Garlic vs. Adrenaline

'Any allergies?' It is one of those questions that as a nurse, doctor or pharmacist you should be asking all the time.



Some people know all about their allergies, how to treat them and how best to avoid problems with them. Some don't know about them and only find out about them when they are all puffied up, or red or wheezing.



And some, bless them, know all about them and think, 'Meh.'



I'm not here to judge people. My role is to tell the story.



I was stood at my little kitchen window in the on-call quarters. I was preparing something to eat and wishing I was at home so I could have a beer. Out the front of the clinic I saw a familiar sight. Some frequent flyers had arrived. That familar big station wagon. These people were so regular they deserved their own car parking spot. They were all quite nice actually.



Most people will attempt to use the clinic when it is open. That means it is often busy. Some use the clinic when is is closed and for 'Emergencies Only.' They use it then because it is not busy even if it is not an emergency. I don't mind too much as I get paid overtime for the callout, but then I'm taxed at nearly 50% so net gain is minimal.



Back to the flyers. Within a few seconds of them arriving my telephone rings, it is the security guard in the clinic.

'Hi Rob, can you come and see Frank, he err, umm, well he, err.'

'On my way.' I reply. After a while the guards for some reason like to tell you what is going on. They don't have to of course, just 'come over' is all that is required.

I enter the clinic throught he back and within in a minute I am letting the man in.

What is immediately obvious is his tongue. Usually if somebody sticks their tongue out it is a bit rude. With an allergic reaction it is potentially life threatening. The swelling can block the airway.



In the simple cascade of first aid, ABC without A there is not much point worrying about B and C. No airway means if you are not dead you will be soon. Bottom line you obtain an airway and you can go crazy with all sorts of equipment to do it.



There are stories of people cutting holes in necks, tubes that can be slide down the throat and into the lungs and when the mouth is blocked up the nose and down the throat.

The guy can not talk. His breathing doesn't sound too bad but I worried the tongue will continue to swell and occlude his airway. I put on oxygen mask on him to give him as much oxygen as I can. His wife tells me he has had some garlic butter. He has been admitted before with a similar things, twice before. He still eats it because he likes it.

As I listen to the history and ask a few questions ('How long ago? Any other allergies? etc') I draw up some adrenaline. I give the injection, rub the site and grab my airway kit.

A long thin hollow tube now gets lubed with a bit of sterile gel. I slide this into his nose and into the back of his mouth. If his tongue swells anymore it is emergency trachy time.

Amongst other problems this guy has a history of heart problems, still smokes and very large. He is on the list for by-pass grafts but because he still smokes the surgeon refuses to do them.

By the time the tube is secured in position I give another shot of adrenaline and ring the medics at the big hospital. They know I am by myself. They want me to give some more adrenaline.

The effects of the adrenaline begin to kick in. The tongue slightly reduces in size. All the excitement and huge belts of adrenaline now means his heart rate is well over 120 beats per minute. Now he has chest pain. An ECG shows nothing different compared to the hundreds already in his file. I follow the care path now for chest pain. His BP is a bit borderline for GTN ( also considering the rate related aspect) so straight to aspirin and morphine.

He is taken by ambulance to hospital. Returns a few days later. I see him as I dress one of his leg ulcers. In our chit chat he tells me the tube in his nose was the worst experience he has ever had. This from a man who has had countless operations, heart attacks, various shunts for dialysis, abdo surgery, etc etc etc.

Over the next three years I see him for various call-outs. Usually chest pain. He never touches garlic again. His wife tells me the tube in his nose has cured him of any desire to eat garlic.