Question

Decision-Making Challenges Critical Rescue The patient is a 42-year-old first-grade teacher who is diabetic and has an ulcer on her right foot seriously infected with staphylococcus. She had a débriding procedure earlier today and is prescribed to receive clindamycin 1 g IV as soon as possible. She is 5 feet tall and weighs 202 pounds Her medical record indicates an allergy to cortisone. When you ask her whether she has any other drug allergies, she replies, "No, only to cortisone." The drug comes up from the pharmacy about 7 PM, 3 hours after she returned to your unit after the débridement. About 5 minutes after the infusion is started, the patient says she is having a hard time catching her breath and feels dizzy and scared. You find her pulse to be too rapid to count and thready. Her lips are dusky, and she begins to wheeze. Should you continue the clindamycin? Why or why not? 1. 2. How should you manage her current IV access? 3. Should you call her surgeon or the Rapid Response Team (provide a rationale for your choice)? 4. Why should you or should you not start oxygen on this patient? 5. Would epinephrine be helpful in this situation? Why or why not? Where, how much, and by what route would y ou expect to administer it? 6. Would diphenhydramine (Benadryl) be helpful in this situation? Why or why not? 7. How likely is an allergy to cortisone?

Answer 1

Decision-Making Challenges Critical Rescue The patient is a 42-year-old first-grade teacher who is diabetic and has an ulcer on her right foot seriously infected with staphylococcus. She had a débriding procedure earlier today and is prescribed to receive clindamycin 1 g IV as soon as possible. She is 5 feet tall and weighs 202 pounds. Her medical record indicates an allergy to cortisone. When you ask her whether she has any other drug allergies, she replies, "No, only to cortisone." The drug comes up from the pharmacy about 7 PM, 3 hours after she returned to your unit after the débridement. About 5 minutes after the infusion is started, the patient says she is having a hard time catching her breath and feels dizzy and scared. You find her pulse to be too rapid to count and thready Her lips are dusky, and she begins to wheeze Should you continue the clindamycin? Why or why not? L. Clindamycin should be discontinued in this patient as the signs of allergy (difficulty in breathing, feeling dizzy, and scared) are apparent. 2. How should you manage her current IV access? The IV administration of clindamycin should be stopped immediately 3. Should you call her surgeon or the Rapid Response Team (provide a rationale for your choice)? One should immediately call rapid response team (RRR) as the patient requires emergency care for allergic response, which would otherwise lead to shock or coma. 4. Why should you or should you not start oxygen on this patient? Oxygen therapy would be appropriate for this patient if provided as needed as the patient had ditticulty in breathing and starts to wheeze 5. Would epinephrine be helpful in this situation? Why or why not? Where, how much, and by what route would you expect to administer it? Yes, epinephrine would be helpful in this patient as it is an anaphylactic reponse. It can be given in 1:10,000 dilution through the intravenous route 6. Would diphenhydramine (Benadryl) be helpful in this situation? Why or why not? Beadryl is a corticosteroid, so it is not helpful in this patient as he is allergic corticosteroids 7. How likely is an allergy to cortisone? The patient had positive history of allergy to corticosteroids. So, it is more likely in this patient.