This is a rare and extremely dangerous process associated with the ingestion of a child of a certain allergen, provoking an immediate and rapid allergic reaction. This condition is characterized by a severe course. If the baby does not receive medical care in time, he may die.
The mechanism of anaphylactic shock has been studied in detail by experts. At the first contact with allergens in the body, hypersensitivity occurs, and protective cells produce a small amount of antibodies. The second meeting with hostile "agents" already leads to the release of a huge number of biologically active substances - histamines, causing shock manifestations.
Anaphylactic shock is the most severe form of an allergic reaction.
Anaphylaxis often affects children with allergies, but it may occur in seemingly perfectly healthy babies. In this case, the first contact with the allergen occurred even during the prenatal development through the placenta.
As we have said, anaphylactic shock develops when the allergen is re-injected into the body of the child. There are several ways of "penetration" of a foreign substance:
- intravenous administration of a drug - an antibiotic, a local anesthetic or a contrast agent prior to x-ray examination,
- insect bite (wasp, hornet, bee),
- intradermal tests for allergens,
- vaccination, administration of serum, gamma globulin,
- eating food that is “rich” in allergens (milk, fish, eggs, etc.).
Cases of anaphylaxis in response to low temperatures are very rare.
Anaphylactic reaction of the body can manifest itself as a certain product, and the drug
Symptoms in children
The first signs of this severe allergic reaction in a child are a decrease in pressure and depression of consciousness. In children, the skin “burns”, anxiety and fear arise, a headache appears. In addition, itching is possible with subsequent urticaria or angioedema.
For ease of diagnosis, allergists identify four forms of anaphylaxis with characteristic symptoms.
- Asfix. The child has acute respiratory failure caused by bronchospasms and laryngeal edema. Blood pressure drops sharply, instantly dropping to the lowest rates, leading to fainting.
- Hemodynamic. The pressure in this form of anaphylaxis also decreases rapidly. But this is due to violations of the cardiovascular system. The baby complains of pain behind the sternum, parents note the pallor of the skin and threadlike pulse.
- Cerebral. This form of an allergic reaction is dangerous in that it can affect the central nervous system. There are epileptic seizures with severe convulsions, involuntary urination and foam from the mouth. Without emergency help, death is possible.
- Abdominal. Babies have abdominal pain, which is fraught with bleeding in the abdominal cavity.
The speed of propagation of these signs depends on the way the allergen enters the body:
- with intravenous administration, anaphylaxis occurs instantly,
- when taking pills or using an ointment, anaphylactic shock develops gradually - as the drug is absorbed,
- with food allergies, symptoms appear after a few hours.
The severity of the reaction does not depend on the dose of the drug. In medical practice, there have been cases when anaphylactic shock in a patient with penicillin intolerance developed when communicating with a nurse who had previously had contact with this drug.
If anaphylaxis is suspected, an ambulance team should be called in and, in a telephone conversation with the dispatcher, describe in detail all the warning signs. Pending a doctor, you need to give first aid yourself:
- Place the child on a horizontal surface, lift the legs, turn the head to the side, extending the lower jaw to prevent the tongue from falling. Be sure to remove the caps (if any) from the mouth.
- If the baby has vomited, clean the mouth from vomitus.
- Stop the flow of allergens in the body:
- if the deterioration of health began during the injection, apply ice to the injection, apply a bandage above the injection site for 20-25 minutes (if the injection location allows),
- if an insect bite, remove the sting and perform the steps described in the previous paragraph,
- when instillation into the nose or conjunctival bags, wash them thoroughly with running water,
- if you take pills or hit an allergen with food, immediately rinse the baby's stomach (of course, if his well-being allows), and give activated charcoal or another sorbent.
- On the phone, consult your doctor about the use of a solution of adrenaline and an antihistamine drug (Tavegil or Suprastin).
- Provide a sick child with oxygen: open the collar, remove the scarf and tight clothes, open the window.
While waiting for the ambulance crew, watch your blood pressure and pulse. Remember the exact time of occurrence of anaphylaxis, the imposition of tourniquet, do not forget to mention the names of those drugs that you gave the baby.
Medical procedures for anaphylactic shock are carried out in accordance with the severity of the child’s condition. The main thing is to render qualified assistance very quickly in order to avoid consequences or death.
To begin with, doctors reintroduce a solution of adrenaline to the full recovery of all vital processes. In addition, other actions are performed:
- intravenous administration of antiallergic drugs (Dimedrol, Suprastin),
- bronchodilators are used to relieve spasms of the bronchi and facilitate breathing (for example, Eufillin),
- steroid hormones, in particular prednisone, hydrocortisone,
- if penicillin allergy occurs, penicillinase enzyme is used,
- with a certain periodicity, norepinephrine is administered to raise blood pressure,
- in severe cases, artificial respiration is performed and an indirect heart massage is performed.
