BRIAN CAHILL Shore Medical Center
Shore Medical Center is proud to celebrate two providers, Dr. Farhan Qadeer, MD, and pharmacist Dr. Ramzan Judge, who were recently published in the International Journal of Critical Care and Emergency Medicine.
Their work titled “Use of Tranexamic Acid Prevents Intubation in ACE Inhibitor-Induced Angioedema” prevented a patient from needing to be intubated to prevent respiratory failure due to a rare allergic reaction to an ACE inhibitor commonly prescribed for hypertension.
Dr. Qadeer, a doctor trained in dritic care and a member of the intensive care team at Shore Medical Center, and Judge were able together to prevent serious illness and release a patient after an overnight stay to resume his life normal. Their decision to provide the patient with a dose of tranexamic acid (TXA) prevented the cascade of factors that lead to angioedema, a life-threatening event.
Shore clinical experts explained that the patient arrived at the emergency room with a swollen tongue and was struggling to breathe. The patient’s spouse thought he might be suffering from an allergic reaction to the Chinese food he had eaten the night before, although he had no known food or drug allergies. The patient had a medical history of hypertension, coronary heart disease and chronic kidney disease. His medication regimen for hypertension included an ACE inhibitor.
People also read…
The patient was initially treated in the emergency room with corticosteroids, epinephrine and an antihistamine for an allergic reaction. Thirty minutes later his symptoms had worsened and he consented to an emergency intubation to be performed in the operating theatre.
Dr. Qadeer reported that it was decided to give the patient ATX before the planned intubation. Prior to the procedure, the patient was re-examined and the patient’s tongue swelling was reduced, his speech was clearer and it was decided that he did not need to be intubated. The team determined that Chinese food was not the culprit, but rather angioedema, a rare but life-threatening serious allergic reaction to its ACE drug for hypertension. Angioedema causes rapid swelling of the soft tissues of the airways.
Angioedema presents with rapid asymmetrical swelling of the airways and may include the face, lips, genitals, and/or extremities. As Dr. Qadeer explained, there is currently no clear specific treatment for angioedema. Typical first-line management includes a combination of antihistamine-targeted therapies that are minimally effective, according to Dr. Qadeer.
Other measures include steroids, airway support and oxygen as well as stopping the drug. TXA, when introduced to the patient prior to scheduled intubation, thwarted the neurochemical pathways that lead to angioedema, preventing the formation of factors that would have allowed the swelling to continue.
Once the patient’s symptoms resolved, the intubation procedure was canceled and he was admitted to intensive care for observation. He underwent no further surgery and was discharged just 28 hours after arriving in the emergency room with swelling and difficulty breathing.
“The patient was counseled about allergy to ACE drugs and future avoidance of ACE drugs and related drugs. The patient’s medical records were updated to include the allergy,” said the Dr Qadeer: “It was really amazing that we were able to intervene for our patient. He was about to be intubated and would have meant that he stayed in the hospital. Instead, he was able to go home and he said, “I just want to go home and feed my dog. I think it’s wonderful that we were able to step in and allow this result.”
“We are so proud of our critical care physicians, pharmacy and all staff who, day in and day out, provide dedicated team care at the highest level of scientific pursuit of best practices and new therapies,” said said Dr. Jeanne Rowe, chief medical officer at Shore Medical Centre. “Through their care and treatment of this patient with tranexamic acid, Dr. Farhan Qadeer and Ramzan Judge, PharmD were able to prevent their patient in intensive care from developing more serious illness and requiring intubation. Dr. Qadeer and Dr. Judge are recognized by their peers as leaders in their fields, and we are fortunate to have them on our team at Shore.
