You are working on a hot June day in a BLS unit. You would rather be camping with the kids at Writing-on-Stone Park. You're trying to stay cool and the tones go off, calling you to work. The address is a legal land description in a rural area. You have no trouble finding the patient. He is sitting on the ground beside his tractor, which is connected to an anhydrous ammonia applicator. His wife is there with him and she is frantic. She identifies herself as a nurse and keeps saying that her husband has a heart condition, but this could be an allergic reaction. She is crying and keeps repeating herself.
The patient's skin is flushed. There is no history of trauma. The patient appears conscious but is not actively moving. You have parked your ambulance upwind from the tractor.
Your partner obtains the following information from the patient's wife. This 75-kg 68-year-old man has no allergies. Medications are ASA, NTG and Inderal. He suffers from angina and suffered a myocardial infarction last year. He has been otherwise healthy and active and doesn't smoke or use alcohol. He has a family history of CAD as his father and two brothers suffered fatal myocardial infarctions while in their 60s. He had his lunch on the tractor about a half an hour ago. After taking his lunch to him his wife noticed that he stopped going around the field and climbed out of the tractor. She went to check on him and found that his tongue was “all swollen” and he had trouble speaking.
Your patient is lethargic but responds to voice. He is unable to speak in comprehensible words and you notice his tongue is significantly swollen.
Primary Exam and Initial VS
He is breathing 24 times a minute and has wheezing in both lungs. His breathing is laboured. His heart rate is regular 96 beats per minute and weak at both the radius and at the carotid. His blood pressure is 160/74. His O2 sat is 95 per cent. His temperature is 37.0 ºC. His BGL is 7.5 mmol/l. His skin is flushed with no insect stingers found, no pacemaker or surgical scars and no needle marks. His abdomen is soft. He is continent and you notice tearing of the eyes. Pupils are equal and reactive.