Chapter 2: The Pressure Drops

I put down my chart and followed them into the trauma room, asking the nurse to prioritize this patient: first, start an IV and begin a saline drip—then oxygen on, cardiac monitor and pulse-ox leads, two large-bore IVs if we could, and IM epinephrine to the thigh right away with readiness to repeat. Adjuncts like H1/H2 blockers and steroids could follow once he was more stable.

I flagged the charge nurse—Renee—making sure she understood this was a priority. “Let’s get that IV in, fast. Saline wide open,” I said. A half-eaten donut sat on the nurse’s station as the bustle seemed to slow for a second and the team sprang into action: oxygen cannula in place, monitor chirping to life.

Since there were no beds and the wheelchair hadn’t arrived yet, I pulled over a plastic stool for him to sit on. I posted a spotter at his shoulder, and once the chair showed up, we’d lock the brakes and keep him tethered to the monitor right outside the bay.

It wasn’t the most comfortable setup, but you make do. I grabbed a sturdy blue stool from the corner, set it down, and helped him ease onto it. He looked pale and tense, knees bouncing slightly as adrenaline and fear mixed in, leads stickered on his chest and finger probe blinking.

Then I took his blood pressure: 95/60 mmHg. I measured again, and it was about the same. His heart rate hovered at 112, respirations 22, oxygen saturation 96% on nasal cannula, and his temperature was normal. The monitor gave a soft alarm chirp as the BP cuff cycled again.

I watched the numbers on the monitor, not liking what I saw. Low, and staying low. I double-checked, just to be sure, and got the same reading. The nurse shot me a knowing glance—this wasn’t normal—and we shared a tight beat as I steadied my stethoscope at his chest.

A guy his age should have a blood pressure around 100–120 over 60–80 mmHg. Since he’d just arrived at the ER and was so uncomfortable and a little agitated, his blood pressure should have been even higher than normal. In anaphylaxis, though, distributive shock can hit—massive vasodilation and leaky capillaries that drop pressure despite the body’s own adrenaline.

He was young, looked like he played some kind of rec league sports, and yet here he was with numbers that belonged to someone way older—or way sicker. Adrenaline usually spikes BP, but his was dropping, pointing toward a systemic reaction.

But his was only 95/60 mmHg. Clearly, his blood pressure was low—an unmistakable red flag.

That was a red flag—hypotension like that can mean something more serious is brewing, like his body’s tanking in response to the allergy. I felt the tension ramp up in the room, every nurse glancing over at us now, the monitor’s chirps sharpening.

“This is why you need to stay in the trauma room,” I told him. “We’re going to give medicine that quickly reverses this and keep a close eye on your breathing.”

I tried to keep my tone steady, but made sure he understood. “This isn’t just a rash. We want you close by, just in case things change fast. Any lip or tongue swelling? Hoarseness? Chest tightness or wheezing? Feeling dizzy?”

Ordinary allergic reactions aren’t much to worry about; at most just—hives, itching, and some discomfort.

—and as I started to say it, I caught myself glancing at the crash cart one more time. The cuff cycled lower, the monitor alarm chirped again, and Jake’s voice thinned for a moment. In the ER, it pays to expect the unexpected; the nurse uncapped the epinephrine as the room felt a little tighter, a little more electric, and the team prepped for whatever might come next.