Question

J.E., a 37-year-old woman with no prior history of allergies, was working in her yard when she received a sting on the right wrist from a yellow-jacked wasp. Several minutes later she complained of a itching sensation and cramping abdominal pains. She then became acutely short of breath with wheezing. A patchy erythema radiating from the area of the sting was noted along with swollen eyelids and lips. A neighbor took her to the hospital where she became very faint and could not talk or provide information to assist with a diagnosis. Vital signs were as follows: BP of 60/34; Pulse of 156; Respiration rate of 40

Epinephrine 1/1000 was administered IM along with 100 mg of hydrocortisone. Within minutes, an improvement in the respiratory rate was noted and blood pressure increased to 100/70 with a pulse of 112.

QUESTION:

2) Explain the rationale for each of the following signs and symptoms:

a) Pruritus

b) Increased pulse

c) Difficulty talking and breathing

d) Feeling faint

e) Erythema

f) Low BP

Answer 1

Difficulty talking and breathing: The reason for the occurrence of this is anaphylactic shock. The allergen in the body of JA must have spread to such an extent via blood that it would have cause difficulty in breathing due to pulmonary inflammation. The allergen must have also cause vasodilatation leading to blood pressure. All this causes difficulty in talking as well as breathing.

Pruritus (Itchy skin): The reason behind the occurrence of Pruritus in Mr J is must be the presence of poisonous chemical through the sting. These chemicals must have stimulated the release of chemical mediators at the site of sting and this can causes local Inflammation and itchy skin.

Feeling faint: The allergen ultimately spreads to all the body and begins general actions like causing vasodilatation and hence low blood pressure. The less supply of blood to Tie brain makes a person feel gelling fainted