Content
- What happens in the body during anaphylactic shock?
- The first signs and symptoms, causes
- Classification of anaphylactic shock, how does care for patients with different severity of symptoms differ
- With a mild course
- With moderate flow
- Heavy current
- Diagnostics
- First aid
- Patient Pose for Assistance
- What is injected first? Anti-shock drug set
- How to administer Adrenaline?
- Algorithm of emergency care for anaphylactic shock (medical care)
- The use of medicines
- Airway management for laryngeal edema
- Follow-up treatment at the hospital
- Nursing care for anaphylactic shock
- Federal Clinical Practice Guidelines for Anaphylactic Shock
- Consequences of anaphylactic shock
- Who is more likely to experience anaphylactic shock?
- Prediction of how likely death from anaphylactic shock is
- How can the patient's risk of shock be minimized?
- First aid video for anaphylactic shock
Anaphylactic shock is one of the forms manifestations of an acute allergic reaction with lightning-fast development, always acute dynamics and pronounced symptoms. Patients with signs of anaphylaxis need urgent medical attention. At the same time, the first steps aimed at stabilizing the patient should be performed at the pre-medical stage, when the ambulance workers are still on the way. Otherwise, there is a high risk of death.
What happens in the body during anaphylactic shock?
With anaphylactic shock, an immediate reaction of the body's hypersensitivity to internal or external stimuli occurs. In fact, this is one of the most severe allergic reactions. Immediately after contact with the allergen, the secretory activity of the cells responsible for the release of histamine is activated.
An excess amount of this substance enters the patient's blood, which provokes an extensive allergy with irritation of all mucous membranes of the body. Under the influence of histamine, the peripheral circulation is first disturbed, and then the general circulation. A patient who has not received emergency first aid in a timely manner begins to feel short of breath, he has a feeling of discomfort and anxiety.
The first signs and symptoms, causes
The severity of anaphylaxis depends on what triggered the acute allergic reaction of the body. The table below lists the symptoms and main causes of anaphylactic shock in children and adults.
Signs | Causes |
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Clinical manifestations of anaphylaxis may occur in the first 1-2 minutes. or after 5 hours after contact with the allergen. The more time has passed after the body has interacted with a potential irritant, the more likely it is that the anaphylactic reaction will have less severe symptoms.
Classification of anaphylactic shock, how does care for patients with different severity of symptoms differ
The emergency for anaphylactic shock should begin after the first symptoms of this condition appear. The nature of the actions aimed at normalizing the patient's well-being depends on the severity of anaphylaxis.
With a mild course
In the presence of minor symptoms of anaphylactic shock, which are expressed in redness of the skin, itching of epithelial tissues and mucous membranes of the eyes, the appearance of edema, it is necessary to apply a tourniquet 10 cm higher from the injection site or poisonous bite insect.
After that, the patient must take an antihistamine, which stops the allergic reaction. In the absence of acute signs of anaphylaxis, you can take Aleron, Suprastin, L-Ceta tablets. An ambulance team is called without fail, since the condition of a person with signs of anaphylactic shock may worsen.
With moderate flow
A moderate course of anaphylaxis is accompanied by an increasing bronchial spasm, a feeling of lack of air. In this case, the patient needs to receive intravenous injections with drugs from the pharmacological group of glucocorticoids. Urgent hospitalization in the intensive care unit is required. In the absence of drug therapy, there is a real risk of death.
Heavy current
A severe form of anaphylactic shock is accompanied by a rapid drop in blood pressure, impaired consciousness and thought process, fainting, edema of the larynx and oral tissues. Patients with a similar course of anaphylaxis should urgently learn injections of Adrenaline, Dexamethasone, Prednisolone.
If there is no effect on the removal of airway edema, tracheal intubation is performed to perform mechanical ventilation. The patient receives supportive drug therapy until the functions of the respiratory and cardiovascular systems are fully restored.
Diagnostics
Examination of patients with signs of anaphylaxis is carried out in the hospital of a medical institution after the acute symptoms of an allergic reaction have been removed. Diagnostics is aimed at determining the allergen that provoked anaphylactic shock.
