Algorithm for emergency care in anaphylactic shock. First aid for anaphylactic shock

Anaphylactic shock is a dangerous condition that threatens the patient's life.. Usually develops after contact with some foreign substances (antigens).

This is a generalized rapid allergic reaction. Accompanied by a violation of hemodynamics, which leads to circulatory failure, hypoxia.

Without emergency medical care, it can end in death.

We will learn what to do with anaphylactic shock at home, how to provide first aid.

Anaphylactic shock occurs under the influence of various factors.

Main reasons:

In children, the cause of the reaction is usually the introduction of gamma globulin, vaccines, sera. More often, the condition develops with repeated use of the drug or allergen.

If mothers during pregnancy and lactation took such a drug, the occurrence of anaphylactic shock is possible at the first contact with the drug. The dose of the allergen does not matter to the sensitized person.

The time of development of shock depends on the ability to introduce the allergen.. When injected, it proceeds more rapidly. If the drug was administered intravenously, shock occurs instantly.

Usually appears within an hour. The maximum time for the development of anaphylactic shock is up to 3-5 hours. The frequency and severity of symptoms increase with age.

Risk factors

An increased risk of developing anaphylactic shock is found in people with asthma, eczema, and allergic rhinitis.

Food, latex, and contrast usually cause the condition, but not drugs or insect bites.

Anaphylactic shock. How not to die from allergies

The condition is characterized by the speed of development, the symptoms appear immediately after contact with the allergen. Three periods of development of symptoms are distinguished:

Flow options:

Malignant (lightning). Acute cardiovascular and respiratory failure develops. In 90% it is characterized by a lethal outcome.
lingering. Perhaps due to the introduction of long-acting drugs. Intensive therapy and observation of the patient is extended to several days.
abortive. Does not threaten the patient's condition. Anaphylactic shock is easily stopped.
Recurrent. This is an episodic occurrence. The allergen enters the body without the knowledge of the patient.

Moderate severity is characterized by pain in the heart, suffocation, Quincke's edema, urticaria, cold sweat, cyanosis of the lips, convulsions. Sometimes there are bleeding uterine, from the nose, gastrointestinal.

The patient does not have time to complain about his condition, he loses consciousness after a few seconds. A person with manifestations of anaphylactic shock should immediately receive emergency care, otherwise sudden death will occur.

The patient turns pale sharply, foam is released from the mouth, large drops of sweat are on the forehead.. The pupils are dilated, breathing is wheezing, with an extended exhalation, blood pressure is not detected, heart sounds are not audible, the pulse is thready.

Consider the algorithm of actions for the provision of pre-medical and medical care for anaphylactic shock.

First aid

If the reaction occurred due to the introduction of various drugs, the part of the body that is located above the injection site is tightened with a tourniquet. The tourniquet is not removed for half an hour.

That's all you can do yourself. Next, you need to wait for the provision of professional medical care. The introduction of anti-shock drugs requires a certain qualification.

As soon as the doctor arrives, he needs to tell him everything that you know about the patient's condition and the situation that led to this condition.

Describe in as much detail as possible your steps to help the patient. Tell how much time has passed since the onset of the reaction, what medications you gave the patient.

The main drugs that can save a life:

adrenalin;
hormones;
antihistamine medicines.

Forbidden:

start therapy with an antihistamine;
take the medicine that provoked anaphylaxis;
take a product containing components that can cross-react;
take pollen-based drugs to a patient with an allergy to it.

Diseases do not go unnoticed. After relief of cardiovascular and respiratory failure, symptoms of a pathological condition may remain: lethargy, weakness, fever, shortness of breath, vomiting, nausea.

Long-term low blood pressure is relieved by adrenaline. For pain in the heart, nitrates (nitroglycerin) are administered. With headaches, reduced intellectual functions, nootropics, vasoactive substances are used.

From infiltrates at the site of the bite, injections will relieve hormonal ointments (Hydrocortisone, Prednisolone), absorbable gels, ointments (Heparin, Troxevasin).

Possible late complications:

hepatitis;
allergic myocarditis;
neuritis;
glomerulonephritis;
diffuse damage to the nervous system (may cause the death of the patient);
10-14 days after suffering anaphylactic shock, Quincke's edema, urticaria, bronchial asthma, systemic lupus erythematosus may appear.

It is difficult to predict the development of shock. It is necessary to carefully prescribe and take drugs with bright antigenic properties.

Consider the general principles of prevention:

Treatment rooms should have anti-shock first-aid kits and hang signs with a list of drugs that cause cross-allergic reactions.

If the patient has suffered anaphylactic shock, when discharged from the hospital, a note is made on the title page of the medical history in red. Such patients should be registered with the dispensary.

