Treatment of anaphylactic shock in the hospital. Treatment of anaphylactic shock

The acute pathological condition, differing from other allergic diseases by the generalized nature of the body's reaction. Anaphylactic shock is the most severe allergic reaction in the clinic. Its symptoms are usually developing lightning, and the salvation of the patient depends on the rapid actions of the doctor.

In recent years, cases of anaphylactic shock in all countries of the world have become more frequent. In this regard, every therapist should have the necessary knowledge of software. etiology, clinic, pathogenesis, treatment and prevention of this formidable allergic complication.

Causes of anaphylactic shock

Already in the early stages of the application of the antibiotic, it was found that it can be very easily born with albumin plasma of blood, while forming a full-fledged antigen (Penicillin-albumin complex), against which specific aggressive antibodies are formed in the human body. Often the cause of anaphylactic shock is Vitamin B1 (Novocaine, Streptomycin, OrganoPreparations, acetylsalicylic acid, iodide. In recent years, there are cases of anaphylactic shock from ACTG, Cortisone, Dimedrol, Pask. The cause of anaphylactic shock (sometimes deadly) is often the bites of bees, OS, Sherne In sensitized persons. Heavy anaphylactic shock often occurs in patients with sharply pronounced cold allergies. Such patients suffer from a hut, swelling when exposed to cold air or water on the skin. Anaphylactic shocks can occur when exposed to cold air or water on a large body surface ( For example, when bathing in the river or the sea).

Anaphylactic shock can develop in patients with an extremely high degree of allergy even with skin diagnostic testing (for example, with penicillin) or during their stay in a procedural room saturated with penicillin vapor, vitamin in 1 and other medicines, or when using syringes from a common sterilizer. Rare cases of anaphylactic shock are described in specific hyposensitization of patients with bronchial asthma and pollinosis of allergens from pollen plants and epidermis of animals. The reason for these complications has always been the negligence of medical personnel (excessively large dose of allergen).

High-caliped foods (eggs, crabs, nuts, citrus fruits, fish) can cause severe anaphylactic shock in sensitized small children, especially suffering from exudative diathesis.

Pathogenesis

Anaphylactic shock is a typical example of a common chimergic reaction, which develops when the specific allergen is re-administered into a sensitized organism. Responsible for the occurrence of anaphylactic shock aggressive humoral leather-mensorsitize antibodies (react), which, connecting with a specific allergen, cause a heavy allergic reaction. As a result of this reaction, a very fast liberation of histamine occurs.

Symptoms and signs of anaphylactic shock

The first symptoms usually appear during the first 20-30 minutes after the administration of allergen. The earlier these symptoms arise, the harder the anaphylactic shock flows, the worse the forecast. Cases of a deadly anaphylactic shock arising during the injection of the drug are described.

The clinical picture of anaphylactic shock may vary, but the most severe and prognostically bad symptom is the lightning of the upcoming vascular collapse. More often, the patient first notes the weakness, feeling of tingling the skin in the face of the face, soles, palms and chest. In the future, the clinical picture is deployed very quickly: the feeling of weakness is increasing, which is accompanied in some cases a sense of fear and samples for the sternum; The patient becomes very pale, there is a rich cold sweat, abdominal pain, a sharp drop in blood pressure to zero, weak, frequent pulse, involuntary defecation, etc.

Sometimes patients immediately appear feeling in the ears, itching of the whole body and generalized urctural rashes, symptoms of conjunctivitis, rhinora, swelling of the tongue, eyelids, ears, asthmaticallywasser breathing, and then the vascular collapse and loss of consciousness.

The symptoms described and their severity may vary. However, in all cases there is a severe condition of the patient, requiring urgent and qualified medical care.

ASH is characterized by a turbulent clinical picture. Suddenly there appears a feeling of pressure, stuening in the chest, weakness, difficulty of breathing. The feeling of heat in the whole body, headache, dizziness. Nausea, worsening, prejudgement of ears, paresthesia, numbness of the language, lips, limbs, increasing itching of the skin, especially palms, urticaria and swelling.

Patients are restless, frightened. Breathing noisy, whistling, heard at a distance. As a rule, the deterioration of cardiovascular activities with a sharp drop of blood pressure, frequent threaded pulse occurs. Sick pale, cyanosis appears, acricyanosis. There may be severe microcirculation disorders, and in patients with coronary heart disease - coronary insufficiency, which significantly aghesives the clinical picture.

The spasm of a smooth muscles, leading to bronchospasm, and the angioedema swelling of the larynx determine the respiratory failure. The obstruction of the respiratory tract with pulmonary hypertension and the increased permeability of the vessels can lead to a pulmonary edema, psychomotor excitation, moving in adamise, loss of consciousness with involuntary urination and defecation. Various violations of rhythm and conductivity are detected on the ECG, the overload of the right heart departments, there may be signs of coronary failure. With an extremely heavy lightning shock, a sudden stopping of the heart may occur.

