Description of Event or Problem · 1
PT WITH HISTORY OF TETROLOGY OF FALLOT STATUS POST REPAIR, AND HISTORY OF "ALLERGIC REACTION" TO ADHESIVES, RECENTLY DIAGNOSED WITH POSTERIOR RIGHT CHEST IIA MEDIASTINAL NEUROBLASTOMA STATUS POST 90% RESECTION INITIALLY OBSERVED WITH LOCAL RECURRENCE ADMITTED FOR CHEMOTHERAPY TREATMENT. IN PREPARATION FOR CHEMOTHERAPY ADMINISTRATION, LMX-4 WAS APPLIED TO PORT-A-CATH SITE TO FACILITATE ACCESS. SITE WAS ACCESSED AND IV FLUIDS 0.9% NACL- WERE BEING ADMINISTERED WHEN PT BEGAN TO HAVE AN "ANAPHYLACTIC-LIKE RESPONSE" WITHIN ONE OR TWO HRS OF LMX-4 APPLICATION. PT BECAME PROFUSELY DIAPHORETIC, LETHARGIC, WAS COUGHING, AND BECAME NON-RESPONSIVE OVER THE COURSE OF SEVERAL MINUTES. DURING THIS EPISODE, HER PUPILS WERE PINPOINT, BLOOD PRESSURE, HEART RATE, AND PERFUSION REMAINED NORMAL AND SHE DID WITHDRAW TO PAIN. GIVEN HISTORY OF PROBLEMS WITH ADHESIVES, ALL ADHESIVES -MEPILEX LITE BANDAGE, MEDIPORE TAPE, COBAN- WERE REMOVED. DIPHENHYDRAMINE 10 MG IV AND EPINEPHRINE 0.08 MG SC WERE GIVEN. PT BECAME MORE ALERT AND STARTED CRYING. AFTER 10 MINUTES, PT BECAME LETHARGIC, MOTTLED, AND SLEEPY. ONCE AGAIN, WOULD ONLY RESPOND TO PAINFUL STIMULI. PARENTS STARTED SPEAKING TO PT AND HER LEVEL OF CONSCIOUSNESS RECOVERED. HYDROCORTISONE 8 MG IV WAS GIVEN. PT FELL ASLEEP AGAIN, BUT WAS EASILY AROUSED. VITAL SIGNS MONITORED EVERY 15 MINUTES. ABOUT ONE HOUR LATER, PT WAS HYPOTENSIVE 77/38, REPEATED 81/40. PT WAS AROUSED FROM SLEEP AND BP RECOVERED TO 128/69. ELECTROLYTES AND CBC WERE DRAWN DURING EVENT AND WERE UNREMARKABLE. POSSIBILITIES FOR OFFENDING AGENT INCLUDE ADHESIVES, LIDOCAINE, AND A BLUEBERRY MUFFIN THE PT INGESTED PRIOR TO THIS EVENT. SUSPECT PRODUCT: NAME, STRENGTH, MANUFACTURER: LMX-4 LIDOCAINE 4%, FERNDALE LABORATORIES, INC. ROUTE: TOP. DATES OF USE: 2009. DIAGNOSIS OR REASON FOR USE: SECURE IV ACCESS TO PORT-A-CATH; TOPICAL ANESTHETIC TO FACILITATE LINE ACCESS. EVENT ABATED AFTER USE STOPPED OR DOSE REDUCED?: YES.