Also, if there are family members, especially children prone to allergies, you need to have disposable syringes and anti-shock drugs in your home and travel first-aid kit. You also need to know how to provide first aid for anaphylactic shock, how to administer such drugs.

Anaphylactic shock is a serious condition that threatens the patient's life.. Usually it develops rapidly, so it is immediately necessary to call an ambulance.

The life of a patient who has undergone anaphylactic shock depends on the speed of providing quality care.. The reaction is so rapid that with improperly provided medical care or its absence, death can occur within an hour or less.

Anaphylactic shock always develops suddenly and at lightning speed. Therefore, it requires equally lightning-fast action.

What is anaphylactic shock and why is it dangerous?

Anaphylactic shock is an extremely severe form of allergy.

As with any allergy, the body, faced with a substance that seems to be poison to it, begins to defend itself. And he does it so actively that he harms himself.

But in the case of anaphylaxis, the situation is special: the immune response to the irritant is so strong that not only the skin and mucous membranes, but also the digestive tract, lungs, and cardiovascular system are affected. The consequences can be extremely unpleasant:

Arterial pressure drops sharply.
Tissue edema develops rapidly, including the larynx - breathing problems begin.
The brain begins to experience acute oxygen starvation, which can lead to fainting and further impairment of vital functions.
Due to swelling and lack of oxygen, other internal organs also suffer.

This combination of symptoms is fraught with serious complications and can be deadly. Therefore, it is important to quickly recognize anaphylaxis and provide first aid.

How to recognize anaphylactic shock

The first and one of the most important points in the diagnosis is contact with the allergen. Be especially careful if the following symptoms develop after an insect, medication, or food. Even seemingly harmless peanut cookies can turn out to be an allergen.

Shock develops in two stages. The main symptoms-harbingers of anaphylaxis look like this:

An obvious skin reaction is redness or, conversely, pallor.
Tingling in the arms, legs, around the mouth, or all over the head.
, itching in the nose, desire to sneeze.
Labored and/or wheezing breathing.
A lump in the throat that prevents you from swallowing normally.
Abdominal pain, nausea, vomiting, diarrhea.
Swollen lips and tongue.
A clear feeling that something is wrong with the body.

Already at this stage it is necessary to take urgent measures (about them below). And even more urgent help is needed if anaphylaxis reaches the second, shock stage. Its symptoms:

Dizziness.
Sharp weakness.
Paleness (the person literally turns white).
The appearance of cold sweat.
Severe shortness of breath (hoarse, noisy breathing).
Sometimes .
Loss of consciousness.

3 main rules of first aid for anaphylactic shock

1. Call an ambulance

This must be done as soon as possible. From a mobile phone, call 103 or 112.

2. Urgently inject adrenaline

Adrenaline (epinephrine) is given intramuscularly to raise low blood pressure. This drug is sold in pharmacies in the format of autoinjectors - automatic syringes that already contain the required dose of the drug. Even a child can make an injection with such a device.

As a rule, the injection is made in the thigh - the largest muscle is located here, it is difficult to miss.

Don't Be Afraid: Adrenaline Won't Hurt Severe Allergic Reaction Treatment with false alarms. But if not false, it can save a life.

People who have already experienced anaphylactic reactions often carry epinephrine autoinjectors with them. If the victim is still conscious, be sure to ask if he has the drug. There is? Follow the instructions above.

It makes no sense to take antihistamines: anaphylactic shock develops very quickly and they simply do not have time to act.

If the victim did not have adrenaline, and there are no pharmacies nearby, it remains to wait for the ambulance to arrive.

3. Try to alleviate the person's condition

Lay the victim on their back with their legs elevated.
If possible, isolate the person from the allergen. If you notice an allergic reaction after an insect bite or drug injection, apply a bandage over the bite or injection site to slow the spread of the allergen throughout the body.
Do not give the victim to drink.
If vomiting is present, turn the head to the side to prevent the person from choking.
If the person has lost consciousness and stopped breathing, start (if you have the appropriate skills) and continue until the arrival of the paramedics.
If the condition of the victim has improved, still make sure that he waits for an ambulance. Anaphylactic shock requires additional examinations. In addition, a recurrence of an attack is possible.

Fortunately, in most cases, when timely medical care is provided, anaphylaxis recedes. According to American statistics, a lethal outcome is recorded Fatal Anaphylaxis: Mortality Rate and Risk Factors only 1% of those who were hospitalized with a diagnosis of anaphylactic shock.

What can cause anaphylactic shock

There is no point in listing reasons. Allergy is an individual reaction of the body, it can develop to factors that are completely harmless to other people.

