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Life Threatening? No
Write-up: Patient is a 69-year-old female who reports a history of hayfever who is coming in today after recent Covid vaccination with concerns of facial swelling also complaining of the rash and itching to her chest. On exam the patient has obvious facial swelling. She has what appears to be an urticarial rash on her chest. While she does have swelling around her lips and face otherwise she does not appear to have any obvious signs of airway involvement with no swelling of her tongue or uvula, she has good phonation with normal respirations without difficulty. Does not appear to be having reactive airway disease exacerbation at this time. Does not appear to have impending respiratory distress. She otherwise does have some skin changes in her bilateral lower extremities that she reports is baseline with her history of eczema. Primary concern at this time is for possible allergic reaction. Patient appears to have angioedema. Does not appear to have anaphylaxis. Other abnormalities are considered. Patient will be connected to cardiac and respiratory monitors. IV access will be obtained. The patient will be given a 1 L IV fluid bolus. She will be given Benadryl, Solu-Medrol, and famotidine. Patient be monitored for response. Labs have been ordered to evaluate. EKG as well as chest x-ray will be obtained. We will file VARES report. Chest x-ray obtained. There is no acute cardiac no acute pulmonary pathology on my interpretation. Laboratory evaluation has returned. The patient''s CBC is reassuring. CMP shows a glucose of 78, otherwise reassuring without significant abnormality. Troponin within normal limits. Covid, influenza, RSV testing is negative. On repeat evaluation the patient is resting comfortably. She reports that the itching has resolved. Her face feels less uncomfortable. She has had no progression of the swelling. On repeat examination she continues to have facial swelling as well as swelling around her lips however she has no tongue swelling, no swelling within her posterior oropharynx, and her phonation continues to be normal. She and her friend were informed of the initial findings. Plan at this time is to admit for further evaluation and treatment.
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