Each tenth case ASH ends with a fatal outcome.

In a clinical picture, ASh is sometimes leading any syndrome.

Depending on this, the following forms are allocated:

1. Typical option.
2. Hemodynamic, in which signs of cardiovascular violations are emerging in the first place in the clinical picture: pain in the heart, deterioration of the contractile ability of myocardium, falling blood pressure, rhythm disorder, microcirculation disorder.
3. The asphisical variant in which the phenomena of acute respiratory failure predominate, due to the edema of the shell of the larynx, bronchi, pulmonary alveoli with the phenomena of bronchospasm.
4. Cerebral version with preferential changes in the central nervous system caused by edema of the brain, with phenomena of psychomotor excitation, disturbances of consciousness, convulsion, epileptic status, stopping heart and respiration.
5. Abdominal variant in which swelling and hemorrhage in the abdominal organs with sharp painful manifestations simulate the clinic of acute abdomen.

Basic diagnostic criteria

1. Allergic history (bronchial asthma, polyinose, neurodermatitis, urticaria and other manifestations of allergies).
2. Contact with an allergen. ASH can develop on allergens of any origin, more often the causes are drugs. Less often there is an ASH for food products, insect bites and snakes.
3. Fast development and severity of allergic reaction symptoms.
4. Picture of vascular collapse, brain edema, larynx, lungs.

Treatment of anaphylactic shock

Consultation of a neuropathologist and a gynecologist is necessary, since various allergic lesions of the nervous system (encephalomyelitis, polyradiculoneuritis) and genitals, which require energetic nonspecific desensitizing therapy and surveillance in the clinic are possible. In every medical institution and in service with emergency and emergency care, there must be a set of medicines listed above.

Prevention of medicinal anaphylactic shock

Due to the fact that now the most common cause of anaphylactic shock is penicillin and other medicines, a large role in the prevention of this heavy complication is played by the prevention of medicinal allergies. The best method of preventing various allergic reactions in the clinic is the appointment of medicines parenterally only according to strictly reasonable indications (for example, vitamin B 12 only with pernicious anemia, le-vomitsenetin - with abdominal typhoids, etc.).

Surrostevelopment is played a big role among the population. It is necessary to clarify that medicines should be taken only on the prescription of the doctor.

Temporary instruction for prevention of allergy to drugs

General measures.

1. Appointment of drugs on more stringent medical testimony.
2. The correct organization of the work of nurses in procedural offices, in areas, in the cabinets of specialists, hospitals, etc.:
   a) the presence of a separate tool (needles, syringes, sterilizers) for the introduction of antibiotics and other drugs;
   b) separate sterilization of tools that were in contact with antibiotics;
   c) a survey of the patient before the injection of antibiotics about the former complications related to their application; On cases of identifying the reaction that has arisen, to inform the doctor who solves the issue of continuing treatment.
3. The greatest amount of hazardous allergic reactions occurs during parenteral administration of drugs, so therapy should be started with oral administration.
4. Patients with allergic diseases are prescribed Penicillin only on vital testimony.

Prevention measures in the process of treatment

1. The first injection of the drug should always be produced in the forearm area so that if necessary, it was necessary to impose harness above the injection site, delaying the further absorption of the drug into the bloodstream, and observe the patient's response within 15 minutes.
2. Before the introduction of daryan preparations of Penicillin, especially in persons previously used this drug, it is recommended to make the injection of 2000 units of penicillin and only in the absence of allergies to conventional penicillin, you can proceed to treat with duranic drugs.
3. In the process of treatment, observed the injection site and when local hyperemia appears, edema and itching to cancel the drug.
4. The emergence of allergy symptoms (skin rashes, temperature rise, the occasion of the eyelids and rhinori) serves as a basis for cancellation of the drug.
5. In the process of treatment, the patient should produce a clinical analysis of blood at least once every 4-5 days. The appearance of eosinophilia indicates sensitization to the drug.

It is necessary to know that currently the indirect methods of diagnosis of drug allergies (the basophilic test of Shelly, the test of the lymphoblastic transformation of alpocytes of alperna, etc.) are not absolutely reliable, therefore the main role in the diagnosis and prevention of drug allergies belongs to the allergic-to whom an anamnesis.