But for the letterheads, here is a list of the most common triggers Allergy Attacks and Anaphylaxis: Symptoms and Treatment resulting in anaphylactic shock.

Food. Most often - nuts (especially peanuts and forest), seafood, eggs, wheat, milk.
Insect bites - bees, wasps, hornets, ants, even mosquitoes.
Dust mites.
Mold.
Latex.
Some medicines.

Who is susceptible to anaphylactic shock

The risk of developing anaphylactic shock is high in those Anaphylactic Shock: Symptoms, Causes, and Treatment, who:

Already experienced a similar allergic reaction.
Has any type of allergy or.
Has relatives who have had anaphylaxis.

If you belong to one of the listed risk groups, consult a therapist. You may need to buy an adrenaline auto-injector and carry it with you.

Anaphylactic shock is a rapidly developing allergic reaction that is life threatening. Can develop in just a few minutes. Survival depends on the tactics of the personnel providing assistance. The article deals with questions about what anaphylactic shock is, its symptoms and treatment, the main symptoms and causes of occurrence.

Why does anaphylactic shock develop?

Anaphylaxis can develop in humans under the influence of such allergens.

An extensive group of medicines. These include some antibacterial agents for the treatment of infectious pathologies, hormonal preparations, serums and vaccines, some enzymes, NSAIDs, drugs used in dentistry. In some cases, the cause of anaphylactic shock can be blood substitutes, as well as latex.
Insect bites. The most dangerous for humans were wasps, hornets, ants and some types of mosquitoes. For some people, flies, bedbugs, lice, and fleas are dangerous.
Worms - roundworms, whipworms, pinworms, etc.
Animal hair and bird feathers.
Herbs. Ambrosia, nettle, wormwood are especially dangerous for humans.
Flowers.
Trees, especially those that bloom in early spring.
The etiology of shock includes certain foods - citrus fruits, berries, protein foods, vegetables. For many people, the danger is artificial additives - dyes, emulsifiers, flavors and sweeteners.

Pathogenesis

In pathogenesis, there are three rapidly changing stages - immune, pathochemical and pathophysiological. At the beginning, the allergen comes into contact with cells that secrete specific proteins - globulins. They cause the synthesis of highly active substances - histamine, heparin, prostaglandins, etc.

As shock develops, these substances penetrate the tissues and organs of the human body, causing a painful process that can lead to the development of edema, severe respiratory and cardiac disorders. In cases of rapid development of an allergic reaction without treatment, death occurs.

Stages and variants of the course

The classification of types of anaphylactic shock is as follows.

Swift. It is malignant because it causes severe heart and lung failure. And it is developing extremely fast. The probability of a lethal outcome in a fulminant course of such a pathology is about 90%.
A protracted version of shock is formed with the introduction of certain drugs.
The recurrent variant of shock is characterized by the fact that its episodes can be repeated many times. This happens if the allergen continues to enter the body.
The mildest form of the disease is abortive. This condition is easily stopped without consequences for a person.

There are three stages of anaphylactic shock.

prodromal period. The first signs of the development of pathology include weakness, nausea, dizziness, the patient has blisters on the skin. Sometimes anxiety, a feeling of suffocation, and discomfort appear at the precursor stage.
At the height of the patient loses consciousness, his skin is pale. The pressure drops, signs of hypovolemic shock are observed. Breathing is noisy, cold sweat appears on the skin, lips are cyanotic.
During recovery, weakness and severe dizziness are observed within a few days. Often there is no appetite.

There are three degrees of severity of the disease.

With a mild course of the disease, the prodromal period lasts up to a quarter of an hour, blood pressure drops to 90/60 mm, syncope is always short-lived. The shock is well stopped.
With moderate anaphylactic shock, the pressure drops to 60 / 40 mm, the precursor stage lasts minutes, and the duration of loss of consciousness is about 10 - 15, sometimes 20 minutes (maximum time). The effect of the therapy is long, the patient needs careful monitoring.
In severe allergic shock, the prodromal period lasts seconds, blood pressure cannot be determined, and the syncope period lasts more than half an hour. There is no effect from the therapy.

Signs of shock

The symptoms of anaphylactic shock differ depending on its severity.

Light degree

At the stage of precursors, the patient complains of itching, a feeling of heat. The swelling of the larynx progresses, because of which breathing is disturbed, and the voice changes, becomes weak. Quincke's symptoms appear.

Symptoms of the height of the disease in adults are as follows.

