Emergency nursing care of a patient with acute appendicitis complicated by esomeprazole-induced anaphylactic shock: a case report.

RATIONALE: Esomeprazole-induced anaphylactic shock followed by cardiac arrest is an extremely rare but life-threatening adverse event, particularly in patients with acute appendicitis. Clinical nursing experience in managing such critical conditions remains limited, and this case report provides valuable insights into emergency and intensive nursing care.

PATIENT CONCERNS: A 53-year-old male patient with acute appendicitis developed facial flushing, urticaria, and loss of consciousness within 5 min after starting esomeprazole infusion, rapidly progressing to ventricular fibrillation and cardiac arrest.

DIAGNOSES: Acute appendicitis complicated by esomeprazole-induced anaphylactic shock and secondary cardiac arrest.

INTERVENTIONS: Key nursing interventions included rapid identification of allergic manifestations, immediate activation of the rapid response team, cardiopulmonary resuscitation, electrical defibrillation, endotracheal intubation, and timely initiation of Veno arterial extracorporeal membrane oxygenation (VA-ECMO) combined with mechanical ventilation. Nursing care also encompassed development of a safe transport plan under VA-ECMO support, dynamic monitoring of inflammatory markers with anti-infective nursing, precise targeted temperature management using specialized observation charts, close skin monitoring to prevent recurrence of allergic reactions, and multimodal psychological nursing interventions.

OUTCOMES: After 48 days of intensive treatment and meticulous nursing care, the patient's condition stabilized, and he was successfully discharged with good recovery at one-month follow-up.

LESSONS: Rapid recognition of drug allergy, efficient multidisciplinary collaboration, precise VA-ECMO circuit management, systematic temperature control, and comprehensive psychological support are critical to improving survival and neurological outcomes in patients with esomeprazole-induced anaphylactic shock complicated by cardiac arrest.