Anaphylactic shock is a rapidly developing reaction to an allergen, accompanied by circulatory disorders, spasms, oxygen deficiency. The shock can happen instantly, or it can last for several hours.
The degree of its severity depends on the amount of the allergen that has entered the body. It can occur under various circumstances:
- When bitten by poisonous insects, snakes. Bee sting.
- The use of medicines (first aid may be required for anaphylactic shock in dentistry during banal tooth treatment, in gynecology, urology, traumatology, when visiting a surgeon, during injections).
- When vaccinated.
- For food allergies. Seasonal hay fever can also result in severe consequences.
Manifestations of anaphylaxis
- Sharpdeterioration of peripheral and central circulation, accompanied by a decrease in pressure in the arteries. At the same time, the victim feels headaches, nausea, clouding in the eyes, while pale skin is observed, the pulse is filiform.
- Shock (painful and toxic): a person experiences severe chest pain, suffocation.
The nature of an anaphylactic reaction, and therefore the provision of first aid for anaphylactic shock, depends on which organ is affected. From here, 4 types of anaphylaxis are distinguished:
- affecting the skin;
- nervous system (cerebral type);
- cardiac muscle (cardiogenic: heart attacks, myocarditis);
- respiratory organs (asthmatic type).
Most often, allergic reactions of this type are recurrent. In order to provide first aid for anaphylactic shock in time, it is necessary to have the appropriate drugs on hand. Usually people who are prone to such reactions have these remedies. Also, each specialist providing medical care should have a special first-aid kit with him. Without an anti-shock first-aid kit at hand, not a single physician has the right to work.
First aid
First first aid for anaphylactic shock consists of the following activities:
- Depending on the location of the victim, call an ambulance, doctor, resuscitation team.
- Remove the patient from the source of the allergic reaction depending on the situation: remove the needle frommedicinal solution, wash the stomach of allergenic food, pull out the sting, try to squeeze out the poison, offer the patient an air-conditioned room without access to harmful pollen, and so on.
- Lay the patient down with the legs up to pillow height.
- Allow the victim to breathe fresh cool air (open the window, if it is an allergic reaction to some environmental factors, pollen, turn on the air conditioner).
- Make sure that the person is conscious (ask him about something, for example, what he associates this reaction with, exert a slight physical impact).
- Clear the respiratory system of mucus, vomit if necessary.
- Lay your head on your side.
- When providing first aid for anaphylactic shock, you may encounter respiratory and circulatory arrest - urgent resuscitation is necessary. The basis of these activities are: indirect heart massage (30 clicks) and artificial respiration (2 breaths).
- If two people are helping, you need to change every 2 minutes. Only chest compressions are allowed until the arrival of the ambulance team if first aid providers are not trained in the correct technique of artificial respiration or there is a risk of infection.
- When such a condition occurs in a person, it is also recommended, if possible, to check his pulse and pressure. If the pressure is not determined, the shock develops rapidly, it is urgent to carry out resuscitation measures, applymedicines.
- As a first aid for anaphylactic shock, apply a tourniquet above the injection site with the allergen. Do not forget about the rules for applying a tourniquet. Be sure to put a note under it, with the date and time of the overlay. The maximum overlay time in summer is 2 hours, in winter 1.5 hours. Optimal - every 30 minutes, loosen the tourniquet for 5 minutes, in order to avoid circulatory disorders in the limb.
- It is necessary before the arrival of the doctor to be close to the patient, to control his consciousness, to provide all possible assistance. The arriving resuscitation team needs to know: how long the victim has been in this state, what the reaction to, information about the manipulations performed.
Providing first aid for anaphylactic shock is a very serious event, its timely provision will help to avoid death.
Every middle and senior he alth worker should know the rules for providing this care. Always when carrying out manipulations that can lead to an allergic reaction, specialists should carry drugs used to relieve an attack. There is a special list of first aid medicines for anaphylactic shock.
This list includes
Adrenaline 0, 1%, in ampoules of one milliliter. There are also special EpiPens that contain a single-dose dose of adrenaline
- Norepinephrine 0.2% in ampoules of 1 milliliter.
- Antiallergic drugs ("Suprastin", "Dimedrol", "Loratadin", "Zirtek").
- Corticosteroids (prednisolone in ampoules of 30 milligrams, hydrocortisone in ampoules of 4 milligrams).
- Means that increase blood pressure ("Ephedrine" 5% in ampoules, "Mezaton" 1%).
- Broncholytics (relieving bronchospasm) - "Eufillin" 2, 4% in ampoules.
- Cardiac glycosides ("Strophanthin" 0.05%, "Korglikon" 0.06% in ampoules).
- Tonics (caffeine 10%).
- Respiratory stimulants ("Cordiamin").
- For intravenous (IV), intramuscular (IM) infusions of drugs, physical. solution, glucose solution 5%, infusion systems. Alcohol, gloves, sterile syringes, wipes, fixing adhesive tape are also needed.
Nursing care
A nurse giving injections to patients always carries first aid medicines for shock. It takes into account the possibility that anaphylactic shock will occur. Nurse first aid: the algorithm is clear and coherent:
- The nurse should stop, no more injections.
- Call a doctor urgently.
- Apply a tourniquet to the injected limb above the injection site.
- Give the patient an appropriate posture (lying down, put his feet on the pillow).
- Put the patient's head to one side, pull out the dentures,push the lower jaw forward, freeing the airways.
- If necessary, start mechanical ventilation, heart massage (indirect).
Anaphylactic shock is a deadly condition. For first aid, the nurse can use:
- With a solution of adrenaline 0.1%: subcutaneously inject half a milliliter. The introduction into the gluteal or femoral muscle is allowed. It is also urgent to puncture the injection site with the allergen with the following composition: dilute half a milliliter of adrenaline 0.1% in a syringe with 5 milliliters of saline. solution, in about five to six places. Here - apply ice.