Headache, syncope, weakness, blurred vision.
Numbness of tongue and fingers.
Pain in the lower back.
Pale or blue skin.
Wheezing due to developing bronchospasm.
Diarrhea, vomiting.
Uncontrolled bowel movements and urination.
Decrease in pressure, the pulse is sometimes not palpable.
Increased heart rate.
Loss of consciousness.

moderate shock

At the stage of harbingers, a person manages to make such complaints:

weakness, syncope;
sharp anxiety;
suffocation;
Quincke type edema;
pupil dilation;
blue lips;
involuntary excretion of urine and feces;
cold sweat;
convulsions.

This is followed by loss of consciousness. Signs of anaphylactic shock are more pronounced: the pressure is low, sometimes it cannot be determined, the pulse is thready (often not determined). In rare cases, there is bleeding from the nose, gastrointestinal tract.

Severe symptoms

Loss of consciousness occurs instantly. The patient does not have time to complain about the symptoms of pathology.

Attention! First Aid (FAC) must be provided immediately or death may result.

In addition to the lack of consciousness, there is the formation of foam at the mouth, blue skin. A large amount of sweat can be seen on the forehead. The pupils are dilated, pronounced convulsions are observed. Blood pressure and pulse cannot be determined, the heart sound is not auscultated.

There are several clinical options for the course of the severe stage.

Asphyxic. There are signs of respiratory disorders and bronchospasm. Due to swelling of the larynx, breathing may stop.
Abdominal. In the first place is pain in the abdominal region, resembling an attack of appendicitis. There is vomiting and diarrhea.
The cerebral form is dangerous with the risk of swelling of the brain and its membranes.
The hemodynamic form is characterized by a sharp drop in blood pressure and the development of symptoms resembling a heart attack.
The generalized form occurs most often, with it all the above described symptoms are observed.

Anaphylactic shock in children is a critical condition. It is necessary to start urgent measures to save the baby as early as possible, regardless of the severity of the pathology.

Diagnostics

Important! Diagnosis of this dangerous disease should be carried out as soon as possible. The life of the patient depends on this, as well as on the experience of the doctor and the tactics of the nurse. It is very important to take an anamnesis, since anaphylactic reactions can be confused with other pathologies.

There are such diagnostic criteria for anaphylactic shock:

anemia, an increase in the number of leukocytes, eosinophilia;
increased activity of liver enzymes;
pulmonary edema on x-ray;
determination of antibodies in the blood.

Emergency help

Especially important! First aid for anaphylactic shock should be carried out as quickly as possible, accurately, smoothly and without panic.

There are such components of the algorithm for providing emergency care for anaphylactic shock.

Lay the victim on a hard surface, lifting his lower limbs.
Turn your head to prevent the penetration of vomit into the lungs.
Open window.
Apply an ice pack to the insect bite area.
Determine the presence of a pulse: if it is not audible, then start artificial ventilation of the lungs and closed heart massage.
Call an ambulance or transport the victim to the clinic.

During pregnancy, an ambulance should be called urgently, even if the patient has a mild stage of the disease. All urgent measures are carried out only by a doctor.

Compliance with such an algorithm of actions during first aid is a guarantee of a favorable outcome of a severe allergic condition. The components of first aid in such emergencies should be known to everyone.

Medical treatment for anaphylactic shock

Treatment of anaphylactic shock in the ambulance is to carry out the following activities.

Monitoring of basic functions - measurement of blood pressure, heart rate, electrocardiography.
Cleansing the oral cavity from vomit, if necessary - tracheal intubation, incision of the larynx to normalize the flow of oxygen. Tracheotomy is performed exclusively in the hospital.
In anaphylactic shock, a 1% solution of adrenaline is injected intravenously and under the tongue. After that, it is administered drip.
It is advisable to use Dexamethasone.
The use of antihistamines - in the form of injections, then in the form of tablets.
Introduction to Eufillin.
With antishock therapy, the use of plasma-substituting solutions is indicated.
To prevent cerebral edema, diuretics are used - Furosemide, Torasemide.
In the cerebral variant of the pathology, magnesium sulfate, Relanium, Seduxen are prescribed.
The introduction of hormonal agents, in particular, Prednisolone, is shown.

Emergency medical care with early admission of the patient to the hospital guarantees a favorable outcome of the disease.

Danger of anaphylactic shock

This most dangerous disease does not pass without consequences. After his symptoms are stopped, the person may continue to have the following symptoms:

lethargy, weakness and apathy;
persistent pressure drop;
pain in the heart due to ischemia;
decrease in mental abilities due to oxygen starvation of the brain;
development of infiltrates in the brain.

Late effects of anaphylactic shock include the following:

allergic myocarditis;
kidney damage;
generalized damage to the nervous system;
angioedema;
allergic rash;
damage to the respiratory system;
lupus.