Prevention of serum anaphylactic shock. All patients with allergic diseases (bronchial asthma, pollinosis, urticaria, eczema, etc.) Therapeutic serum should be administered only by vital testimony. Patients with allergic diseases should be immunized with a tetanus toxoid and in case of injury to introduce serum, but again toxoid. In the vital testimony, allergic history (reactions to the introduction of medicines, serums in previous years) should be carefully assembled by a sick allergic disease (reactions to the introduction of medicines, sera in previous years). Such a patient is necessary before the introduction of serum to make a scarification or conjunctival test. The scarification sample is made as follows. At a pre-width of alcohol, the leather of the forearm is applied with a drill of serum and make easy scarification. The reaction is read after 10-15 minutes and positive are considered in the occurrence of itching, hyperemia and blister at the site of scarification. In the conjunctival sample in the conjunctival bag of the lower century, a yell drop is made. The reaction is considered positive, if for 10-15 minutes the patient occurs this age, tearing and the phenomena of acute conjunctivitis occurred. Patients with positive results of skin and conjunctival samples with serum is impossible. With negative sample results, it is necessary to enter 0.2 ml subcutaneously, and in the absence of complications after 30 minutes - the rest of the dose (injection should always be done in the shoulder area). It is recommended to produce serum injection with such patients with 1 ml of 1% diploma solution or another antihistamine drug. After injection of the serum, the patient should be observed within 1 hour.

Prevention of anaphylactic shock from the bite of OS and bees. All patients suffering from allergic reactions to the bees and OS bites (urticaria, swelling, anaphylactic shock), should be directed into an allergic office, where, after a thorough specific diagnosis, with the use of extracts from poison bees and the patient, the specific hyposensitizing therapy with these extracts is carried out. This treatment gives a good therapeutic effect. Each patient with allergies to the UK bite and bees should be warned about the possibility of severe complications and have ephedrine tablets, suprastin or other antihistamine preparations with him.

Prevention of anaphylactic shock with cold allergies. Patients with cold allergies should be categorically forbidden bathing in the sea or river with a significant difference in air and water temperature. Patients with cold allergies should be directed into an allergic office for a special examination and treatment (outcasts, hystaglobulin, antihistamine drugs, etc.).

Prevention of anaphylactic shock when conducting specific hyposensibilization. Specific hyposensyribilization should be carried out only under the conditions of a specialized allergological office or an allergological department under the supervision of a doctor-an allergist, from which, when conducting this% treatment method, maximum attention is required. Skin tests with different medicines should be carried out only in a specialized allergology office, an allergist, with the exception of urgent cases, when the use of the medication is vital. The therapist then can very carefully put the skin trial as it is indicated in the "temporary instruction for the prevention of allergy to drugs", having a rubber harness, a solution of adrenaline and sterile syringes to provide an ambulance in the case of an allergic reaction.

Anaphylactic shock - a dangerous rapidly developing pathological response of the body on an allergen. This state may have very negative consequences. And this article will tell you therefore about the pathogenesis of anaphylactic shock in children and adults, will give clinical recommendations and will tell what a first aid kit if you are completely anaphylactic shock.

Features of illness

Anaphylactic shock (anaphylaxis, allergic shock) - acute, rapidly developing pathological response of the body in response to an attack (shock - shock) allergens, in which all systems and organs experience extremely pronounced painful changes, often incompatible with life (each 5 - 10 patient). The rate of leakage of all processes characteristic of banal allergies is accelerated in the event of a shock effect, and their severity is intensified in tens of times.

The effects are exposed:

• all organs and ways of breathing, vessels and capillaries;
• brain, heart;
• organs of the gastrointestinal system;
• leather and mucous.

The greatest frequency of this allergic reaction is occurring in women, young men and young men.

About what anaphylactic shock will tell the video below:

Children

Anfylaxia is a special danger of anaphylaxis for a children's body due to the insufficient development of many systems and organs, protecting function, anatomical and physiological features. For example, the swelling of the larynx in the child is a critical condition, since the respiratory gain is extremely small and the swelling of the mucous membrane on the thickness of only 1 mm will easily block the air access to the newborn and infant.

At this age, vaccination, medications often provoke an acute allergic reaction. But if adult shock usually occurs in the secondary penetration of allergens into the blood, then in children anaphylaxis can develop during the first contact with a provocative of allergic shock, in case the mother when you wear and breastfeeding, a certain medicine was used, and it was used through a placenta or milk in Blood baby. And neither dose nor the method of administering the pharmacological agent matter if the child is already sensitized (has increased sensitivity to a particular substance).

In addition, it is in children who more often develop anaphylaxis for products.

Pregnancy

Pregnancy also creates a special vulnerability of future mother and fetus. In the overloads that the heart and vascular system are experiencing during anaphylaxis, the likelihood of miscarriage, early detachment of placenta, premature genera and intrauterine death is very high. Pregnant woman herself is also the danger of catastrophic bleeding, respiratory and.

