses being stared at by my ugly mug.
I was working on the FRU and was sent to a child who was suffering an allergic reaction. These are normally pretty minor things, mum has changed the washing powder and the little 'un has a bit of a reaction to it.
Not so in this case, the child looked like something from a horror movie. The two year old's skin was covered in itchy and painful looking blisters, his lips were swollen and he was generally a funny shade of red.
The first thing that I checked was is mouth, allergic reactions can cause the tongue to swell up and if this blocks the airway then they can easily choke to death. Luckily this wasn't happening to this child, while his lips were swollen his tongue looked fine. The next thing that you do is to get the stethoscope out and listen to the child's chest, an allergic reaction can have the same sort of effect on the lungs as an asthma attack. Once more the child's lungs sounded fine, maybe a bit of an infection though.
I asked the parents what had happened.
They had realised that the child had developed a runny nose, so they took his temperature and discovered it to be a bit high. Then, unlike a *vast* majority of the parents in the area, they had given him Calpol and Nurofen in order to keep his temperature down. This is something to be applauded as there are large numbers of families who would call out an ambulance for such a thing.
As soon as he swallowed it – pop, pop, pop, the child developed the blisters and his lips started swelling. So it looks like the child was allergic to one of the ingredients in the medicine.
Now it was time to wait for an ambulance, I knew we were short of trucks that night, I'd been bouncing from call to call including a couple that I shouldn't have been sent on but was asked to go because there was nothing else to send (yesterday's post for instance). So we waited, and waited and waited.
Then we waited some more.
And a bit longer.
And even more.
By now the parents were, quite understandably, beginning to get upset. Their child was a bit distressed, although not as much as most kids would have been. There was little I could do as, while I have an injection to reverse life-threatening reactions, it's not very nice to give it to a patient whose tongue isn't swelling up. I've sat around with patients like this before and it isn't much fun as all you can really do is monitor them and if it gets worse give then a shot of Adrenaline/Epinephrine (whatever it's called today).
I phoned Control to see if there was any chance of an ambulance. They told me that they had already put a 'general broadcast' out for this call, but there was only one crew at the hospital and they were the ones I'd just done a job with, so they would still be unloading the last patient.
I even tried phoning my station to see if there was anyone there who was waiting for an ambulance to dry after mopping out after a mucky job. There was a crew there, but they were tied up talking to an officer because they had been assaulted and were also filling in one of our emergency referrals for a child being at risk. I know the crew well and if they could have come to my rescue then they would have.
I can't take small children to hospital as the FRU doesn't have a child seat and it's unsafe to transport a small child in it's mothers arms. I asked the father if he had a car/child seat – but they use public transport. If the child was in danger of not breathing then I might have taken the risk, but while the reaction looked severe the child was more uncomfortable rather than likely to stop breathing – actually the child was having a great time playing with my car keys…
So all I could do was to monitor the child and keep both him, and the parents, calm. I like to think that I'm pretty good at this as, perhaps due to writing this blog, I can explain exactly what is happening in quite simple language. I'm also not quick to panic and my general attitude tends to lend itself to keeping people relaxed.
Listening to the child's lungs he had started to develop a little wheeze, exactly what happens to asthmatics, so I gave him a salbutamol nebuliser (our treatment for this) and it settled down almost as quickly as it had started. His tongue was still the normal size although his lips had become more swollen.
Then the ambulance crew who had been to my last job walked in through the door. They had 'turned around' their last job in just over 40 minutes, which is very fast and had then ridden to my rescue. I love the look on parents faces when they realise that the ambulance has arrived and I love the relaxed feeling in my gut when I have a sick patient and they walk in through the door.
It all worked out fine in the end – the child didn't need the injection and perked right up after some oral medicine, he spent the night and next day in the hospital under observation and made a full recovery. While it might sound daft it probably worked in his favour – at least they'll have a good idea what started this reaction and can plan on avoiding it.
While we go to a lot of rubbish on the car, this was a 'genuine job', it was just a shame that the ambulances in the area were probably going to drunks who have fallen over in the street or other minor illnesses. While the FRU is mainly used to get the government mandated targets it can sometimes be clinically worthwhile. This was such an occasion. I'd also like to applaud the parents for keeping calm while their child looked so ill, they were worried but polite and understanding. A rare combination…
Great story and intriguing look inside FRU.
Hi Tom,Did you fill out a yellow card for this?
You can now do them online at http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&nodeId=288
From what you've said regarding the timings, this looks like a pretty clear-cut case where the medicine was the cause, and info regarding reactions in kids is always very carefully looked at by the MHRA.
Crumbs! Would never have thought Calpol and child Nurofen could cause an allergic reaction.
I know from experience that there are loads of “nasties” in this type of medicine. My middle child is allergic to sweeteners, and we had similar problems the first time she got Calpol – and my youngest is allergic to sweeteners AND to orange … orange is a very popular choice of flavouring for children's medicine …..I'm impressed with the child's parents, as the first allergic reaction is not funny to watch, and can cause much more distress (and panic!) to us parents than to the child concerned. Tom's presence would have been very reassuring, as at least the right medicines were on hand if they had been needed.
Allergic Reactions can be pretty scary things. We had a call to one recently for peanuts. The older gentleman opens the door and begins leading us through the house to what we assume is the patient. We walk into the living room, and he sits down – turns out it was him ! He ate a peanut cookie THREE hours earlier and thought he was having a bit of a reaction. After injecting his epi-pen the wrong way up (nice shot in the thumb), he called us to see if we'd 'top him off with a bit more'.
In the old Avon, the reason Techs were given IM Adrenaline was because they were able to Calpol (or Carlpoll if you're from Bristol) and there was a risk of allergic reaction.You're quite right to applaud the family Tom, I agree that there are not enough parents who give the Calpol or the Ibuprofen, and certainly not early enough. The combined effect of the two can't be beaten!
I also know exactly where you are coming from as an FRU Para, I was sat on scene with a patient with a bradycardia, and they were poorly. I'd done everything I could for the patient, 39 minutes later in walked the crew. I don't know about LAS but GWAS (formerly Avon, Glouc & Wilts) is struggling to cover everything. Unfortunately they don't give any general circulation type messages out down here so you just have to wait your turn. If another red call comes in, no matter how long you are waiting the vehicle will be sent to them, as you've said time and again it's about that 8 & 19 minutes tick, not the patient.
So what are the alternatives for a sick child?
too right – I can't imagine having to look after a child for any real length of time without the knowledge that if they got sick, I could give them Magic Calpol.
My middle daughter has halved adult pills if required (as suggested by our GP), or full-sugar Calpol, and otherwise has had to learn to swallow pills. Thankfully, despite having been a sickly baby, she now doesn't get ill that often. My youngest is more difficult as she's too young at 6 to swallow large pills, so again we rely on full-sugar Calpol or I crush tablets (or half-tablets) and mix them with honey to get her to take them – very long-winded and not an exact science, so she doesn't often get much medication – temperatures tend to be brought down with the tepid sponging and light clothing approach, rather than drugs. Not very scientific, and possibly not as effective, but it does seem to work 🙂 And our GP is great at working out doses and what's suitable for them. The local pharmacist is also fantastic at finding suitable “alternatives” to the proprietary brands.
I'm led to believe that anti-histamines and steroids have less adverse side effects than adrenaline, so is there a reason the car doesn't have them in stock?My daughter has nut allergy so we travel everywhere with the whole works. Living in la belle France, epipens were only introduced a few years ago, so flying with a vial of adrenaline and syringe in a portable fridge was loads of fun! We were back during the recent security clampdown, and it was only the fact that my French doctor had been kind enough to write an explanatory letter in English that prevented muggins from having to taste daughters medecines. Seeing as they are all soporific, the drive in the hire car on the wrong side of the road could have precured you some extra clients!
Antihistamines have realatively few side effects (drowsiness, urinary retention, blurred vision and dry mouth for example), steroids do have side effects, but are mainly related to long term treatment. Adrenaline will increase heart rate, blood pressure and can cause tremors. However, adrenaline works immediately whereas antihistamines and steroids take several hours to start having an effect. So, if you are going into anaphylatic shock, adrenaline will save your life.For further information have a look at http://bnf.org/bnf/bnf/current/100067.htm (registration may be needed).
Our local children's hospital has been running TV spots advising parents not to medicate children to bring down a fever unless it's relatively high (I won't be more specific 'cause I don't remember the exact temp and even if I did, I'd have to look up the celsius equivalent.)Fever isn't just an annoying immune reaction like hives or a runny nose. The higher temperature makes the body a less hospitable place for many organisms. So trying to medicate away a low-grade fever is counter-productive (except in making the patient a bit easier to live with).
Oddly enough, here in the US we're not allowed to give Antihistamines (aka Benadryl), at least not at the Intermediate level. It's something I don't fully understand since there's not much of a clinical downside, and most people freely give them to any family member without worry. Epinephrine is only indicated with respiratory distress, so most times we ride to the ED and then the friendly nurse gives the patient Benadryl and says 'what, you didn't give them any Benadryl ?' (er, no – it's not in our protcols)…
I get so annoyed by parents who bring their kid into ED because they have a runny nose or slight temperature. Then they look at you funny when you ask if they've given any panadol!When I was a kid….
Hmmm, that's a good point. I got used to filling them out in hospitals, but since jumping ship, so to speak, I'd completely forgotten about them.I think I'll have a chat with my complexes training officer, we have an 'ideas' suggestion system.