Prevention

Primary prevention of anaphylactic shock includes the complete avoidance of patient contact with the allergen. People with the risk of an allergic reaction should completely get rid of bad habits, do not eat foods that include various chemical ingredients.

Secondary prevention includes:

treatment of rhinitis, dermatitis, hay fever;
timely testing for allergies in order to identify a potentially dangerous substance;
analysis of anamnesis;
on the title page of the medical record it is necessary to indicate the medicines to which the patient is allergic;
before the introduction of the drug should be tested for sensitivity.

Patients must carefully observe the rules of hygiene. Wet cleaning should be carried out regularly and the room should be ventilated to ensure the flow of moist air. At home, a person who suffers from allergies should have an anti-shock first aid kit with all the necessary list of anti-shock drugs. First aid measures for allergic reactions should be known to the patient's family members.

Anaphylactic shock is one of the most dangerous conditions that require immediate medical attention. Dangerous forms of anaphylactic shock require emergency treatment. The outcome of this disease depends on when treatment was started and on the amount of medical care.

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Anaphylaxis is a systemic allergic reaction to an antigen that is characterized by shock and is suddenly provoked by the release of chemical mediators in previously sensitized subjects. The term "anaphylaxis" was first used in 1902 by P. Richet and C. Poitier to describe severe, fatal shock in dogs that had been repeatedly injected with sea anemone toxin.

This phenomenon is an immediate hypersensitivity reaction with a serious violation of physiological processes in the cardiovascular and respiratory systems, as well as in the skin. Observed manifestations include shock, upper airway obstruction, dyspnea, wheezing, syncope, hypotension, skin rash, and cardiovascular collapse. Anaphylaxis requires prior antigen sensitization. Mortality in anaphylactic shock reaches 3%, so rapid recognition and very active treatment are important.

Pathophysiology

Anaphylaxis can be caused by foods, drugs, blood products, pollens, and insecticides. In this case, the antigen must be polyvalent and sensitize the macroorganism with the formation of antibodies, usually of the IgE class. Upon repeated exposure, the antigen binds to IgE antibodies on the surface of mast cells and basophils. This formation of an antigen-antibody complex activates calcium-dependent reaction steps and causes degranulation processes, which release various pharmacologically active substances. These primary and secondary mediators are responsible for the physiological changes seen in anaphylaxis.

During the degranulation process, histamine, heparin and serotonin are immediately released. Other released vasoactive substances are bradykinin, MRSA and ECTFA. Oxidation of arachidonic acid also occurs, leading to the formation of phospholipid mediators such as leukotrienes, prostaglandins, and platelet aggregation factor.

The hypotension and circulatory collapse that often accompanies anaphylaxis probably develop as a result of decreased cardiac output. The latter is the result of a combination of a number of factors, including a decrease in venous return, an excessive increase in vascular resistance in the lungs, cardiac arrhythmias, spasm of the coronary arteries, dysfunction of the left and right ventricles, and a decrease in coronary blood flow due to a decrease in blood pressure.

Patients receiving beta-blockers or calcium channel blockers may develop severe myocardial insufficiency. If blood pressure does not normalize, cardiac output does not improve, and the arrhythmia is not eliminated, then cardiac arrest can certainly occur. The severe bronchospasm seen in this condition is usually secondary and is associated with reversible obstruction in both large and small bronchi. And mediators such as leukotrienes, MRSA, and histamine can cause persistent bronchoconstriction.

Etiological agents

Anaphylaxis can be caused by almost any chemical. The most common causes of antigenic-mediated anaphylaxis are drugs, blood products, insecticides, foods, diagnostic drugs, and vaccines. Medications that can stimulate an allergic immunological reaction are antibiotics (penicillin and its derivatives), analgesics (such as acetylsalicylic acid and NSAIDs), and local anesthetics. Anaphylactic reactions occur in 1-2% of individuals receiving penicillin; the vast majority of these patients have no history of allergic reactions of any type in the past.

The onset of an anaphylactic reaction

An allergic reaction should be suspected in any patient whose condition changes significantly after receiving medication or a blood product. The frequency and severity of allergic reactions are very variable and depend on the characteristics of the antigen and on the sensitivity of the patient. The severity of the reaction, apparently, is directly proportional to the speed of its occurrence.

In 4.4% of cases, allergic reactions are associated with the use of contrast agents in X-ray examination; 1.4% of these patients develop severe bronchospasm and hypotension, 0.07% require hospitalization for angina pectoris, myocardial infarction, seizures, or ventricular fibrillation, and 0.0006% die as a result of these reactions. When an allergen is administered parenterally to a sensitized organism, the reaction usually begins immediately; but sometimes its onset is delayed by about 20 minutes. Anaphylaxis can also occur after inhalation or oral antigen administration, but the rate of its occurrence is unpredictable.

