"Marisa, get in here quickly! He's having an allergic reaction to shellfish!" my aunt cried out to me one summer Saturday back in August. You see, my aunt is a pediatrician, and I'm a certified PA in a pediatric urgent care, and we can immediately identify when there is a medical emergency. As I ran into her kitchen and saw an adult clutching his throat, covered in hives and having gasping breaths from an allergic reaction, I knew he needed epinephrine STAT.
We immediately called 911, and his friend ran to his car to retrieve the two EpiPens he had sitting in his glove compartment. After giving the first epinephrine and there was no response, we gave the second one, only to realize they were both expired and were likely inactive from being in a hot car during summer months.
As I stood there waiting for EMS (emergency medical services), and feeling helpless, knowing that I could help him if I had been in my office with epinephrine vials on hand, a "crash cart," defibrillator and other lifesaving medications and interventions, I knew I had to immediately jump into action somehow.
When this man's body collapsed on the kitchen floor, my emergency medicine instincts kicked in, and I quickly did a pulse check and determined that he had no pulse. My aunt and I started CPR, and as I compressed on this 30-something-year-old man's chest, my husband who is an FDNY firefighter and was a paramedic for almost 10 years, took over compressions for me and sprang into action himself. Thankfully, EMS arrived on the scene with oxygen, a BVM (bag valve mask), and a defibrillator. While one paramedic gained IV access to administer epinephrine, the other paramedic attempted intubation.
When they finally got him into the ambulance to the nearest hospital, I sat back in awe at the events that had just happened before my eyes. If I learned one thing from PA school when dealing with anaphylaxis, it's that early administration of epinephrine can save lives. That helpless feeling I felt as a medical professional witnessing a medical emergency in which I knew how to treat, yet I was unable to provide the care I know he needed, is a feeling I hope to never experience again.
After decompressing from this heart-racing experience, I realized there was a lot to be learned about EpiPens and their handling and storage. It is so important to keep EpiPens in a dry place within their carrier tube. They should be stored at 20° to 25°C (68° to 77°F), but excursions permitted to 15°C-30°C (59°F-86°F). In addition, check the expiration dates on a regular basis. You should also carry two EpiPens with you at all times if possible.
There is a new product that has returned to the market called Auvi-Q. Auvi-Q is an epinephrine auto-injector that provides voice instructions, is about the size of a credit card and thickness of a cellphone, and fits into most pockets and small purses. This allows for convenience and ease of use. Making yourself and your patients aware of these factors can hopefully prevent the scene that I witnessed on the kitchen floor back in August.
As I write this blog post, I can't help but think of my own 8-year-old son who was recently diagnosed with a tree nut allergy. Although I did not know it at the time of the kitchen floor incident, anaphylaxis and allergic reactions would become a part of my everyday life.
With food allergies more prevalent, being able to recognize the signs and symptoms of anaphylaxis can save your life or someone else's. In addition, as the weather gets warmer and the trees start blooming, allergic reactions to bee stings are more common. Not only food allergies, but other environmental allergies can cause anaphylaxis.
Being knowledgeable about anaphylaxis and allergic reactions has made me a better provider for my patients, and I can only hope that I will never have to experience what happened at my aunt's house that fateful day.
Marisa Rodriguez, PA-C, is a full-time clinical PA at PM Pediatrics, a pediatrics urgent care practice with 21 locations that has treated 1.3 million patients. She is director of procedural training for the company, which includes training physician fellows in a one-year pediatric urgent care fellowship, and she is also the director of the PA fellowship in pediatric urgent care. She is a 2003 graduate of the Weill Medical College of Cornell University and was the first PA in New York state to earn a CAQ in Pediatrics.