The patient will need the advice of an experienced allergist. Venous blood must be donated for biochemical analysis. The type of potential irritant that caused anaphylaxis is determined by conducting an allergy test. Based on the results of the diagnosis, a list of preventive measures is drawn up to prevent another attack of anaphylactic shock.
First aid
An anaphylactic shock emergency should be performed as soon as possible. This will save the patient's life until the arrival of doctors.
Patient Pose for Assistance
A patient with signs of anaphylaxis should take a pose depending on his condition, namely:
- in the presence of signs of impaired peripheral or general circulation, the person lies on his back, and his lower limbs rise up (these manipulations provide blood flow to the brain tissues, warn hypoxia);
- in conditions of respiratory failure, the patient must take a sitting position;
- an unconscious person is laid on its side.
After the patient lies down or sat down, he is provided with emergency first aid, aimed at stabilizing his condition.
What is injected first? Anti-shock drug set
The anti-shock set of drugs provides for the presence of Adrenaline, vasodilating solutions of intravenous administration and glucocorticoids.
The order of administration of these drugs is as follows:
- Adrenalin.
- Methylprednisolone.
- Dexamethasone.
- Prednisolone.
- Euphyllin
- Suprastin or Tavegil.
Throughout the entire period of anti-shock therapy using the above drugs, the blood pressure level is monitored. Particular attention is paid to the patient's respiratory rate, which may be disturbed due to the increasing laryngeal edema.
How to administer Adrenaline?
Epinephrine should be administered immediately after the onset of the first symptoms of anaphylaxis. The initial dose of this drug is from 0.2 to 0.5 ml of an injection solution with a concentration of 0.1%.
The best therapeutic effect for the elimination of anaphylaxis is observed if Epinephrine was administered intravenously. Also, this drug can be injected subcutaneously. For example, if the person providing first aid does not have the skills to administer drugs intravenously.
Patients with signs of edema of the tissues of the larynx are injected with Adrenaline at a dosage of 0.3 ml of a solution of 0.1% concentration, dissolving 0.9% in 10-20 ml of sodium chloride. The total dose of Epinephrine can be increased to 1-2 ml. Intravenous or subcutaneous administration of the drug is performed within a short period of time. On average, every 2-3 minutes.
Algorithm of emergency care for anaphylactic shock (medical care)
There is a generally accepted algorithm of actions for carrying out emergency medical care for patients with signs of anaphylactic shock.
The use of medicines
The use of drugs begins with the intravenous or subcutaneous administration of Adrenaline at the dosages indicated in the previous section.
Then the patient receives therapy with the following medications:
- Methylprednisolone at a dosage of 500 mg.
- Dexamethasone in the amount of 5 ampoules of 4 mg each.
- Prednisolone in a total dosage of 150 mg (5 ampoules of injection solution, 30 mg each).
The above drugs from the pharmacological group of glucocorticoids are administered at the discretion of the attending physician. In this case, only one type of medication can be used, depending on the general condition of the patient. To eliminate signs of an acute allergic reaction, an injection of 1-2 ml of Suprastin or Tavegil is used. To normalize the respiratory function, use 20 ml of the drug Euphyllin with a concentration of 2.4%. This medication is administered intravenously.
Airway management for laryngeal edema
Laryngeal edema caused by severe anaphylaxis is the cause of increased symptoms of shortness of breath.
To ensure sufficient patency of the trachea, the following resuscitation actions are performed:
- airway intubation with patient connection to a ventilator;
- carrying out a tracheostomy (this method of restoring breathing is used if it was not possible to intubate the patient);
- puncture of the trachea using 6 needles that have a wide lumen.
The latter method of ensuring airway patency is the simplest and fastest, and is also used in critical situations. For example, if the medical institution does not have a ventilator, or there is no specialist who is able to perform tracheal intubation.