After providing medical assistance, the child is referred for inpatient treatment, which lasts up to 10 days. Hormones are injected into a small patient, droppers are put in with solutions of medicinal substances to restore the water-salt balance. After the course of rehabilitation, contact your baby with a dangerous allergen.
Allergy Home Kit
Since it is almost impossible to predict the onset of anaphylactic shock, doctors advise parents of allergic children to keep a first-aid kit in the house, which is fully equipped with necessary drugs.
For the relief of a dangerous condition requires:
- adrenaline solution in ampoules,
- prednisolone solution
- antiallergic drugs (Suprastin, Dimedrol, Tavegil) in various dosage forms (tablets, syrups, solutions for injection),
- medical alcohol for disinfection,
- harnesses for laying on the limbs,
- bandages, gauze, cotton,
- syringes for injections.
The dosage and method of use of these drugs must be coordinated with your doctor.
Consequences and possible complications
The most serious complication of anaphylaxis is collapse. This is a severe condition of the body, characterized by heart and respiratory failure, a sharp decrease in vascular tone, a critical decrease in pressure. If not resuscitated in time, the child may die.
After suffering anaphylactic shock, the baby may be tormented for some time by fever, muscle aches, itching and skin rashes of allergic origin.
It is very difficult to predict the course of the disease, since each organism individually reacts to the condition itself and its treatment. Possible consequences of shock can be pathologies such as:
- glomerulonephritis (kidney disease),
- noncommunicable jaundice
- bronchial asthma,
- inflammation of the heart muscle.
Features of the state in infants and babies
Anaphylaxis can occur in people of different ages, even in newborn babies. Previously, it was considered impossible, because such a state is always a reaction to the repeated penetration of the allergen into the body.
For example, infants do not have severe allergic reactions to insect bites. However, anaphylactic shock on food is quite possible if the first contact with allergens occurred during the period of prenatal development.
Experts note that the frequency of anaphylaxis increases with age, and the severity of its occurrence increases. In any case, if the baby has anxious symptoms after the next meal, be sure to call the ambulance and give first aid according to the proposed algorithm.
Anaphylactic shock is dangerous for the child that affects all internal organs and interferes with all vital processes. Such an allergic condition in a short time can cause irreversible pathological conditions and even lead to death. That is why it is so important to provide emergency treatment at the first symptoms of anaphylaxis and to provide the child with further qualified treatment.
Dangers and complications
The main danger of the disease is its fulminant development and the severity of clinical manifestations.
As a result of defects in diagnosis, acute respiratory failure, pulmonary and brain edema, and acute cardiovascular failure can quickly develop.
The rate of development of such reactions is affected by how much the dose of the allergen, how much it is administered.
Complications with parenteral route of administration develop most promptly.
This applies to allergies to the intravenous administration of medicines, including antibiotics.
An allergen entering the blood immediately leads to blocking of the vital centers of the brain, requires instant compensation therapy.
After the relief of the acute phase, complications such as can develop:
- myocardial infarction,
- jade, pyelonephritis,
- pneumonia and other,
- intestinal bleeding,
- clouding of consciousness.
Top 5 Signs of Anaphylactic Shock
As a rule, people who have a non-standard reaction to a particular irritant know about it and try to protect the body from such unwanted contact.
However, there are cases when the allergen in the primary hit leaves without a visible reaction, and in the secondary it causes an “explosion” of symptoms and an immediate-type reaction.
The main symptoms of anaphylactic shock affect consciousness, skin integument, respiratory system, organs and tissues of the heart and blood vessels.
A catastrophic drop in blood pressure, acute cardiovascular insufficiency leads to defects of consciousness, up to its loss.
Initially, the person feels clouded in the head, can be dizzy and nauseous. Often patients note a noise or hum in their ears.
Later, there is a blockade of the brain centers that control the main functions: the person stops responding to external stimuli, his consciousness and emotions are turned off.
Loss of consciousness (otherwise fainting) can be short-lived or fatal.
The lack of oxygen in the brain tissues leads to their hypoxia, heart attack and death.
At the very beginning of an allergic reaction, the color of the skin is determined by hemodynamic changes and a decrease in the tone of the blood vessels.
The initial hyperemia will quickly be replaced by pallor, cyanosis, unhealthy color.
Pathological changes of innervation can lead to profuse perspiration and moisture of the skin, leading to impaired water-salt balance.
Small spots or merging into large agglomerates may appear on the skin and whiten when pressed.
Subsequently, skin defects may have a tendency to flaking, dead layers of the cornea are removed from the surface, creating a picture of beriberi or dermatitis.
Respiratory failure occurs against the background of the destabilization of the normal blood gas composition.
The lack of oxygen and tissue hypoxia initiate an increase in the amplitude of external respiration, but relief is not observed.
In the enhanced mode, the heart also functions, which is a manifestation of compensatory mechanisms.
Despite such serious protective mechanisms, the body still does not receive enough oxygen, and carbon dioxide, due to imperfect excretion mechanisms, accumulates and has a negative effect.