Clinical manifestations

Clinical manifestations of anaphylaxis are variable - from mild to life-threatening. Because of the variability in symptoms of anaphylaxis and the frequent absence of a past history of allergic reactions, early recognition and prompt treatment in the ED requires a high degree of alertness from the clinician. A history of asthma or atopy appears to increase the risk of anaphylaxis.

The manifestation of allergic reactions can also be intermittent symptoms such as itching in the nasal cavity, nasal congestion and a sensation of a lump in the throat. Chest pain, shortness of breath and tachypnea are often noted. When examining a patient, breathing difficulties are often observed (wheezing, stridor, participation of additional respiratory muscles with retraction of the intercostal spaces and jugular fossa, fluttering of the nostrils), cough, cyanosis, or pulmonary edema. Cardiovascular symptoms include dizziness, loss of consciousness, and circulatory collapse.

ECG monitoring may show signs of arrhythmia, ST-T wave changes, slowing of atrioventricular (arteriovenous) conduction, extrasystole, ventricular tachycardia, or ventricular fibrillation. Skin manifestations include increased skin temperature, swelling of the eyelids, itching around the mouth; classic signs of urticaria may be present, indicating release of tissue histamine. Often there is angioedema of the tongue, pharynx and larynx, which is potentially life-threatening. Gastrointestinal symptoms are usually intermittent and include nausea, vomiting, diarrhea, and cramping abdominal pain.

Treatment

Initial treatment is aimed at ensuring the basic vital functions of the body: maintaining airway patency and adequate breathing, as well as correcting any disorders of the cardiovascular system. Ensuring a normal airway is clearly a top priority due to the constant presence of upper airway obstruction. In the presence of obstruction, the necessary measures should be taken, using a counterlung, mandibular advancement techniques, changing the tilt of the head, and inserting a nasopharyngeal airway. Intubation may be required, and in the case of massive laryngeal edema, cricothyrotomy.

Treatment of anaphylaxis includes the use of 100% oxygen, an increase in circulating blood volume, and the reasonable use of medications. Cardiac monitoring and an intravenous infusion system should be established immediately. It is necessary to ensure a normal volume of intravascular fluid; for this purpose, 2-4 liters of a crystalloid solution, such as Ringer's lactate or normal saline, is first injected.

In the ED, the use of anti-shock trousers is readily available and may be a useful adjunctive treatment. Their use is reasonable in cases of high blood pressure in propranolol-allergic patients who do not respond to intravenous fluids, epinephrine, and dopamine. These trousers have also been shown to be effective in treating elevated blood pressure in individuals with an anaphylactic reaction due to bee stings.

Medical therapy

Specific drug therapy has three directions of action: inhibition of the release of mediator substances; blocking tissue receptors; elimination of the influence of these active substances on target organs. Four groups of drugs are used in the treatment of acute hypersensitivity reactions: catecholamines, phosphodiesterase inhibitors, antihistamines, and corticosteroids.

Epinephrine is the drug of choice because it is a potent catecholamine with both alpha and beta adrenergic effects. Its alpha activity increases blood pressure by increasing peripheral vascular resistance. Its beta effects eliminate bronchospasm, increase cardiac activity and inhibit the release of mediators. In patients with cardiovascular collapse or cardiac arrest due to anaphylaxis, the use of epinephrine is necessary. The route of administration of epinephrine depends on the symptoms observed.

In patients with normal blood pressure and mild symptoms, epinephrine (0.3-0.5 mg in a 1:1000 solution) is injected subcutaneously or intramuscularly. In severe hypotension, epinephrine is given as an intravenous bolus at a dose of 0.1 mg (1:10,000) or as an infusion of 0.02–0.05 mcg/kg per minute (2–4 mcg/min). The maximum dose is usually 5-10 ml of a 1:10,000 solution of epinephrine. At low doses, epinephrine causes both alpha and beta-adrenergic stimulation, while at doses greater than 10 µg/min, alpha effects predominate. Side effects of excessive alpha activity can be quite dangerous and include hypertensive crisis, cerebral hemorrhage, cardiac arrhythmias, myocardial ischemia, myocardial infarction and cardiac arrest. In the absence of intravenous access, adrenaline (0.5-1.0 mg) can be administered intratracheally.

