Читать книгу Emergency Medical Services - Группа авторов - Страница 461

The first step in EMS response to calls regarding allergic reactions and/or bites and stings is to ensure that the scene is safe. No rescue or treatment can occur if EMS personnel fall victim to the same process that is affecting the patient. Next, EMS clinicians should determine if the patient was stung or what activity was occurring before the allergic reaction. This will help determine if there is any special treatment needed and the potential for development of a severe reaction or anaphylaxis. EMS personnel should take all proper equipment, including life support, emergency drugs, and monitoring equipment with them when initially approaching the patient. Failure to do so may delay necessary treatment and result in further physiological decompensation of the patient.

Patient assessment should be done rapidly, first ensuring a patent airway. The patient should be queried about subjective shortness of breath or dysphagia, and the clinician should note if the patient’s voice is hoarse. The EMS clinician should listen to breath sounds, assessing for stridor or wheezing. Facial, tongue, uvula, or orbital swelling should be noted. A full set of vital signs should be obtained. In the case of insect stings, the patient should be removed from the scene to prevent further contact with the allergen. Continuous patient reassessment should center on ensuring a patent airway and monitoring vital signs. Any patient with a significant allergic reaction or potential for deterioration during transport should have at least one large‐bore IV line started with normal saline. The patient should be transported expediently to the closest most appropriate facility, depending on availability of local resources and other factors such as distance, weather, and terrain. The EMS clinician must remain vigilant in recognizing the signs and symptoms of anaphylaxis, as it is often unrecognized or there is a delay in recognition, particularly in children.