Allergy & Immunology · Model history
A severe allergic reaction after peanuts: a model emergency history
- Setting
- Emergency department
- Patient
- Mr. Green, 19, developed throat tightness, hives, and dizziness within minutes of eating peanuts.
- Listen
- 2 min
After listening
Say the next question
Read the patient’s answer, say your next question aloud, then reveal the model.
“All over... my chest, my arms... everywhere.”
Ask directly whether the patient feels dizzy or faint, screening for circulatory involvement.
Do you feel dizzy or like you might faint?
Model interview
Full transcript
- Doctor
I'm Dr. Marsh. We're giving you epinephrine right now. While the nurse does that, tell me what happened.
- Patient
I ate pad thai... it had peanuts... I'm so allergic.
- Doctor
How long ago did you eat it?
- Patient
About fifteen minutes ago.
- Doctor
Is it hard to breathe or swallow right now?
- Patient
Yes... my throat feels tight... hard to swallow.
- Doctor
Does your voice sound different to you?
- Patient
Yeah... it feels hoarse.
- Doctor
Do you have hives or itching anywhere on your body?
- Patient
All over... my chest, my arms... everywhere.
- Doctor
Do you feel dizzy or like you might faint?
- Patient
Yes... really dizzy... lightheaded.
- Doctor
Have you had a reaction like this before?
- Patient
Yes... I've been allergic to peanuts since I was a kid.
- Doctor
Do you carry an epinephrine auto-injector?
- Patient
I have one... but I left it at home today.
- Doctor
Do you have asthma, or take any inhalers?
- Patient
Yes... mild asthma... I use albuterol sometimes.
- Doctor
Any other medical conditions or medicine allergies?
- Patient
No... just the peanut allergy.
- Doctor
What are you most afraid is happening right now?
- Patient
I feel like my throat is closing... I'm scared I can't breathe.
- Doctor
Let me make sure I have this. About fifteen minutes ago you ate pad thai with peanuts, and now your throat feels tight, your voice is hoarse, you have hives all over, and you feel very dizzy. You have a known peanut allergy and mild asthma, but you didn't have your epinephrine with you today. Is that right?
- Patient
Yes... that's right.
- Doctor
Thank you. The epinephrine we just gave you is working right now to open your airway and bring your blood pressure back up. We're also giving you oxygen and fluids, and we'll watch you closely for several hours, because these reactions can sometimes come back even after they start improving. Before you go home, we'll make sure you leave with two new epinephrine auto-injectors and a clear action plan.
- Patient
Okay... thank you... it does feel a little easier already.
Flow at a glance
The route through the history
- Start treatment while taking a rapid history
- Confirm the trigger food and timing
- Screen airway symptoms
- Screen skin symptoms
- Screen circulatory symptoms
- Confirm known allergy and epinephrine access
- Check asthma and other background
- Summarize briefly and explain ongoing emergency treatment
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Editorial record
Tied to one reviewed case
This model uses a fictional Bedside English case as its source. The page and pre-generated WAV audio are checked against the same transcript and source-case fingerprints.
Editorial update: