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Scenario: I thought it was marshmallow


Please note: The users who submit scenarios have declared that all patient details are fiction. We cannot guarentee the accuracy of any suggested treatment or the realism of suggested observations. You should judge these for yourself.



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Scenario Overview:
This is a scenario about anaphylaxis (severe allergic reaction). The first aiders are at a local bridge competition and have been called over to one of the lunch areas to a patient who has breathing difficulty. On arrival, they find the patient gasping for breathing with their hands up near their neck, evidently struggling to breathe.
Difficulty:
First Aider Easy
How the scenario should progress:
Assuming the first aiders recognise the cause and use the Epipen in the patient's pocket, the patient's breathing will improve and they will be able to speak to the first aiders. If they do not do this, the patient will stop breathing.
Patient 1:
Name: James Nelson    Age: 36    Sex: Male
Medication: Carries Epipen for nut allergy.
Allergies: Nuts
Past medical/family/social history: Has had two allergic reactions to nuts previously. The first time, the patient just swelled up but it wasn't too bad. The second time was 'pretty bad' as his airway seemed to swell up a bit - it was after this that the patient got his Epipen. This occasion is worse than both of those.
Findings on examination: Initially the patient will be gasping for breath, with swelling around the airway. The patient will become more cyanosed as time progresses. If asked, the people around the patient will be able to tell the first aiders that they do think he is allergic to nuts. The patient will also nod if asked if they are allergic and if he has is Epipen on him. They will find the Epipen in his pocket. After one use of the autoinjector, the patient's breathing will soon be much improved. The patient will tell them that he was eating a brownie and thought that the nuts were marshmallow but they evidently weren't! If the Epipen is not used, the patient will become unresponsive and will stop breathing.
Possible treatment from first aiders: Quick assessment of the situation. Find the epipen and use it.
Time after start: 0 mins After treatment
Response: Alert Alert
Airway: Partially blocked - swelling Clear
Breathing? Just about Yes
Respirations: 23 gasping 18
Pulse: 140 118
Oxygen Sats: 85 on air 94 on air



Tips for the patient actors:
Make or use a fake epipen (you can buy some really realistic looking ones) to put in the patient's pocket.

Scenario submitted by: Scenario Library