About the types and forms of anaphylactic shock read below.

Classification

According to the form of leakage

The classification of the forms of anaphylactic shock (Ash) is tied to key signs of disorder of specific systems and target organs, which are directed by the main aggression of allergens.

For course, anaphylaxis is divided into forms:

1. Typical. It is most frequent, accompanied by violations of the functions of vessels, organs and breathing paths ,.
2. Hemodynamic. Accompanied by violations of blood circulation, insufficiency of myocardial functioning, heart vessels.
3. Asfactic, with the dominance of manifestations of acute respiratory failure, edema and spasms of breathing paths that reach the degree of asphyxia (choking).
4. Abdominal or gastrointestinal shape with symptoms of acute poisoning, "acute abdomen", diseases of the stomach, intestines.
5. Cerebral, with characteristic lesions of the central trunks of the nervous system, cerebral vessels developing to brain edema.
6. ASh, provoked physical overload.

By severity of flow

The severity of leakage of pathology on criteria:

Basic criterion	Severity
I.	II.	III	IV.
Blood pressure in mm RT. Art.	below normal indicator 110 - 120/70 - 90 to 30 - 40 units	Systolic (upper) 90 - 60 and below, diastolic (lower) 40 and below	The upper 60 - 40, the bottom - to 0 (when measuring - is not determined)	Not determined
Consciousness	Persists. Pronounced panic, fear of death	Consciousness confused, state of the copor (stupor), the likelihood of loss of consciousness	High risk of loss of consciousness	Sudden loss of consciousness
Patient reaction for anti-shock treatment	Active	Good or satisfactory	Weak	Weak or absent

The severity of the shock determines the time onset of the first signs. The earlier the symptoms begin to manifest themselves from the moment of penetration into the body of the allergen, the hardest manifestation of anaphylaxis.

By type of flow

ASH classification by the type of flow:

Leaky / type	Features
Acute malignant. More often occurs in typical form.	sudden progressive principle; a sharp drop in blood pressure (the lower - systolic drops to 0); connection confusion, progression of signs of respiratory disorder, bronchi spasm. the severity of manifestations increases, the reaction to active treatment is weak or absent. the development of heavy edema of the lungs, a resistant reduction in pressure, a comatose state. The risk of the patient's death is high.
Acute benign	The main pathological manifestations are expressed quite strongly. But when conducting therapy is not characterized by increasing, amenable to reverse development and subsoia. A favorable forecast is highly likely for emergency treatment.
Absiven	Pathological symptoms are poorly pronounced, quickly suppressed, often without the use of drugs. It is found in patients with asthma taking hormones (prednisone, dexamethasone).
Stretty	For both types are characteristic: Rapid start. Typical clinical manifestations of anaphylaxis. Treatment with a protracted type of leakage gives a temporary, partial effect. For a recurrent flow, a secondary sharp drop in blood pressure after it is stabilized and removing a patient from an acute state. The remaining symptoms are not so pronounced, as with acute types of pathology, but hardly react to therapy. It is often observed with a long-term intake of patients of prolonged drugs (for example - bicillin).
Recurrent
Lightningry	The lightning development of an anaphylactic reaction is within 10 - 30 seconds. It happens more often when injecting medication in Vienna. The forecast is disappointing. A favorable completion is possible only with just as immediate administration of adrenaline and other anti-shock.

About the causes of anaphylactic shock, read further.

Causes of occurrence

Development mechanism

Stage I.

Sensitization (anomalous increase in sensitivity to a certain substance-allergen).

The primary allergen hit is perceived by the immune system as the penetration of an alien agent, which is produced by special protein compounds - immunoglobulins E, G, after which the body is considered sensitized, that is, ready for a sharp allergic reaction with a re-introduction of allergen. Immunoglobulins are fixed on immune (obese) cells.

Stage II.

Directly - anaphylactic reaction.

In the secondary hit of allergen in the blood, immunoglobulins immediately enter into contact, after which specific substances regulating allergic and inflammatory reactions are distinguished from obese cells, the main of which is considered to be a histamine. It causes edema, the extension of blood vessels - and, as a result, is a drop in pressure, breathing disruption. With anaphylactic shock, histamine is thrown out simultaneously and in a huge amount, which leads to disastrous violations of all organs.

When anaphylaxis, such a pathological process, if medical intervention does not occur, develops rapidly, irreversibly leading to death.

Main reasons

Among the many reasons for the development of AS, they allocate, firstly, the introduction of drugs, including:

• antibiotics (penicillin, aminoglycosides, trimethoprim, vancomycin);
• Aspirin, other non-hormonal anti-inflammatory funds (NSAIDs);
• aCE inhibitors (funds from hypertension -, fozinopid, even if the medicine was taken before this, several years);
• sulfanimides, iodized drugs, group B vitamins;
• plasma substitutes, iron preparations, nicotinic acid, immunoglobulins.

