Terima Kasih Nak

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Today morning, just before Subuh prayer, a patient came with complaint of generalised itchiness with periorbital edema (means - bengkak di sekitar mata) that made his eyes become so small, I barely can see.

HCW : dah berapa lama dah jadi macam ni pakcik?

Pakcik : masuk hari keempat ni, pakcik pun taktaw kat mana silapnya. Bangun-bangun tidur, terus jadi camtu, pastu pakcik pergi klinik, dia bagi ubat gatal, ubat allergik, ubat sapu. Tapi makin teruk pulak bengkak kat mata ni.

If you received medications like these (only tablets with label of symptoms), please kindly ask the clinic to write down the name at least. Is it piriton, prednisolone? It is tricky even for us to know the names of medications just from the tablets. 
Something like this. Wikipedia


Maybe there was some allergens on his bed, maybe some insects, or maybe some food he ate before. The patient denied any history of food allergy. Though he had some allergic to an analgesics - pain killer (unsure name), he denied any history of taking analgesics prior to symptoms.

At first I got confused if this is allergic reaction OR anaphylactic reaction (which the latter is worse), I quickly read back the notes shared by one of my favourite medical officer and found this.




Going through by systems:

Skin - yeah, pakcik got some itchiness all over body with periorbital edema.
Respiratory - he denied any problem with breathing - no shortness of breath / chest pain / wheezing etc. And the lung was okay, no wheezing (wheezing ni selalu jadi bila saluran nafas jadi sempit, macam orang kena serangan asma.
Gastrointestinal - he also denied any abdominal pain / vomit / diarrhea
Cardiovascular - no history of dizziness / shock / fainted
Neurological - none as well.



Diagnosis:
Allergic reaction secondary to ? cause.

Intravenous cannulation done, we decided to give these medications given:
- IV hydrocortisone 200mg stat
- IV piriton 10mg stat
- IV ranitidine 50mg stat

After discussing with senior about IM adrenaline, there is less harm than benefits to give... though this is allergic reaction (not anaphylactic) - so, IM adrenaline 0.5mg stat. 
We reaccessed patient about 30minutes later, the first thing he said "Nak, pakcik dah boleh nampak, terima kasih, nak." We can see the swelling around his eyes already improved much! He claimed the itchiness also had improved, hence we decided to allow him to go home with some medications


A thing about this pakcik was he kept on smiling through out his visit in ED, soft spoken as well. Dah la mata tengah sepet, senyum senyum lagi la sepet pakcikkk. 
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I always feel anxious to work night shift in Emergency Department. With this current Covid situation, staffs are distributed to many teams, hence, I need to survive on my own feet managing the Non Respiratory cases (green zone, yellow zone and red zone). Every single night shift, I will always pray for smooth shifts and the senior MOs working on respi team will not be annoyed to share their opinions for management. Alhamdulillah. the senior MOs, staff nurses, medical assistants are helping a lot and HO colleagues are good as well :)
Till next story :)Salam Ramadhan semua

SM, Perak, Malaysia200430

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