Antihistamines such as diphenhydramine act on H receptors in target organs and competitively inhibit the binding of histamine to cellular receptors. Antihistamines do not reverse the physiological effects of anaphylaxis and have minimal effect on actual histamine release; however, they are routinely used in the treatment of anaphylactic reactions. For mild reactions, diphenhydramine can be given orally at a dose of 25–50 mg, and for life-threatening anaphylaxis, 2 mg/kg is administered intravenously.

Phosphodiesterase inhibitors, such as aminophylline, increase cyclic AMP levels and relieve the bronchospasm seen in anaphylaxis. Recent studies show that phosphodiesterase inhibitors can also stimulate ventilation, increase ventricular ejection fraction, and inhibit the release of histamine from basophils. Initially, a loading dose of 5.6 mg / kg is administered intravenously, and then a long-term maintenance infusion is performed at a rate of 0.2-0.9 mg / kg per hour. Side effects of aminophylline include hypotension and tachyarrhythmias.

Corticosteroids are a valuable anti-inflammatory agent, but they are ineffective in the initial treatment of anaphylaxis. Steroids have been shown to inhibit the breakdown of phospholipids, promote the synthesis of certain proteins, enhance the action of beta-adrenergic agents, and reduce capillary permeability. According to experimental studies, steroids inhibit the later stages of the inflammatory response by limiting cell aggregation. Although steroids are not the first choice, they are prescribed to mitigate the secondary reactions seen in anaphylaxis. If symptoms persist, hydrocortisone is given (intravenously) at an initial dose of 100 mg followed by every 6 hours.

Other drugs

In patients with persistent bradycardia, with hypotension and bronchospasm, the use of atropine is advisable. Atropine reduces bronchospasm by causing relaxation of the bronchiolar muscles by blocking cholinergic receptors. In resistant hypotension, administration of dopamine (5 µg/kg per minute) and norepinephrine (4 µg/min) is recommended. In patients treated with beta-blockers, in whom adrenaline treatment was not effective enough, intravenous administration of glucagon is advisable.

J. E. Tintinalli, M. Zwanger

This term refers to an extremely dangerous condition that can lead to the threat of death. Therefore, it is important to strictly follow the algorithm for providing emergency care for anaphylactic shock.

Danger signs

With the development of anaphylactic shock, a person first of all has symptoms-precursors:

skin rash, itching sensation;
angioedema;
sensation of heat;
redness of the mucous membranes of the nasopharynx and eyes;
mood swings;
pain syndrome - can be localized in the abdomen, head or heart.

Even these manifestations are enough to talk about a threat to the life and health of the patient.

If you do not help a person at this stage, more dangerous symptoms of anaphylaxis appear:

a sharp decrease in pressure - in some cases it cannot be determined;
an increase or decrease in the pulse - the rate of heart contractions can exceed 160 beats per minute;
depression or complete loss of consciousness;
convulsive syndrome;
severe pallor of the skin;
cold sweating;
blue lips, tongue, fingers.

If at this stage you do not provide a person with urgent medical care, the risk of developing a fatal outcome increases significantly.

How to help before the doctor arrives

At the first symptoms of anaphylaxis, you should call a doctor. It is important to remember that a two-phase reaction takes place. After stopping the first attack, after a certain time, a second one appears - this can happen after 1-72 hours. The appearance of such a reaction occurs in 20% of cases of anaphylaxis.

Before the arrival of the doctor, you need to carry out the following activities:

Remove the source of the allergen - for example, stop the administration of the drug or get rid of the sting of an insect.
Lay the victim on his back and slightly raise his legs.
Check human consciousness, reactions to mechanical stimulation.
Release the respiratory system. To do this, you need to put your head on one side, get rid of mucus or foreign objects in the oral cavity. If the patient is unconscious, it is recommended to pull out the tongue. Then you need to make sure that you are breathing.
If there is no pulse and breathing, you should begin to restore the work of the heart and lungs. However, it is important to bear in mind that with severe edema and spasm of the airways, without the introduction of adrenaline, these measures will be ineffective.

Therefore, in such situations, you need to do a heart massage. If there is a pulse, this procedure is not carried out.

Algorithm of actions for providing emergency care for anaphylactic shock

Introduction of adrenaline

Medical assistance with the development of anaphylaxis always begins with the intramuscular injection of an adrenaline solution. To achieve the fastest possible result, a small amount of the drug is injected into various areas of the body.

It is this drug that has a pronounced vasoconstrictor effect. Its use prevents the progression of respiratory and heart failure.

After the introduction of adrenaline, it is possible to normalize blood pressure and pulse, restore breathing.

If you need to achieve an additional stimulating effect, use a solution of cordiamine or caffeine.