The defeat of the respiratory system can lead to bronchospasm, which is often combined with increased cough reflex and sneezing.
The cardiovascular system
A reaction to the reintroduction of an allergen is often a malfunction of the heart and a decrease in the tone of the blood vessels.
As a result of the general lack of blood supply to the heart muscle, the rhythm of its contractions is disturbed, the tones weaken.
Pulse becomes frequent and filiform. Can not be felt at all.
This leads to a drop in blood pressure. It can occur in the form of several waves. That is why it is so important to ensure that such patients are monitored over time, for a certain period of time.
Often the continuation of the symptoms of cardiovascular disorders is the clinic of the pathology of the gastrointestinal tract (abdominal syndrome). The patient may note:
- aversion to food
- taste changes
- increased salivation,
- abdominal pain and others.
How to provide emergency care for anaphylactic shock in children? The instruction is here.
The nature of the lesion of the central nervous system
Anaphylactic shock clinic may include pathological changes in the functioning of the central nervous system (according to the cerebral mechanism).
In this case, characterized by:
- psychomotor agitation
- speech disturbance
- an overwhelming sense of fear
- severe and severe headache
- epileptic seizure syndrome
- psycho-emotional imbalance.
A person practically ceases to own his emotions, there is a pathology of the vegetative regulation of individual processes of life activity.
Additional or rare symptoms
Often, anaphylactic shock clinic is accompanied by abdominal pain syndrome. More often it appears half an hour after the crisis.
Often these pains are confused with signs of perforation of gastric or duodenal ulcers. The same symptom of an irritated peritoneum, the same "acute abdomen."
And only by the presence of other symptoms (drop in blood pressure, cardiovascular disorders, the presence of changes in the nature of the skin), as well as the corresponding history of the disease, you can reliably diagnose an allergic reaction of the immediate type.
Ways to provide emergency care
The provision of medical care should be based on the following principles:
- emergency character
- elimination of the action of the allergenic factor,
- presence of damage to vital organs and systems
- a high percentage of deaths
- the need to neutralize antibodies and antigens,
- the possibility of the development of severe forms of the disease and complications.
The introduction of anti-shock drugs should be started as quickly as possible (preferably intramuscularly, in the absence of effect, intravenously).
Sometimes this is enough to take a person out of a critical state. As an aid, antihistamines.
The directions of medical care are:
- arrest of cardiovascular failure
- relieving symptoms of asphyxia
- conducting despazmiruyuschego therapy of smooth muscles of the bronchi,
- prevention of complications of the gastrointestinal and excretory systems.
If there is a cerebral form (paralysis, loss of consciousness), it is necessary to take measures to prevent asphyxiation of vomit and mucus, to ensure adequate oxygen supply.
All treatment is carried out under the control of the pulse and blood pressure, preventing collapse and coma.
It is impossible not to pay attention to the restoration of the normal volume of circulating blood and the improvement of the conditions of its circulation.
It is necessary to restore the physiological ventilation of the lungs with the obligatory suction of mucus from the tracheal tree. Artificial lung ventilation is acceptable, in some cases, tracheal intubation and even conicotomy.
The treatment regimen includes corticosteroid drugs. Their doses depend on the severity of the clinical picture and the dynamics of its treatment.
The presence of bronchospasm necessitates the introduction of aminophylline, the dose of which in severe form can reach 5-6 μg per kg patient weight.
Оказание медицинской помощи больным с остановкой сердца может проводиться только в отделениях интенсивной терапии и реанимации.
Какой должна быть первая помощь при отеке Квинке у взрослых? Смотрите здесь.
Как проявляется диатез у грудных детей? Узнать подробнее.
В основе анафилактического шока лежит высокая чувствительность организма к определенным компонентам (аллергенам).
Therefore, the guarantee of the absence of their ingestion is the main preventive measure.
There are cases when it is impossible or very difficult to prevent the ingestion of an allergen (for example, an allergy to pollen - will not work until the plant fades), solar activity, insect bites (it is difficult to predict) and other cases.
Then you need to take measures to protect:
- strengthen the body's immunity,
- to live an active lifestyle,
- eat healthy food (without flavor enhancers, flavors and preservatives), it is advisable to use a hypoallergenic diet,
- strengthen the sanitary and hygienic regime in housing and work,
- not to take several drugs at the same time, especially antibiotics,
- use personal protective equipment (respirators, masks, gloves, hats when working with household chemicals,
- apply cosmetic and perfumery products, prepared on a natural basis,
- for prophylaxis, take an adequate antihistamine.
During the period of remission, it is worthwhile to make allergic tests in order to determine on which component the body reacts with a hyperreaction.
Perhaps the allergist will advise you to undergo prophylactic treatment by administering histaglobulin or minor doses of the allergen in an ascending pattern.
The development of anaphylactic shock can be prevented in most cases.
But this is a scrupulous and careful monitoring of the state of his body, identifying patterns of reaction to a particular agent.
Today, allergies can be called the scourge of modern society. Therefore, such an individual feature requires close attention of medical professionals, pharmacists, manufacturers of goods for general use and the people themselves.
Varieties of pathology
There are the following forms of anaphylactic shock (classification determines the speed of the reaction):
- lightning fast. Most often, it is she who is fatal due to rapid cardiac arrest. It develops instantly (in 1-2 minutes), a person does not even have time to complain about his condition. Symptoms: severe pallor, signs of clinical death.
- heavyIn order for the patient to feel unwell after contact with the allergen, 5-10 minutes should pass. then comes the reaction: a person feels fever, headache, lack of air, pain in the heart. Heart failure develops in a short time, so quick help from professionals is needed, otherwise it will be fatal.
- form of moderate severity. The state of health worsens in half an hour after an allergen enters the body. In this case, patients most often complain of redness, fever, headache. Often there is a fear of death or intense excitement.
Why anaphylactic shock occurs
If anaphylactic shock occurs, the reasons for determining it are very important, since the most important thing in first aid is to eliminate the allergen. Most often, the body reacts so acutely to insect bites or drugs (penicillin, vaccines). Much less often, the condition is explained by eating foods like nuts or fish, much less a reaction to pollen, dust, cold, or blood transfusions. Much in this case is determined by hereditary predisposition.
The development of anaphylactic shock is as follows:foreign substance, combining with the antibodies of the human body, which arose during the first contact with the allergen, leads to the appearance of immune complexes. Being in the blood, they have a destructive effect on the cell membrane. As a result, biologically active substances contained in these cells leave their limits, causing a shock reaction in humans.
Every one of us needs to know, how manifest signs of anaphylactic shock, anticipating the manifestation of this most difficult pathology. First of all, it warns about the terrible effect of the allergen the speed of the onset of the reaction - from a few seconds to five hours.
An unusually severe pain or a well-pronounced edema with redness can usually occur at the site of an insect sting or drug administration, itching may start, which in a few minutes will spread throughout the skin. If the food was an allergen, the person will feel severe abdominal pain, vomiting, swelling of the oral cavity, and diarrhea may follow. If the shock reaction was caused by a drug administered intramuscularly, the patient already experienced 10–60 minutes after the injection.
Also typical of many patients are such signs of a developing shock as headache, fever, skin flushing, fear of death.
Manifestations and symptoms of anaphylactic shock
When a person develops anaphylactic shock, symptoms it manifests itself as follows (the classification is based on the dependence of the development of pathology on the clinical picture):
- cardiogenic variant. The main load falls on the cardiovascular system. The most frequent variant of the development of events after contact with the allergen. As a rule, a person can breathe freely, but he has low pressure, tachycardia, pallor and blueness of the skin due to microcirculation disorders.
- asthmoid (asfixic) option. In this case, suffocation occurs due to swelling of the larynx or trachea, the occurrence of bronchospasm.
- cerebral variant. Under the blow of the central nervous system, the reason for that - acute swelling of the brain, hemorrhage. Manifested in the form of convulsions and loss of consciousness.
- abdominal option. The reaction is characteristic of such an allergen as an antibiotic. The shock begins with severe abdominal pain. Then acute cardiovascular insufficiency develops, to which hypoxia and cerebral edema join.
Photo of anaphylactic shock
One on one
Emergency care for anaphylactic shock consists mainly in the termination of the action of the allergen. That is, if a person was stung by a wasp, you must immediately apply a tourniquet above the bite and remove the sting. But the first thing to do in case of suspected anaphylaxis is to call an ambulance brigade.
Help with anaphylactic shock includes the choice of the correct position for the patient. Lay it in such a way that in case of vomiting it does not choke on vomit or asphyxia does not occur due to a drop in the tongue. In this case, it is best for the person to be on the back, with the head tilted to one side. After the done manipulations, release the neck, chest and abdomen of the victim from the clothes - it will be easier to breathe.
If a person has developed anaphylactic shock, first aid should be immediate. Delay can lead to the hardest consequences for the victim or death, because at this moment all body systems are exposed to the strongest effects ... Remember that when a person gets into such a situation not the first time, the shock reaction is more severe than before.
Yours action in anaphylactic shock also implies control of the patient's condition - watch the victim's pulse and breathing, make him take an existing antihistamine (not only in the acute stage of shock, because taking the medication can help lower the pressure). After the arrival of the ambulance crew, be sure to inform the doctor about the measures taken by you, as well as the time of the onset of the reaction and the symptoms, if there is a version concerning the suspected allergen, sound it.
First aid for anaphylactic shock
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How to recognize anaphylactic shock
The first and one of the most important points in making a diagnosis is contact with an allergen. Be especially careful if the symptoms listed below develop after an insect bite, taking any medicine or food. Even a seemingly harmless peanut cookie can be an allergen.