In the intravenous injection of the medication, the reaction develops after 10-15 seconds, with intramuscular injection - after 1 to 2 minutes, when taking tablets and capsules - 20-50 minutes later.

Risk factors:

1. Available allergic diseases (, allergic rhinitis)
2. Chronic respiratory diseases, including asthma, chronic pneumonia, bronchitis, bronchial obstruction).
3. Heart disease and vessels
4. The presence of transferred anaphylactic reactions.
5. Concomitant patient treatment with the following drugs:
   • beta adrenoblockers (the response of the respiratory tract to histamine, bradykinin increases and decreases the effect of adrenaline used to remove the patient out of the shock).
   • inhibitors of MAO (suppress the enzyme, splitting adrenaline, reinforcing, thus, the side effect of adrenaline).
   • ACE inhibitors (can cause swelling of the larynx, language, pharynx with the development of choking, "drotted cough").

Signs of anaphylactic shock

Symptoms

The initial manifestations in the rapid development of anaphylaxis are observed in the first seconds after the penetration of allergen into the blood. It usually happens when the drug injections in Vienna. Typical increase in signs - ranging from 5 to 40 minutes.

But it is often observed a two-phase current of anaphylactic shock, when after an element of all signs against the background of intensive treatment after a day - three can suddenly begin the second wave of anaphylaxis.

Basic symptoms of anaphylactic shock are often combined or manifested in comprehensive - in accordance with the forms of ASH:

Frequency of manifestations	Signs
In 9 cases out of 10	exhaustion, fear of death; feeling heat on face, hyperemia (redness) of the skin; itchy rash, red spots and bubbles by the type of urticaria (with the rapid development of pathology - changes on the skin appear later than the remaining symptoms); highlights of the larynx, lips, tongue, pharynx, century, genitals, fingers, neck reduced pressure.
Half patients	nasal sinuses, sneezing, nasal mucus; bouts of dry cough; feeling lump in a sip, superficial heavy breathing, hoarseness; stridor (whistling breath and exhalation), wheezes in the lungs; bronchial spasm; sharp, blue lips, skin around the nose and mouth, nail plates; eye irritation, itching;
Third part of patients	pain in the head grave or pulsating; a significant and sharp decline in pressure; pain and feeling of squeezing for the sternum, in the obedient region; , Failure in the rhythm of heart cuts.
Each 3 - 4 patients	itching mucosa; hoping; attacks, vomiting, liquid chair, grasp pain, spasms in the stomach, intestines.
In 5 - 10% anaphylaxia:	numbness of the muscles of the face, lips; visual impairment (fuzziness, bone, nebula); panic attacks, tremor (trembling), convulsions; uncontrolled urination and defecation; brain swelling.

Diagnostics

If the episodes of an anaphylactic reaction have never been determined in the patient earlier, the research is not able to predict its manifestation in the future, that is, to predict its development. However, the probability of its occurrence to one degree or another can be predicted:

• absolutely everyone who suffers from any form of allergies;
• in people whose relatives (especially - parents) experienced similar anaphylaxia experience.

Since anaphylaxis is a state in which all manifestations grow very quickly, diagnosis is most often put during the development of pathology, based on the speed of development of symptoms, and even more often after treatment or death. Since the delay in such a situation leads to the death of the patient, a detailed study of each symptom is impossible at this point and simply - extremely dangerous.

Danger of false diagnosis

On the other hand, due to the shortage of time and insufficient professionalism, false diagnoses are often put.

• For example, with the development of gastrointestinal (abdominal form) anaphylaxis, all signs are very similar to the symptoms of acute poisoning, appendicitis, pancreatitis, bile colic.
• With hemodynamic form with its severity of heart pain and manifestations of insufficiency - a person is diagnosed ".
• Spasification of bronchi, and even larynx swells refer to signs of asthmatic attack, and brain and neurological disorders - to, and other diseases that do not have any attitude towards anaphylactic shock.

Such false diagnoses are fatally dangerous for the patient, since the time for proper treatment simply does not remain.

Therefore, if after a glass of orange juice, the strongest pains for the sternum unexpectedly arise, it immediately indicates the development of anaphylaxis. And no need to wait for any other signs.

Actions at AS.

Detection of a problem

The detection of an allergen-aggressor that caused an anaphylactic shock is a very important stage that should be included directly into the treatment of pathology. If the patient did not come across allergic reactions, conduct special research. They are able to confirm the diagnosis of body allergization as a whole, as well as the causal allergen in a particular case of anaphylaxis.

Of them allocate:

• skin, ache, appliquational samples (PATCH test);
• blood test for the presence of immunoglobulins E (IgE) responsible for allergic reactions;

To ensure the safety of the patient's health in the event of a sharp response to allergy provocation, all studies are conducted with a high degree of caution. The most safe is the radioimmunological method when conducting an allergensbent test (RAST), which with the greatest accuracy determines the anaphylactic allergen, without affecting the structures of the body.

Safety is ensured by analyzing outside the patient's body. In the blood taken in the patient, alternately add various types of allergens. If, after the next interaction of blood with an allergen, an anomalous amount of antibodies is distinguished, this indicates this allergen, as for the cause of an anaphylactic reaction.

This video will tell about the first aid for anaphylactic shock:

Treatment

In the hospital - in the intensive care and separation of intensive therapy, the main treatment of anaphylactic shock is carried out.

Basic principles

The basic principles of the treatment of anaphylactic shock:

1. Elimination of serious dysfunctions in the work of the heart muscle, vessels, respiratory and nervous system.
2. Prevention of sudden falling pressure and development of coma.
3. Prevent, brain, asphyxia, heart stop.
4. Removing the life-threatening lives of larynx swelling, trachea, bronchi.
5. Suppression of further hystamine emissions, bradykinin, kallicrein and removal of allergen substances.

About whether adrenaline is introduced with anaphylactic shock and what other drugs will be needed, let's tell later.

Events and medicines

1. Intramuscular injections of adrenaline (epinephrine) 0.1% after 10 - 15 minutes by 0.2 - 0.8 ml. When calculating children's doses, the rate of 0.01 mg (0.01 ml) per kilogram of the baby weight is taken into account. If a positive reaction does not occur - the intravenous administration of 1 ml of adrenaline in 10 ml of NaCl solution is slow - 5 minutes to prevent myocardium ischemia. Or 1 ml of medication in 400 ml NaCl through a dropper, which is more rational.
2. Pouring liquids to prevent coma: 1 liter of NaCl solution, then -0.4 liter polyglyukin. Initially, the inkjet introduction is provided up to 500 ml for 30 to 40 minutes, later - through the dropper. It is believed that colloidal solutions are actively filled with vascular bed, however, crystalloid fluids are safe, since the dextns themselves can cause anaphylaxis.
3. Glucocorticoids.
   • Hydrocortisone into the muscle or vein: adults from 0.1 to 1 gram. For children, intravenous injections from 0.01 to 0.1 grams.
   • : 4 - 32 mg intramuscularly, daily dose for intravenous injection 3 mg per kilogram. After removing the patient from the acute state, dexamethasone is prescribed in pills in a daily dose to 15 mg. Children's doses are calculated by the weight of children: from 0.02776 to 0.16665 mg per kilogram.
   • : 150 - 300 mg once intramuscularly, infants up to a kilogram of weight 2 - 3 mg, from 1 year to 14 years 1 - 2 mg.
4. Means for the restoration of respiratory patency and removal of spasm of bronchi, overwhelming hystamine emissions.
   • 2.4% 5 - 10 ml intravenously. Drip administration provides for a dose of 5.6 mg per kilogram (20 ml of the preparation is divorced in 20 ml of 0.9% NaCl and 400 ml of saline). The greatest doses per day per kilogram of weight: 10 - 13 mg, children from 6 years - 13 mg (0.5 ml), from 3 to 6 to 20-22 mg (0.8 - 0.9 ml). Carefully use Eufillin in the last trimension of pregnancy, since Mother and Fetal has tachycardia.
   • In addition to euphilline, aminoophyllin, albuterol, metaproterol are used.
5. Medicines to activate the work of the heart. Atropine 0.1% subcutaneously 0.25 - 1 mg. Children's single doses are prescribed by weight and age in the range of 0.05 - 0.5 mg.

1. Medicines that prevent pressure drop and reinforcing cardiac output.
   • Dopamine. Apply intravenously after dilution in a glucose solution of 5% or sodium chloride. Adults (per kilogram of weight per minute) from minimal dosages 1.5 - 3.5 μg (the rate of infusion of 100 - 250 μg / min) to 10.5 - 21 μg (750 - 1500 μg per minute). Children over 12 years old the greatest dose per kilogram 4 - 8 μg (per minute).
   • In pregnant patients, dopamine is used only with the threat of life for the mother, teratogenic (rinking fruit) dopamine action has not been detected. Breastfeeding stop.

1. Antihistamines, stopping the emission of allergy provocateurs in the blood, eliminate itching, swelling, hyperemia. It is possible to rationally after restoring the circulation volume of blood, as they can lower the pressure.
   • Oxygen therapy. Helps with an increase in oxygen fasting fabrics and bronchospasm.
   • Hemosorption - Special outnore techniques for eliminating allergens from blood when passing it through sorbents.

