Help with anaphylactic shock

Author: ambulance doctor Deryushev A.N.

Anaphylactic shock is, perhaps, the most severe form among allergic reactions of immediate type. Such a shock develops as a result of repeated contact with a certain allergen and manifests itself as an acute violation of hemodynamics, which leads to circulatory insufficiency and further to hypoxia of all important organs.

The most common causes that lead to anaphylactic shock are:

1. Medicines: most often - antibiotics, non-steroidal anti-inflammatory drugs, some analgesics, etc.

2. Food allergens

3. Insect bites

4. Household allergens: household chemical products, etc.

The clinical picture of anaphylactic shock manifests itself within the first minutes after direct contact with the allergen - after the injection, or during the first two hours after ingestion, which contains the allergen. In some cases, the entire picture of shock can unfold in just a few seconds.

At a light current the patient complains of dizziness, on occurrence of noise in ears, and weakness, at the same time it is possible to record lowering of arterial pressure. For a severe course, the beginning is characterized by a loss of consciousness, a sharp drop in blood pressure to undetectable values. первую помощь при кровотечениях и ранениях для сравнения состояний . Read first aid for bleeding and wounds to compare states .

Before beginning emergency medical care, all factors that make breathing difficult (unfasten the collar, give the body a comfortable position) should be ruled out. With an insect bite or reaction to an injection, it is possible to use a local cold or temporarily apply a tourniquet to a limb. You can give the patient an anti-allergic drug from a home medicine chest. If it is a question of stopping the cardiac and respiratory activity, then it is necessary to begin resuscitation before the doctors arrive, including indirect cardiac massage and, of course, artificial respiration.

Emergency medical care includes the following activities:

1. Termination of the receipt of the allergen in the body. To do this, stop the parenteral administration of the drug and apply a tourniquet just above the injection site for 25 minutes (every 10 minutes it needs to be weakened for 1-2 minutes).

2. It is necessary to remove the sting of the insect from the wound, and it is recommended to do this with the injection needle, since when removing by hand or using tweezers, it is possible to squeeze the remains of the poison into the wound.

3. Cold is applied to the injection or sting site (ice pack, or hot water bottle with cold water for 15 minutes)

4. Place of injection or stinging can be cut at 5-6 points with a 0.1% solution of epinephrine

5. In the presence of shock symptoms, immediately begin a complex of anti-shock measures, which begin with ensuring the patency of the airways, and for this the patient is laid (the head part should be slightly lowered), the head should be turned aside so that in case of vomiting - the vomit does not get into the throat, push the lower jaw, in the presence of dentures - they must be removed.

6. Immediately inject epinephrine. It is possible to inject it intramuscularly into the lateral surface of the thigh, or subcutaneously, even through clothing! Further, his repeated injections are carried out every 5-20 minutes.

7. Venous access is provided, after which the volume of circulating blood is replenished by infusion of solutions of at least 1 liter for adults and at a rate of 20 ml per 1 kg of body weight for the baby.

8. Glucocorticoids are mandatory: prednisolone in a dose of at least 90-150 mg (for children up to one year the dose is 2-3 mg per kg of body weight, from 1 to 14 years 1-2 mg per 1 kg of body weight). Prednisolone is administered intravenously, by jet.

9. When bradycardia occurs, atropine is used.

10. When joining the clinical picture of bronchospasm - salbutamol, preferably through a nebulizer.

11. Application of inhalation of oxygen is shown.

12. Be sure to be ready, if necessary, to start a cardiopulmonary resuscitation complex.

Unlike emergency care in syncope and collapse , anaphylactic shock is an absolute indication for hospitalization, as it is necessary to monitor it further due to the risk of developing a delayed phase.