The shock develops in two stages. The main symptoms, the forerunners of anaphylaxis, look like Anaphylactic Shock: Symptoms, Causes, and Treatment:
- An obvious skin reaction is redness or, on the contrary, pallor.
- Tingling in the hands, feet, near the mouth or over the entire surface of the head.
- Runny nose, itchy nose, desire to sneeze.
- Difficult and / or wheezing.
- A lump in the throat, making it difficult to swallow 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 the more emergency help is needed if anaphylaxis reaches the second, shock stage. His symptoms are:
- Sharp weakness.
- Pallor (man literally turns white).
- The appearance of cold sweat.
- Severe shortness of breath (hoarse, noisy breathing).
- Sometimes cramps.
- Loss of consciousness.
2. Immediately enter adrenaline
Epinephrine (epinephrine) is injected intramuscularly to raise fallen blood pressure. This drug is sold in pharmacies in the format of autoinjectors - automatic syringes that already contain the required dose of medication. Even a child can make an injection with such a device.
As a rule, an injection is made into the thigh - the largest muscle is located here, it is difficult to miss.
Do not be afraid: adrenaline will not harm the Severe Allergic Reaction Treatment with a false alarm. But in case of a false one, it can save a life.
People who have already experienced anaphylactic reactions often carry autoinjectors with adrenaline with them. If the victim is still conscious, be sure to ask if he has a drug. There is? Follow the instructions above.
It does not make sense to take antihistamines: anaphylactic shock develops very quickly and they simply do not have time to act.
If the victim had no adrenaline, and there are no pharmacies nearby, it remains to wait for an ambulance to arrive.
3. Try to alleviate the human condition.
- Lay the victim on his back, raising his legs.
- If possible, isolate the person from the allergen. If you notice that an allergic reaction began to develop after an insect bite or an injection of a drug, apply a bandage above the bite or injection site to slow the spread of the allergen throughout the body.
- Do not let the victim drink.
- If vomiting is present, turn your head to the side so that the person does not choke.
- If the person has lost consciousness and stopped breathing, start cardiopulmonary resuscitation (if you have the appropriate skills) and continue until the arrival of the doctors.
- If the condition of the victim has improved, still make sure that he waits for an ambulance. Anaphylactic shock requires additional examinations. In addition, it is possible to repeat the attack.
Everything, you did what you could. Further hope only on the body of the victim and the qualifications of doctors.
Fortunately, in most cases, when providing timely medical care, anaphylaxis retreats. According to American statistics, fatal outcome is recorded by Fatal Anaphylaxis: Mortality Rate and Risk Factors only in 1% of those who were hospitalized with an “anaphylactic shock” diagnosis.
What can cause anaphylactic shock?
There is no special reason to list the reasons. Allergy is an individual reaction of the body, it can develop into factors that are completely harmless to other people.
But for primers, we still give a list of the most common triggers Allergy Attacks and Anaphylaxis: Symptoms and Treatment, in response to which anaphylactic shock occurs.
- Food. Most often - nuts (especially peanuts and wood), seafood, eggs, wheat, milk.
- Pollen plants.
- Insect bites - bees, wasps, hornets, ants, even mosquitoes.
- Dust mites.
- Some medicines.
Who Is Anaphylactic Shock?
The risk of developing anaphylactic shock is high in those of Anaphylactic Shock: Symptoms, Causes, and Treatment, who:
- Already experienced a similar allergic reaction.
- Has any type of allergy or asthma.
- He has relatives who have had anaphylaxis.
If you belong to one of the risk groups listed above, consult a physician. Perhaps you need to buy an adrenaline autoinjector and take it with you.
Causes of anaphylactic shock
Anaphylactic shock can occur under the influence of many factors, be it food, drugs or animals. The main causes of anaphylactic shock:
- Antibiotics - penicillins, cephalosporins, fluoroquinolones, sulfonamides
- Hormones - insulin, oxytocin, progesterone
- Contrasting substances - barium mixture, iodine-containing
- Serum - anti-tetanus, anti-diphtheria, rabies (for rabies)
- Vaccines - anti-influenza, tuberculosis, anti-hepatitis
- Enzymes - pepsin, chymotrypsin, streptokinase
- Muscle relaxants - tracrium, norkuron, succinylcholine
- Nasteroid anti-inflammatory drugs - analgin, amidopyrine
- Blood substitutes - albulin, polyglukin, reopolyglukin, refortan, stabizol
- Latex - medical gloves, instruments, catheters
- Insects - bites of bees, wasps, hornets, ants, mosquitoes, ticks, cockroaches, flies, lice, bugs, fleas
- Helminths - roundworms, whipworms, pinworms, toxocara, trichinae
- Pets - wool of cats, dogs, rabbits, guinea pigs, hamsters, feathers of parrots, pigeons, geese, ducks, chickens
- Herbs - ambrosia, wheat grass, nettle, wormwood, dandelion, quinoa
- Coniferous trees - pine, larch, fir, spruce
- Flowers - rose, lily, daisy, carnation, gladiolus, orchid
- Deciduous trees - poplar, birch, maple, linden, filbert, ash
- Cultivated plants - sunflower, mustard, castor oil, hop, sage, clover
- Fruits - citrus fruits, bananas, apples, strawberries, berries, dried fruits
- Proteins - whole milk and dairy products, eggs, beef
- Fish products - crayfish, crabs, shrimps, oysters, lobster, tuna, mackerel
- Grains - rice, corn, pulses, wheat, rye
- Vegetables - red tomatoes, potatoes, celery, carrots
- Food additives - some dyes, preservatives, flavor and aromatic additives (tartrazine, bisulfites, agar-agar, glutamate)
- Chocolate, coffee, nuts, wine, champagne
What happens in the body with shock?
