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 kept a patient from needing to be intubated to prevent respiratory failure from a rare allergic reaction to a commonly prescribed ACE inhibitor for hypertension. Their work underscores the quest for excellence in patient care available close to home, here at Shore. To read the published article, “Use of Tranexamic Acid Prevents Intubation in ACE Inhibitor-Induced Angioedema” click here.
Dr. Farhan Qadeer, a Critical Care trained physician and member of the Shore Medical Center ICU team, along with Shore Pharmacist Dr. Ramzan Judge, were together able to prevent severe illness and discharge a patient after an overnight stay so he could return to his normal life. Their decision to provide the patient with a dose of tranexamic acid (TXA) prevented the cascade of factors that lead to angioneurotic edema, a life-threatening event.
The Shore clinical experts explained that the patient came into the emergency room with his tongue swollen and was having trouble breathing. The patient's spouse thought he may have been suffering from an allergic reaction to the Chinese food eaten the prior evening, though he had no known food or drug allergies. The patient did have a past medical history inclusive of hypertension, coronary artery disease and chronic kidney disease. His drug regimen for hypertension included an ACE inhibitor.
The patient was originally 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 emergent intubation to be performed in the OR. Dr. Qadeer reported that there was a decision to give the patient TXA before the scheduled 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 he did not need to be intubated. The team determined Chinese food was not the culprit, rather it was angioedema, a rare but possibly life-threatening severe allergic reaction to his ACE medication for hypertension. Angioedema causes rapid swelling of the soft tissues of the airway.
Angioedema presents with rapid asymmetric swelling of the airway and can include the face, lips, genitalia and/or extremities. As Dr. Qadeer explained, there is currently no clear specific treatment for angioedema. Typical first-line management includes a combination of anti-histamine targeted therapies which are minimally effective, according to Dr. Qadeer. Other measures include steroids, airway support and oxygen along with discontinuation of the medication. The TXA, when introduced to the patient before the scheduled intubation, counteracted the neurochemical pathways which lead to angioedema, preventing the formation of factors that would have allowed the swelling to continue.
Once the patient’s symptoms subsided, the intubation procedure was canceled, and he was admitted to the ICU for observation. He had no further intervention and was able to be discharged just 28 hours after arriving at the emergency room with swelling and difficulty breathing.
“The patient was given counseling on ACE medication allergy and avoidance in the future of ACE medications and the medications related. The patient’s medical records were updated to include the allergy,” said 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 remained in the hospital. Instead, he was able to go home and he told me, ‘I just want to go home and feed my dog.’ I think it is wonderful that we were able to intervene and enable this outcome.”
As Dr. Qadeer explained, “There is an impressive sense of cooperation here at Shore. We all know we are working together for our patients. I can put in a call to colleagues and they will get right back to me or will join me in the ICU. We are all working collaboratively to provide the very best outcome for every patient. We are a community hospital truly providing the best care for our community.”
"We are so proud of our ICU doctors, pharmacy and all staff who day after day, provide dedicated team care at the highest level of scientific quest of best practice and new therapies,” said Dr. Jeanne Rowe, Chief Medical Officer at Shore Medical Center. “Because of their attention and treatment of this patient with tranexamic acid, Dr. Farhan Qadeer and Ramzan Judge, PharmD were able to prevent their ICU patient from developing more severe illness and requiring intubation. Their study was recently published in the International Journal of Critical Care and Emergency Medicine and thus the treatment may indeed help others. 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.”