WFR SOAP Note Review
Case 3 - Anaphylaxis
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Anaphylaxis
You identified that this is a likely case of anaphylaxis, based on the hives, abnormal tingling in the throat, history of severe allergic reactions in the past, and sudden onset of symptoms. There is some intentional ambiguity in the case, because the victim did not consume any nuts himself, and he’s displaying some, but not all, of the symptoms of anaphylaxis. However, you made the correct decision to err on the side of caution with anaphylaxis and assume that’s what’s going on.
You didn't note that this is a likely case of anaphylaxis, based on the hives, abnormal tingling in the throat, history of severe allergic reactions in the past, and sudden onset of symptoms. There is some intentional ambiguity in the case, because the victim did not consume any nuts himself, and he’s displaying some, but not all, of the symptoms of anaphylaxis. However, you should err on the side of caution with anaphylaxis and assume that’s what’s going on.
Anaphylaxis correct
You identified that this is a likely case of anaphylaxis, based on the hives, abnormal tingling in the throat, history of severe allergic reactions in the past, and sudden onset of symptoms. There is some intentional ambiguity in the case, because the victim did not consume any nuts himself, and he’s displaying some, but not all, of the symptoms of anaphylaxis. However, you made the correct decision to err on the side of caution with anaphylaxis and assume that’s what’s going on.
Anaphylaxis incorrect
You didn't note that this is a likely case of anaphylaxis, based on the hives, abnormal tingling in the throat, history of severe allergic reactions in the past, and sudden onset of symptoms. There is some intentional ambiguity in the case, because the victim did not consume any nuts himself, and he’s displaying some, but not all, of the symptoms of anaphylaxis. However, you should err on the side of caution with anaphylaxis and assume that’s what’s going on.
Anaphylaxis calc
Epi
You correctly advised use of the Epi Pen immediately. It is important for this victim to take the Epi Pen as soon as possible to prevent further progression of the airway swelling. As the Wilderness First Responder, you should advise him to take it. Ultimately it will be the decision of the patient as to take it or not.
You should advise use of the Epi Pen immediately. It is important for this victim to take the Epi Pen as soon as possible to prevent further progression of the airway swelling. As the Wilderness First Responder, you should advise him to take it. Ultimately it will be the decision of the patient as to take it or not.
Epi correct
You correctly advised use of the Epi Pen immediately. It is important for this victim to take the Epi Pen as soon as possible to prevent further progression of the airway swelling. As the Wilderness First Responder, you should advise him to take it. Ultimately it will be the decision of the patient as to take it or not. Remember that if antihistamines like Benadryl are available, they can help slow or prevent further swelling. However, they are NOT a substitute for an EpiPen.
Epi incorrect
You should advise use of the Epi Pen immediately. It is important for this victim to take the Epi Pen as soon as possible to prevent further progression of the airway swelling. As the Wilderness First Responder, you should advise him to take it. Ultimately it will be the decision of the patient as to take it or not. Remember that if antihistamines like Benadryl are available, they can help slow or prevent further swelling. However, they are NOT a substitute for an EpiPen.
Epi calc
Evac
You correctly identified that he should go to the hospital immediately because anaphylaxis may worsen or return, even after EpiPen administration.
It's important that he go to the hospital immediately, since anaphylaxis may worsen or return, even after EpiPen administration.
Evac correct
You correctly identified that he should go to the hospital immediately because anaphylaxis may worsen or return, even after EpiPen administration.
Evac incorrect
It's important that he go to the hospital immediately, since anaphylaxis may worsen or return, even after EpiPen administration.
Evac calc
Pros/cons content
The decision to administer epinephrine in a situation where anaphylaxis is suspected but not confirmed can be a complex one, and there are both potential benefits and risks to consider. Here are some of the pros and cons of giving epinephrine in this scenario: Pros: Epinephrine is a potent medication that can quickly alleviate the symptoms of anaphylaxis, potentially saving the person's life. Anaphylaxis can be difficult to diagnose, and waiting too long to administer epinephrine can be dangerous. Giving epinephrine early on can be a prudent course of action, especially if there is a high likelihood of anaphylaxis. Epinephrine can be given quickly and easily via an auto-injector, making it a relatively low-risk intervention. Cons: Epinephrine can have some side effects, such as increased heart rate, anxiety, tremors, and headache. For most people, these side effects are very mild and pass quickly. However, for some, the side effects can be uncomfortable and potentially dangerous, especially in people with certain heart and lung conditions. Giving epinephrine unnecessarily can be harmful, as it can lead to unnecessary medical interventions, unnecessary hospitalization, and increased healthcare costs. Epinephrine auto-injectors can be expensive, and some people may not be able to afford them. If you’re in a remote area far from emergency care and only have one EpiPen available, you’ll have to apply your training and judgment to the observable facts and the patient’s insights based on their experience. Overall, the decision to administer epinephrine in a situation where anaphylaxis is suspected but not confirmed is a complex one that must be made on a case-by-case basis. It is important to carefully consider the potential benefits and risks of the intervention, and to consult with EMS if you are able to contact them. However, if you have significant concern that the victim is experiencing anaphylaxis, you should advise use of the Epi Pen. In most cases, the benefits can be lifesaving and outweigh the potential drawbacks. For more information, read the Epi Pen and Anaphylaxis PDF Guide built into your WFR course.
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Full SOAP
SOAP NOTE EXAMPLE: A male adult patient is complaining of itchy hives and tingling in the throat. Symptoms started suddenly a few minutes ago. He reports a history of severe allergy to tree nuts and carries an Epi Pen. He is not aware of having ingested any tree nuts. The man is currently AOx4, with stable vital signs and no wheezing or signs of airway closure. There are some pink patches on the stomach and chest in addition to a sunburn. The tongue and lips are not swollen, and he is able to talk and swallow. This patient is showing signs of a possible anaphylactic reaction. It’s possible he was exposed to tree nuts from another passenger on board, as several people were eating snacks with high winds. I’ll advise him to use the Epi Pen. We’ll drive the boat immediately back to the dock or other nearest location we can get him off. I’ll call ahead to have EMS waiting for him. He should go to the hospital immediately due to the risk of progression of the anaphylaxis or return of the symptoms.
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