   All patients who survived anaphylaxis should be observed in the hospital to 2 - 3 weeks, due to the probability of developing re-anaphylaxia and late complications from the heart, vessels, respiratory and urinary system.

   Therefore, in the hospital there are several times:

   • blood test, urine;
   • study of urea indicators, creatinine in the blood;
   • or ;
   • research Cala on the Reaction of Gregersen.

   Prevention of the disease

   To reduce the risk of developing ASh in people with a high probability of an allergen impact necessary:

   • be sure to have a set of emergency medical drugs (we wrote separately):
     • adrenaline solution;
     • Prednisone in ampoules;
     • Ventolin, Salbinanal;
     • Suprastin or Tueva or Dimedrol (in ampoules)
     • harness.
   • be able to use the automatic syringe for adrenaline injection (Epi-Pen, AllerJet);
   • avoid insect bites (cover outdoor places, do not use outside the house of sweets and mature fruits), apply special discharges;
   • correctly evaluate the components in well-used products to avoid penetration of allergens through the stomach;
   • in production, avoid contact with industrial chemistry, inhalation and skin allergens;
   • do not apply β-blockers at risk of severe anaphylaxis, replacing them to medicines of another group;
   • when conducting research using radiocontrase substances in advance prednisolone
   • make samples for allergies from medicinal and other substances;
   • choose medicines in tablets, and not in injections;
   • always have with you "passport" (card, bracelet, suspension) with information about allergic diseases and preparations that help with ASH.

   About possible complications after such an allergic reaction as an anaphylactic shock, read further.

   Complications

   • Heavy complications may be diagnosed:
   • Glomerulonephritis
   • Intestinal and gastric bleeding
   • Cardic pathology, including myocarditis
   • Bronchospasm and pulmonary swelling;
   • Sweet and hemorrhage in the brain

   If the help is delayed, the pulse becomes weak, a person loses consciousness, there is a high risk of fatal outcome.

   Forecast

   The forecast is favorable only in the case of immediate medical care in the formulation of an accurate diagnosis and emergency hospitalization of the patient.

   According to statistics, almost 10% of people with anaphylactic shock are dying.

   However, even the relief of drugs of the acute state of anaphylaxis does not mean that everything has completed safely, since the likelihood of secondary drop in the pressure and the development of anaphylaxis (as a rule, within 3 days, but there is a longer interval).

   About what to do when anaphylactic shock will tell this video:

Anaphylactic shock is a heavy allergic condition representing the threat of a person's life, which develops due to the impact on the body of various antigens. The pathogenesis of this pathology is due to the reaction of an instantaneous type organism, in which there is a sharp admission to the blood of such substances such as histamine and others, which causes an increase in the permeability of blood vessels, internal organ mascles, and other multiple disorders. As a result of these disorders, Hell falls, which leads to a lack of treatment with the brain and other bodies of due amount of oxygen. All this leads to the loss of consciousness and the development of many internal disorders.

Etiology and pathogenesis

Anaphylactic shock is a superdexcination of our body to foreign exposure from the outside. The severity of the patient's condition is directly related to the failure of the organism's immunological response to the invasion of the foreign agent.

Most often, this reaction develops in children, but also in adults prone to manifestations of allergies, such a powerful response of the immune system is possible. Some insect bites are often the cause of such a reaction, for example, bees, as well as the introduction of drugs (antibiotics, vaccines). Less often, the ultrasound immunological response is developing in response to the use of some foods with a high allergy index, such as nut pastes, peanuts, oranges and other foods. More often anaphylactic shock develops due to inhalation of pollen of some plants.

The tendency to the development of anaphylaxis is in people with pronounced, in which, when exposed to cold wind and water, such allergic reactions can develop as. Anaphylactic shock is sometimes becoming the most powerful reaction to stimuli.

At times, the reaction appears unexpectedly - in people who had not previously observed a tendency to allergies. For example, it often face domestic owners, in which, with a long-term content of a pet, signs of allergies for wool or epithelium of their favorite can develop, and the ultimate (often unexpected) reaction becomes anaphylactic shock.

Symptomatics

After accidentally entering allergen inside the body, the symptoms of anaphylactic shock appear or instantly or for half an hour. Moreover, the sooner they appear, the worse the forecast of the flow of an allergic reaction, because it means that the human immune system is completely unable to cope with the allergen. In some cases, people die from the heavy duty allergic reaction before the introduction of the drug that caused it will be completed, but it is rather exceptional cases.

