The possibility was rare.

-Bhupinder Singh, Junior Resident at Punjab Institute of Medical Sciences, Jalandhar, India.

No one can expect a sudden collapse of a building while partying on the 5th floor due to a deadly earthquake. Similarly, I did not expect that anything would go wrong in a perfectly stable-looking medical ward. But the tables were turned all of a sudden when I was informed by one of the nurses that the patient receiving the albumin infusion had started feeling breathless and dizzy. I rushed to the patient’s room. All the possible scenarios started running through my mind of what the albumin infusion could have done—an allergic reaction, fevers and chills, hypotension, urticaria, and anaphylaxis. All through this, I told myself that I should expect the worst, even though I was not ready for it. The next thing I remember is me at the bedside of the patient with a small team consisting of an intern and two nurses. “Vitals. I need his blood pressure, pulse, and breathing”, I shouted as I stuck the diaphragm of my stethoscope to his chest. It was noisy, like the wind blowing through an obstructed tunnel, and at the end of this tunnel was I, shuddering and sweating. “Is it anaphylaxis?”, I asked myself. I was not sure. I needed to know his vitals. I had never seen a patient with anaphylaxis before. My mind had no memory of what anaphylaxis looked like in reality.

“It’s 84/60, and his saturation is dropping, dropping to 85%”, the intern shouted. “I am rushing the fluids, doctor”, the nurse said. “I don’t need any more evidence”, I told myself. “This is anaphylaxis, and we can prevent it from getting worse”. I wanted to take a call for an epinephrine injection, but I called the on-call attending instead and explained everything. He told me to neubulise the patient and wait for his arrival. I followed the order and did what I was told to do. He was nebulised, but his status didn’t improve. His SpO2 was dropping: 80%, 78%, 74%, 70%, and his lips started to swell. “For God’s sake, it is anaphylaxis!” With all the confidence I could gather, I shouted, “give him epinephrine!” The nurse didn’t waste a single second and injected the epinephrine into his vastus lateralis.

That day, we injected three shots of epinephrine into his thigh to prevent his symptoms from progressing. Our on-call doctor arrived and took him into his care. Thankfully, we saved him from a deadly reaction—anaphylactic shock. This incident, however, totally changed my thinking on approaching emergency conditions, as it was enough for deep introspection and for evaluating the effectiveness of my action. In medical practice, we often put such emergency situations on the back burner, considering them rare. However, in the realm of common events, the rare can emerge as a dazzling anomaly, reminding us that even the smallest of possibilities can have the biggest impact.

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