Case Summary
A patient in profound anaphylactic shock following multiple wasp stings remained unconscious and hypotensive despite repeated doses of epinephrine. As the patient’s condition continued to decline close to hospital arrival, the EMS team initiated rapid crystalloid infusion with LifeFlow. This proved to be the decisive intervention, underscoring the role of fluid resuscitation in distributive shock and the value of a rapid manual infusion technology in the prehospital setting.
Initial Presentation
Palm Beach County Fire Rescue was dispatched for a reported cardiac arrest. On arrival, the crew found a man unconscious and in severe respiratory distress after sustaining multiple wasp stings. Another EMS team had already placed a humeral intraosseous (IO) line and initiated bag-valve-mask ventilation. The patient had no radial pulse and no measurable blood pressure, indicating severe anaphylactic shock.
Resuscitation Strategy and LifeFlow Utilization
The team initiated guideline-directed anaphylaxis treatment, including:
- IM epinephrine
- Push-dose epinephrine (60 mcg total, delivered as 6 × 10 mcg / 1 mL aliquots)
- Diphenhydramine
- Methylprednisolone
- Nebulized albuterol
- Initial normal saline bolus by gravity
Following these interventions, oxygen saturation improved, a faint radial pulse returned, and blood pressure rose to 90/palp. However, the patient remained unconscious. Recognizing that ongoing distributive shock required rapid fluid resuscitation in addition to pharmacologic therapy, the crew decided to deploy LifeFlow, and approximately 700 mL of crystalloid were delivered through an IO in less than three minutes.
Definitive Management and Outcome
As the saline bolus was finishing the patient then opened his eyes and smiled at the crew. He arrived at the emergency department awake and interactive—an outcome the receiving team, preparing to initiate chest compressions, had not anticipated. Rapid fluid resuscitation, paired with appropriate pharmacologic management, enabled the patient to be delivered to the ED in stable condition.
Clinician Feedback
Reflecting on the call, Dr. Peter Antevy, EMS Medical Director for PBCFR, shared: “What I witnessed firsthand will never leave me. We’ve used LifeFlow for whole blood transfusion, but today it helped us saved a life through rapid crystalloid infusion. This man didn’t just need epi, he needed volume, and fast. As the ED doors opened, the staff expecting a full cardiac arrest was greeted by a smiling patient. And our team? We couldn’t stop smiling either.”
Clinical Discussion
Anaphylaxis is a form of distributive shock state in which vasodilation and capillary leak produce profound intravascular volume depletion. While epinephrine remains the cornerstone of treatment, rapid restoration of circulating volume is frequently required to reverse hypoperfusion and end-organ dysfunction. In the prehospital environment, where vascular access is often limited to a single peripheral IV or IO line, the ability to deliver a significant volume of fluid quickly and predictably is essential.
This case reinforces that the value of rapid manual infusion technology extends beyond hemorrhagic shock and whole blood delivery to any shock state in which volume restoration is needed to bridge the patient to definitive care, or itself may be the definitive intervention.
Source and Attribution
Adapted and republished with permission from a clinical case originally shared on LinkedIn by Peter Antevy, MD, FAEMS, EMS Medical Director, Palm Beach County Fire Rescue.
LinkedIn profile: linkedin.com/in/peter-antevy-md-faems
Original post: View on LinkedIn