Another ED Experience...

We had another patient who came in to the ED complaining of nausea and vomiting, with a sharp pain in her lower right abdomen. My preceptor started the IV, gave the patient morphine IV push and then started a bag of normal saline. When I came back 15 minutes later to check on the patient, I noticed that she had red streaks running up her arm, and her veins were puffy. I stopped the IV and placed a cool compress on her arm, and then went for my preceptor.

All we had given the patient so far was morphine, and I could see the veins leading away from her IV site were red and puffy, so I knew it was probably a local reaction to the medication. I asked her again if she had any allergies, and she said no. I stopped the IV pump and got a washcloth from the cabinet, wet it and placed it on her arm. I told her that she was probably having a small reaction to the morphine that we pushed (which is why her arm wasn't hurting now that the saline was running), and that I went to go get my nurse.

I told my preceptor about the situation, and what I had done so far. She went into the room and took a look, and pretty much told the patient what I had - that this was probably a local reaction to the morphine, and that this reaction was common. To make sure we were right, she asked the doctor to come in and take a look at the patient. Begrudgingly he took a minute and went to look at the patient's arm. He agreed it was a reaction to the medication, and prescribed Benadryl IV push.
 

This situation kinda freaked me out - I mean, who has seen red streaks running up someone's arm?? It looked like blood poisoning or something. It all worked out, but I couldn't help but think about what would have happened it it wasn't a local reaction, but a systemic one. Her airway would have closed off or her breathing could have slowed. Since she wasn't hooked up to a monitor...how long would it have taken for me to come back and check on her? That thought chills me...