- Quick access to the patient's veins is very important in anaphylactic shock. First aid: the nurse's algorithm also includes intravenous infusion. The nurse must provide quick access to the patient's vessels. To do this, she catheterizes a vein and injects saline drip. Injects a solution of prednisolone, 60-150 milligrams in 20 milliliters of saline intravenously (in the calculation of 1-2 milligrams per kg of the victim's weight). (Dexamethasone 8-32 milligrams, 100-300 milligrams hydrocortisone per muscle or vein are allowed.)
- It is advisable to inject 5 milliliters of 1% "Dimedrol", 2 milliliters of 2% "Suprastin" into the muscle.
Medical help
- It is necessary to carry out infusion into the venous catheter: physical. a solution with a total volume of at least 1 liter, if possible, inject 0.5 liters of saline. solution and 0.5 l"Refortana GEK".
- If there is persistence of hypotension, it is necessary to re-inject 0.5-1.0 milliliters of adrenaline 0.1% into the muscle, 15-20 minutes after the first injection. You can do this every 15-20 minutes.
- If there is no effect, dopamine is injected. For 400 milliliters of normal saline, 200 milligrams of dopamine is given intravenously by drip, very slowly (2-11 drops per minute) until the systolic pressure reaches 90 millimeters of mercury.
- With the development of heart failure, cardiac glycosides (strophanthin 0.05% 1 milliliter or corglicon 0.06% 1 milliliter) are used intravenously for physical. solution.
- If there is a development of bradycardia (heart rate less than 55 per minute), first aid for anaphylactic shock includes the subcutaneous injection of half a milliliter of 0.1% atropine. If the condition persists, repeat in the same amount after five to ten minutes.
- For breathing problems, inject 10 milliliters of "Euphyllin" 2, 4% in saline into a vein, or into a muscle with a 24% solution.
- Keep pressure, heart rate, breathing rate under constant control.
- Ensure the delivery of the victim to intensive care.
Anaphylactic shock in children
Is the most severe acute form of an allergic disease in which there is a direct threat to the life of the child. Anaphylactic shock is dangerous due to severe disorders in the cardiac, vascular, respiratory and nervous systems.
This type of allergic reaction can be caused by foods, medicines, insect bites, and more.
Symptomatics
The child begins to feel dizzy, headaches, weakness, cold sweat. Children during this period experience fear, become pale. The picture of the further development of anaphylaxis is similar to adults: hypotension, suffocation develops, the child loses consciousness, the pulse is thready. The process may be accompanied by convulsions.
Sometimes the course of shock is different. In this case, you can observe reddening of the skin, the child sneezes, coughs, says that he is hot, it is hard to breathe. Abdominal pain may occur.
So, in pediatrics, the following forms of anaphylaxis can be distinguished:
- Typical - low blood pressure, respiratory failure, impaired consciousness, seizures, skin reactions.
- Asphyxial - the predominance of respiratory failure due to swelling of the respiratory system, the development of bronchospasm.
- Hemodynamic - there are heart rhythm disturbances, accompanied by painful sensations, heart sounds are muffled, pressure drops, the pulse becomes thready.
- Cerebral - the child loses consciousness, the respiratory rhythm goes astray, cerebral edema occurs, convulsions.
- Abdominal - symptoms of an acute abdomen, which is why this form may cause errors in diagnosis.
Treatment
First aid for anaphylactic shock in children includes mandatory activities included in internationalstandards. The goal of treatment is to restore blood circulation, oxygen saturation of the body. An important task is also to relieve spasms from smooth muscles in order to avoid late complications.
When conducting medical care for a child, it is imperative to take into account the age and weight of a small patient. First aid for anaphylactic shock - algorithm of actions in pediatric practice:
- Stop the penetration of the allergen into the body. Inject epinephrine 0.1% from 0.3 to half a milliliter at the injection site.
- Apply a tourniquet to the affected limb, above the injection site with the allergen that caused the reaction.
- Lay the baby down, turn the head to the side.
- Inject adrenaline into the muscle at the rate of 0.01 milliliter per 1 kilogram (not more than 0.5 milliliter).
- Inject "Dimedrol" 1% into the gluteal muscle at the rate of 1 milligram per 1 kg. It is allowed to use "Tavegil" or "Suprastin" according to the instructions on age dosages.
Pipolfen cannot be used in pediatrics, as it is an antihypertensive drug.
Further, the use of corticosteroids is necessary (dexamethasone 0, 3-0, 6 milligrams per kg, hydrocortisone 4-8 milligrams per kilogram, prednisone 2-4 milligrams per kg.
Further, having provided venous access, inject the above funds in appropriate amounts intravenously. The rate of intravenous administration of drugs, as well as the amount of fluid administered, depend on the pressure of a small patient.
Fightingbronchospasm
First aid for anaphylactic shock - algorithm of actions to combat bronchospasm:
- Oxygen therapy.
- Intravenous use of the Eufillin solution, at the rate of 3-5 milligrams per kilogram of the child.
- Inhalations with Salbutamol, Berotek.
If a child experiences convulsions, Sibazon, Diazepam, Droperidol are used.
A clear control of blood pressure, respiratory rate, and cardiac activity is constantly needed.
Resuscitation in Pediatrics
If necessary, an indirect heart massage is performed along with artificial respiration. Frequency of pressing on the chest area of the child:
- up to a year - more than 120 times per minute, combined 1 breath - 5 clicks;
- from one to seven years - 100-200 times per minute, combined 1 breath - 5 clicks;
- over seven years old - 80-100 times per minute, combined 2 breaths - 15 clicks.