Follow-up treatment at the hospital
After removing the acute symptoms of anaphylactic shock, normalizing breathing and eliminating edema of the mucous membranes, the patient receives symptomatic treatment depending on his general condition. The main therapy is aimed at cleansing the blood from the remnants of the allergen that caused the attack of anaphylaxis. In this case, antihistamines, glucocorticoids, and physical solution are used.
Nursing care for anaphylactic shock
Nursing care for a hospitalized patient with symptoms of anaphylactic shock includes the following:
- inserting and flushing a urine diversion catheter (for example, if the patient is unconscious);
- taking out and sanitizing duck;
- installation of intravenous droppers;
- taking blood for analysis;
- intravenous, subcutaneous and intramuscular administration of drugs;
- blood pressure measurement;
- fixation of the patient's pulse rate.
The nurse monitors the general condition of the patient at all stages of his treatment. Particular attention is paid to patients with severe anaphylaxis. In such cases, a second phase of anaphylactic shock is possible, which manifests itself 5-7 hours after the symptoms of the first attack are eliminated.
Federal Clinical Practice Guidelines for Anaphylactic Shock
Federal clinical guidelines for the treatment of patients with signs of anaphylactic shock are enshrined in regulations in the form of orders from the Ministry of Health. This documentation contains guidelines for the use of medication therapy, restoration of airway patency. All these recommendations duplicate the algorithm of actions for the provision of first-aid and medical care, which was described in the sections above.
Consequences of anaphylactic shock
After suffering anaphylactic shock, a person may develop the following complications:
- inflammation of myocardial tissue;
- bronchial asthma;
- recurrent Quincke's edema;
- damage to the kidneys and liver.
To minimize the risk of these consequences, it is necessary to undergo a comprehensive examination of the body. Diagnostics should be performed immediately after stabilization of the general condition.
Who is more likely to experience anaphylactic shock?
Emergency for anaphylactic shock, involves the use of potent drugs with antiallergic properties.
Adults and children with the following diseases of the body are at risk for anaphylaxis:
- eczema;
- atopic dermatitis;
- rhinitis of an allergic nature of origin;
- mastocytosis;
- bronchial asthma.
A significant influence on the appearance of anaphylaxis has a hereditary tendency to acute allergic reactions to food, chemicals, drugs.
Prediction of how likely death from anaphylactic shock is
The incidence of anaphylactic reactions in the body is 50 cases per 100 thousand. Human. Moreover, from 10 to 20% of clinical manifestations of anaphylaxis lead to death. Younger men and women are more likely to die from anaphylactic shock. The vast majority of deaths are associated with acute allergic reactions to food and drugs.
How can the patient's risk of shock be minimized?
To minimize the risk of developing anaphylaxis, the following prevention rules must be followed:
- do not eat food in relation to which the body shows a hypersensitivity reaction;
- always make allergic tests for a drug intended for intramuscular, subcutaneous or intravenous administration;
- use personal protective equipment if there is a real risk of being bitten by poisonous insects (mask, gloves, special suit that bees, wasps do not bite through);
- in the habitats of poisonous snakes, it is necessary to move in rubber boots with a high bootleg;
- to minimize the use of cosmetics, which contain a large amount of chemical components;
- wear clothes made from natural materials (synthetic fibers increase the risk of developing an acute allergic reaction).
These recommendations will minimize the risk of developing anaphylactic shock. Prevention of anaphylaxis is mandatory for individuals who are initially prone to acute allergic reactions.
Anaphylactic shock is the most acute and fulminant form of an allergic reaction, the result of which is the release of an excess amount of histamine into the general bloodstream. Anaphylaxis is accompanied by a rapid drop in blood pressure, darkening of the eyes, and confusion. Patients with signs of anaphylactic shock feel an acute shortage of air caused by edema of the larynx and oral tissues.
With anaphylaxis, it is very important that the person receives qualified first aid. Upon the arrival of an ambulance, the patient is admitted to the hospital of the intensive care unit, where he urgently receives anti-shock and antihistamine therapy. Average mortality rates from anaphylactic shock range from 10 to 20% of cases.
First aid video for anaphylactic shock
Emergency care for anaphylactic shock: