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Old 07-05-2005, 05:00 AM
MKSchlegl
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Default Asthma and Definity

We had a 74 yr old lady with no Coronary Artery Disease but had history of Hypertension and Asthma (requiring frequent use of inhalers and on Singulair qhs as well as nightly O2 at 2L N/C) Pt was given 1cc Definity pre-echo. 5 minutes later before the Dobutamine stress echo- she had complained of difficulty catching her breath and attributed it to her anxiety. We gave her 2 puffs of her combivent, checked her pulse ox and it was in the low 80's so we put on o2 via Face mask at 4 L and then she felt much better. The physician had wanted to cancel the test but the pt wnted to proceed stating she felt better.<br><br>During the dobutamine infusion, she was given .8cc of Definity and then continued with the test. By the next 10 minutes she had an adequate heart rate response and we shut off the dobutamine and the O2 was stopped near the end of the test. During the last 2 minutes of the dobutamine test, pt had complained of some chest tightness and some shortness of breath- her pulse ox started to fall again so we gave her the O2 again. Symptoms started to improve and so we proceeded to set her up from the lying position.<br><br>Breathing was OK at this point, but pt had orthostasis- dropping down to 60/40 when sitting, but better when lying 90-100/50. IV Normal Saline administered, Lungs remained clear and pulse ox WNL. Fluids were continued<br>but pr still orthostatic-B/P at this point now 120/60, pulse ox 95% with O2 remaining on via Face Mask.<br> <br> Pt then sent over to ER- it was then noted at that time that she had developed urticaria. She was treated for urticaria and allergic reaction to Definity. She was kept overnight and monitored. She was given solumedrol IV and sent home the next day. Pt had an adverse drug reaction<br>to Definity-which was nearly life-threatening. We will avoid those people with moderate to severe asthma. Will plan to administer benadryl, epinephrine and other measures as above if it would happen again.
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