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    Default Angioedema Management with a full belly

    So got called in @ 0100 last night to find a 47 y.o. female, BMI: 41, GERD, OSA, HTN, DM II, only listed allergy to sunscreen in severe resp. distress due to oropharyngeal swelling. Had been started on lisinopril (10mg Q day) 20 days ago, and it was truly a textbook picture of angioedema straight out of Barash (i.e. her tongue was about 3 x normal size and about 2/3 of it was protruding out of her mouth). Not to be insensitive but I was oddly reminded of a giant garden slug. Ate dinner at about 1800, took all prescribed meds as normal. Upon presentation: 184/101, HR: 112, RR: 33, 94% on FM 8L, obvious resp difficulty altho still able to accomplish ventilation, normal LOC. The case went very smoothly, got her tubed nice n' tidy and sent to the ICU to be treated for further inflammation and to stabalize. Before I divulge how the case was handled, I'm still new to my practice and would like to hear from the veterans how they've handled similar situations, and any specific techniques they used. Additionally, it would be great if the students would like to chime in about angioedema in general, how the RAAS gets interrupted and what inflammatory mediators are produced in order to produce this notorious symptom of ACEI's, and what specific populations might be more susceptible.

    Cheers,
    sweep
    Last edited by thasweepa; 07-01-2013 at 05:47 PM.

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