The pathogenesis of the disease is quite complex and consists of three successive stages:
The basis of the pathology is the contact of a specific allergen with the cells of the immune system, after which specific antibodies (Ig G, Ig E) are released. These antibodies cause a huge release of inflammatory factors (histamine, heparin, prostaglandins, leukotrienes, etc.). In the future, inflammatory factors penetrate into all organs and tissues, causing impaired circulation and blood clotting in them up to the development of acute heart failure and cardiac arrest.
Usually, any allergic reaction develops only upon repeated contact with the allergen. Anaphylactic shock is dangerous because it can develop even with the initial ingress of an allergen into the human body.
Symptoms of anaphylactic shock
Variants of the disease:
- Malignant (fulminant) - characterized by a very rapid development in the patient of acute cardiovascular and respiratory failure, despite the ongoing therapy. Outcome in 90% of cases - lethal.
- Protracted - develops with the introduction of long-acting drugs (for example, bitsillin), so intensive therapy and monitoring of the patient must be extended to several days.
- Abortive - the easiest option, the patient is not in danger. Anaphylactic shock is easily relieved and causes no residual effects.
- Recurrent - characterized by recurring episodes of this condition due to the fact that the allergen continues to enter the body without the knowledge of the patient.
In the process of developing symptoms of the disease, doctors distinguish three periods:
Initially, patients feel general weakness, dizziness, nausea, headache, rash on the skin and mucous membranes in the form of urticaria (blisters) may appear. The patient complains of a feeling of anxiety, discomfort, lack of air, numbness of the face and hands, impaired vision and hearing.
It is characterized by loss of consciousness, a drop in blood pressure, general pallor, increased heart rate (tachycardia), loud breathing, cyanosis of the lips and extremities, cold sticky sweat, cessation of urine excretion or, conversely, urinary incontinence, itching.
May continue for several days. Patients still have weakness, dizziness, and lack of appetite.
With easy flow
Precursors with mild shock usually develop within 10–15 minutes:
- skin itch, erythema, rash urticaria
- feeling hot and burning all over
- if the larynx swells, then the voice becomes hoarse, until aphonia
- Quincke's edema of different localization
With his mild anaphylactic shock, a person has time to complain to others:
- They feel headache, dizziness, chest pain, decreased vision, general weakness, lack of air, fear of death, tinnitus, numbness of the tongue, lips, fingers, back pain, stomach pain.
- Cyanotic or pale skin is noted.
- Some people may have bronchospasm - wheezing can be heard from a distance, difficulty exhaling.
- В большинстве случаев возникают рвота, понос, боли в животе, непроизвольное мочеиспускание или акт дефекации.
- Но даже при этом больные теряют сознание.
- The pressure is sharply reduced, thready pulse, heart sounds are deaf, tachycardia
With moderate flow
- Also, as in mild, general weakness, dizziness, anxiety, fear, vomiting, pain in the heart, asphyxiation, angioedema, urticaria, cold sticky sweat, cyanosis of the lips, pallor of the skin, dilated pupils, involuntary defecation and urination.
- Often - tonic and clonic convulsions, followed by loss of consciousness.
- The pressure is low or not detected, tachycardia or bradycardia, pulse pulse, heart sounds are deaf.
- Rarely - gastrointestinal, nosebleeds, uterine bleeding.
The rapid development of shock does not allow the patient to have time to complain about his feelings, because in a few seconds there is a loss of consciousness. A person needs instant medical care, otherwise sudden death will occur. The patient has severe pallor, frothiness from the mouth, large drops of sweat on the forehead, diffuse cyanosis of the skin, pupils dilate, tonic and clonic convulsions, wheezing with an extended exhalation, blood pressure is not detected, heart sounds are not heard, the pulse is threadlike, almost not palpable.
