April 22, 2021

In the fall of 2014, while working overnight in the emergency department at a community hospital in NJ, a patient (let's call him John) presented with ACE inhibitor angioedema. At first glance, his lips were swollen, but his tongue and oropharynx were unremarkable, and there were no signs of respiratory distress. I ordered an "anaphylaxis cocktail" and checked on him a few moments later.  John's condition deteriorated. His tongue, now swollen, protruded and forced his mouth open. He spoke in a muffled voice and drooled his oral secretions. I quickly phoned anesthesia for fiberoptic intubation. My heart sank when I was notified they were unavailable.
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