The introduction of aminophylline

To restore the patency of the respiratory system and cope with spasm, a solution of aminophylline is used. This drug in a short time copes with a spasm of the smooth muscles of the bronchi.

After the introduction of the remedy, the condition of the victim immediately improves.

Introduction of steroid hormones

The algorithm for assisting with anaphylaxis requires the mandatory administration of steroid hormones. These include drugs such as dexamethasone and prednisolone.

These funds help reduce tissue swelling, reduce the volume of lung secretions and stop the symptoms of oxygen deficiency in the body.

In addition, steroid hormones contribute to the suppression of immune reactions, including allergic ones. To enhance their effectiveness, antihistamine solutions are used. The doctor can use tavegil, suprastin.

Elimination of the allergen

Equally important in such a situation is the elimination of the impact of the allergen on the patient's body. This event is carried out after the restoration of breathing and pressure. A provoking factor can be an insect bite, eating a food product, taking a medicinal substance.

To stop the effect of the allergen, you need to remove the sting of the insect or rinse the stomach when exposed to a food product. If anaphylaxis is the result of inhalation of an aerosol, it is worth using an oxygen mask.

Resuscitation measures in the development of anaphylaxis require the implementation of a closed heart massage, artificial respiration.

In difficult cases, a tracheostomy may be necessary, artificial ventilation is light. It also sometimes requires the introduction of adrenaline directly into the heart.

After stopping the acute condition for another 2 weeks, the patient needs desensitizing treatment.

What to do if symptoms appear on the street

The appearance of signs of anaphylactic shock on the street should be the reason for providing urgent assistance to the victim:

First of all, you should call a doctor.
Eliminate the influence of the allergen - for example, apply a tourniquet above the site of an insect bite, make a cold compress, and treat the affected area with an antiseptic.
If possible, it is worth laying the patient horizontally. With a drop in pressure, the legs need to be slightly lifted up, the head turned to one side, and the lower jaw extended.
Before the arrival of doctors, control the pressure, pulse and breathing of a person.
If you have an antihistamine on hand, give it to the victim to drink.

Features of first aid for children

The algorithm of actions to provide emergency care for anaphylactic shock in children includes the following activities:

Stop the introduction of an allergenic substance that provoked the development of an attack.
Put the baby, lifting his legs, cover with a warm blanket and put heating pads, turn his head to one side, provide oxygen access.
Inject 0.1% adrenaline solution into the affected area. The dosage of the drug is determined at the rate of 0.1 ml per year of the child's life. The agent is diluted in 5 ml of sodium chloride solution.
Place a pressure bandage over the affected area. Leave it for half an hour. Do not compress the arteries.
If the allergenic substance gets into the eyes or nose, they should be thoroughly rinsed and dripped with a 0.1% adrenaline solution. As an addition, hydrocortisone should be used.
Simultaneously with the above measures, an adrenaline solution should be injected into any other area of \u200b\u200bthe body every 15 minutes until the victim's condition improves. If a progressive deterioration is observed, a 0.2% solution of norepinephrine is administered intravenously, diluted in 20 ml of glucose.
Give intravenous prednisolone or hydrocortisone. If necessary, the procedure must be repeated after an hour.
Intramuscularly inject a 2% solution of suprastin. Also, 2.5% tavegil is suitable for this purpose.
In the presence of heart failure, intravenous administration of a 0.06% solution of corglycone is indicated.

Even with the relief of life-threatening symptoms, the child must be hospitalized. This is due to the risk of developing a secondary shock. In a hospital setting, similar activities are carried out.

What to do after the condition improves

After the condition of the victim improves, it is imperative to deal with the prevention of the development of an attack.

Primary prevention is to exclude any human contact with the allergen:

rejection of bad habits;
the use of exclusively high-quality medicines;
exclusion of the use of hazardous food additives;
refusal of uncontrolled use of medications.

Secondary prevention helps to diagnose and eliminate the disease in time:

adequate treatment of eczema, atopic dermatitis, allergic rhinitis;
performing allergological tests to detect provoking factors;
a detailed medical history;
indication of information regarding intolerance to medicines on the title page of the medical record;
conducting sensitivity tests before the introduction of drugs;
monitoring the patient's condition for 30 minutes after using the drug.

Tertiary prevention helps to prevent the development of recurrence of the disease:

personal hygiene;
constant cleaning of the premises - helps to fight house dust and insects;
regular ventilation of the premises;
refusal to use upholstered furniture;
food control;
the use of masks and sunglasses during flowering plants.

Anaphylactic shock is a very serious condition that requires urgent medical attention. If any symptoms of an immediate type reaction appear, you should immediately call a doctor and provide assistance to the victim. This will save his life.