There are 5 clinical forms of pathology:
- Asphyctic - in this form, patients have symptoms of respiratory failure and bronchospasm (shortness of breath, difficulty breathing, hoarseness), Quincke’s edema often develops (laryngeal edema, up to complete cessation of breathing),
- Abdominal - the predominant symptom is abdominal pain, imitating the symptoms of acute appendicitis or perforated gastric ulcers (due to spasm of smooth muscles of the intestine), vomiting, diarrhea,
- Cerebral - a feature of this form is the development of edema of the brain and meninges, manifested in the form of seizures, nausea, vomiting, not bringing relief, a state of stupor or coma,
- Hemodynamic - the first symptom is pain in the region of the heart, resembling myocardial infarction and a sharp drop in blood pressure,
- Generalized (typical) - occurs in most cases, includes all common manifestations of the disease.
Diagnosis of anaphylactic shock
Diagnosis of pathology should be carried out as quickly as possible, so the prognosis for the patient's life depends largely on the experience of the doctor. Anaphylactic shock is easily confused with other diseases, the main factor in diagnosis is the correct history taking!
- In general, a blood test reveals anemia (decrease in the number of red blood cells), leukocytosis (increased leukocytes) with eosinophilia (increased eosinophils).
- In the biochemical analysis of the blood, an increase in liver enzymes (AST, ALT, ALP, bilirubin), and kidney tests (creatinine, urea) is determined.
- At a survey radiography of the chest revealed interstitial pulmonary edema.
- ELISA is used to detect specific antibodies (Ig G, Ig E).
- If the patient finds it difficult to answer, after which he developed an allergic reaction, he is advised to consult an allergist with conducting allergy tests.
Emergency Algorithm for Anaphylactic Shock (Medical Assistance)
- Monitoring vital functions - measuring blood pressure and pulse, determining oxygen saturation, electrocardiography.
- Ensuring airway patency - removal of vomit from the mouth, removal of the lower jaw for triple reception Safar, tracheal intubation. In case of spasm of the glottis or angioedema, conicotomy is recommended (performed in emergency cases by a doctor or paramedic, manipulation consists in cutting the larynx between the thyroid and cricoid cartilage to ensure air flow) or a tracheotomy (performed only in a hospital, the doctor performs dissection ).
- The introduction of adrenaline - 1 ml of 0.1% solution of epinephrine hydrochloride is diluted to 10 ml of saline. If there is a direct injection site of the allergen (bite site, injection), it is desirable to chop it with diluted adrenaline subcutaneously. Then it is necessary to inject 3-5 ml of the solution intravenously or sublingually (at the root of the tongue, as it is abundantly supplied with blood). The rest of the adrenaline solution must be introduced into 200 ml of physiological saline and continue the injection intravenously under the control of blood pressure.
- The introduction of glucocorticosteroids (adrenal hormones) - mainly used dexamethasone at a dosage of 12-16 mg or prednisone at a dosage of 90-12 mg.
- The introduction of antihistamine drugs - first injected, then transferred to tablet form (diphenhydramine, suprastin, tavegil).
- Inhalation of moistened 40% oxygen at a rate of 4-7 liters per minute.
- In case of severe respiratory failure, administration of methylxanthines is indicated - 2.4% aminophylline 5-10 ml.
- Due to the redistribution of blood in the body and the development of acute vascular insufficiency, it is recommended to administer crystalloid (ringer, ringer-lactate, plasmalit, sterofundin) and colloid (helofusin, neoplasm-gel) solutions.
- To prevent edema of the brain and lungs, diuretics are prescribed - furosemide, torasemide, minnitol.
- Anticonvulsant drugs with cerebral disease form - 25% magnesium sulfate 10-15 ml, tranquilizers (sibazon, Relanium, seduxen), 20% sodium hydroxybutyrate (GHB) 10 ml.
Consequences of anaphylactic shock
Any disease does not go away without a trace, including anaphylactic shock. After arresting cardiovascular and respiratory failure in a patient, the following symptoms may persist:
- Inhibition, lethargy, weakness, pain in the joints, muscle pain, fever, chills, shortness of breath, pain in the heart, as well as pain in the abdomen, vomiting and nausea.
- Prolonged hypotension (low blood pressure) - stopped by prolonged administration of vasopressors: adrenaline, mezaton, dopamine, norepinephrine.
- Heart pain due to ischemia of the heart muscle - the introduction of nitrates (isoket, nitroglycerin), antihypoxants (thiotriazolin, mexidol), cardiotrophs (riboxin, ATP) is recommended.
- Headache, decrease in intellectual functions due to prolonged hypoxia of the brain - nootropic drugs are used (piracetam, citicoline), vasoactive substances (cavinton, ginkgo biloba, cinnarizine),
- With the appearance of infiltrates at the site of the bite or injection, local treatment is indicated - hormonal ointments (prednisolone, hydrocortisone), gels and ointments with absorbable effect (heparin ointment, troxevasin, lyotone).
Sometimes there are late complications after anaphylactic shock:
- hepatitis, allergic myocarditis, neuritis, glomerulonephritis, vestibulopathy, diffuse damage to the nervous system - which causes the death of the patient.
- 10–15 days after shock, Quincke’s edema, recurrent urticaria, bronchial asthma may develop
- with repeated contacts with allergenic drugs, diseases such as periarteritis nodosa, systemic lupus erythematosus.
Primary shock prevention
It involves preventing a person from contacting an allergen:
- exclusion of bad habits (smoking, drug addiction, substance abuse),
- control over the quality production of medicines and medical devices,
- the fight against environmental pollution by chemical products,
- ban on the use of certain food additives (tartrazine, bisulfites, agar-agar, glutamate),
- the fight against the simultaneous appointment of a large number of drugs by doctors.
Promotes early diagnosis and timely treatment of the disease:
- timely treatment of allergic rhinitis, atopic dermatitis, pollinosis, eczema,
- conducting allergy tests to identify a specific allergen,
- careful collection of allergic history,
- indication of intolerable medical products on the title page of a medical history or outpatient card with red paste,
- conducting sensitivity tests before i / i or i / m administration of drugs,
- monitoring patients after injection for at least half an hour.
Prevents disease recurrence:
- personal hygiene
- frequent cleaning of premises to remove house dust, mites, insects
- indoor airing
- removal of extra furniture and toys from the apartment
- precise control of food intake
- use of sunglasses or masks during the flowering period of plants
How can physicians minimize the risk of patient shock?
For the prevention of anaphylactic shock, the main aspect is the carefully collected history of the patient’s life and illness. To minimize the risk of its development from taking medication:
- To appoint any drugs strictly according to indications, an optimum dosage, considering tolerability, compatibility
- Do not administer several drugs at the same time, only one drug. Making sure of portability, you can assign the following
- The patient's age should be considered, since daily and single doses of cardiac, neuroplegic, sedative, antihypertensive drugs for elderly people should be reduced by 2 times than the dose for middle-aged patients
- In the appointment of several drugs, similar to the farm. action and chemical composition, consider the risk of cross-allergic reactions. For example, in case of intolerance to promethazine, antihistamine-derivatives of promethazine (diprazine and pipolfen) cannot be prescribed, and in case of allergies to procaine and anesthesin, there is a high risk of intolerance to sulfonamides.
- It is dangerous for patients with fungal diseases to prescribe penicillin antibiotics, because fungi and penicillin have a common antigenic determinant.
- Antibiotics must be prescribed taking into account microbiological studies and determine the sensitivity of microorganisms
- For antibiotic solvents, it is better to use saline or distilled water, since procaine often leads to allergic reactions.
- Assess liver and kidney function
- Monitor the content of leukocytes and eosinophils in the blood of patients
- Before starting treatment, patients with a high risk of developing anaphylactic shock, 30 minutes and 3–5 days prior to the introduction of the planned drug, prescribe 2 and 3 generation antihistamines (Claritin, Sempreks, Telfast), calcium preparations, according to the indications of corticosteroids.
- In order to be able to impose a tourniquet above the injection site in case of shock, the first injection of the medication (1/10 dose, for antibiotics less than 10,000 IU) should be administered in the upper 1/3 of the shoulder. If intolerance symptoms occur, apply a tight tourniquet above the drug injection site until the pulse stops below the tourniquet, chop off the injection site with an adrenaline solution (9 ml of saline with 1 ml of 0.1% adrenaline), apply cold water to the injection area or apply ice
- Procedural rooms must be equipped with anti-shock first-aid kits and have tables with a list of medications that give cross-allergic reactions, with common antigenic determinants
- There should not be a ward of patients with anaphylactic shock near the manipulation cabinets, and also no placement of patients with shock in the anamnesis to the wards where patients are injected with those drugs that cause allergies in the first.
- In order to avoid the occurrence of the Artyus-Sakharov phenomenon, the injection site should be monitored (skin itching, swelling, redness, later with repeated injections of medications skin necrosis)
- For patients who have suffered anaphylactic shock during hospital treatment, when they are discharged on the title page of their medical history, they are marked with a red pencil “drug allergy” or “anaphylactic shock”
- After discharge of patients with anaphylactic shock on medications should be sent to specialists in the place of residence, where they will be on dispensary registration and receive immunocorrective and hyposensitizing treatment.
I was treated with GHA by injecting a contrast agent containing iodine. I didn’t know about it, I almost didn’t throw off the skates, anaphylactic shock occurred. I heard that the doctors said: what is the second one today? ”The doctors didn’t do anything, except for letting me lie down. After that, wet in a cold sweat, I couldn’t be dragged to the third floor of my room in the cold room. They said that I was completely white. Nobody wondered if I was allergic to anything (I have iodine), they didn’t even think about why I had such a reaction. In the same hospital, during the examination I smeared the inner thighs with iodine. I had to be treated. When the GHA was reappointed, I was already in the dispensary. Sealy, I stand iodine, and, of course, sent vosvoyasi.Ne given die
Galina 05.11.2017 The son went to the dentist. They made an anesthetic injection - ULTRAKAIN. Lost consciousness. Now he lies in the Emergency Room Complex in Volgograd, in the pulmonology department. It happened literally in a matter of seconds.