The symptoms of anaphylactic shock may be more or less pronounced. Lightning the upcoming vascular collapse is the most formidable sign of this pathology, but most often a person begins to complain about the weakness and feeling of tingling in the footsteps, palms, on the face. If these complaints ignore the further development of the situation becomes unmanageable - the feeling of weakness is intensified, the person is pale, begins to experience fear, he appears abundant sweat and pain in his stomach. A sharp drop of blood pressure is the cause of loss of consciousness and even involuntary urination and defecation.

Sometimes there are other signs of such pathology as an anaphylactic reaction:

• itching through the body;
• ears ears, language, century;
• the appearance of rashes on the skin;
• tearing and excretion of mucus from nasal moves;
• the appearance of noisy difficulty breathing.

In the future, the clinic is characterized by loss of consciousness and vascular collapse.

It should be said that the condition of the patient with such an allergic reaction, as an anaphylactic shock, is very heavy and therefore a person urgently needs qualified medical care, without which he can die for days. That is why in the manipulation offices and in dental offices, the first-aid kit with drugs with preparations that allow you to stop the attack of ASH are always ready.

It should be noted that before the loss of consciousness and the occurrence of a collapse, patients usually behave very restlessly - they are scary, and they breathe hard, and in those people who have CNS disorders or cardiovascular pathologies, the clinical picture is aggravated by specific symptoms, for example,. Due to the spasm smooth musculature, breathing is disturbed and arises, and as its consequence -.

Unfortunately, every tenth case of such a superdexcation is lethal, and especially a lot of mortality from such pathology, as an anaphylactic shock, in children, the immune system of which is very violently responding to the introduction of the antigen. It should be noted that children have some other signs than in adults. Little patients initially experience strong fear, and they have shortness of breath. Then children are cold sweat, and spastic abdominal pain appear, after which vomiting occurs, dizziness, appearance of foam from the mouth and the development of convulsion.

The pulse in children is a thread-shaped, practically does not fit, swells tongue and larynx, which leads to a violation of the function of respiration and the development of cyanosis.

First aid

The main thing is to be taken in an emergency, it is to conduct urgent events to stop an anaphylaxis attack. Emergency care is to provide preference and medical care. Proponial urgent assistance in anaphylactic shock is represented by a complex of measures aimed at stopping or eliminating the action of an irritant and introducing antihistamine to the body.

If the patient has developed anaphylactic shock - it is impossible to slow. First of all, there should be access to fresh air to the victim from the bite or the administration of allergen to another way, put a person on a horizontal surface and freeing his body from tight clothing. The legs should be slightly lifted, and turn the head to turn the chasso so that the victim does not choke from the vomit.

From antihistamine preparations, which should be tried to give the victim, you can use Tuese or Supratin, or another means that is at hand.

If anaphylactic shock occurred in a medical institution, the doctor on the spot has emergency assistance to the patient. Also, medical assistance is on arrival at the scene of the incident, and it consists in the introduction of a solution of adrenaline that increases blood pressure.

In addition, human glucocorticosteroids and Eufillin, eliminating respiratory failure. The following actions of the doctors are:

• the respiratory tract is cleaned of vomit;
• the symptoms of heart failure are eliminated;
• oxygen is supplied using the installation of the nasal catheter.

Emergency assistance in children is carried out similarly, with the only difference that the necessary drugs are introduced every 15 minutes before stabilizing the state of a small patient.

Further treatment of anaphylactic shock after stabilization of the patient's condition is carried out under hospital. It involves cleaning the body from toxins and replenish the blood volume. In severe cases, the treatment of anaphylactic shock requires the use of resuscitation equipment to maintain the vital activity of the internal organs.

Adults and children who endured this allergic reaction are left under the hospital surveillance for two weeks. This is necessary in order to eliminate the likelihood of the development of complications, for example, a violation of the work of the heart or the urinary system. Extract from the hospital is carried out after testing and ECG. In the future, that the clinic does not repeat again, it is necessary to complete contacts with the allergen heavy duty allergic reaction.

Forms of anaphylactic shock

Anaphylactic shock is the most severe form of an allergic reaction, which is accompanied by violations of the functioning of blood supply and respiration systems. With the subsequent development of the described state, it can lead to a fatal outcome.

This circumstance is determined by interest in which the stages and forms of anaphylactic shock are determined. It is very important to know the first symptoms of the development of this allergic reaction and be able to distinguish them. In time, the initiated treatment will help to avoid possible complications of the disease.

Modern medicine allocates several basic stages of the development of anaphylactic shock:

1. Immunological stage. At this stage, an increased sensitivity of the human body is formed to a certain substance. The specified stage begins after allergen penetrates the body. It was then that specific immunoglobulins are distinguished. The duration of this period can be measured by days and months, and sometimes years. In this case, there may be a completely absent symptoms of a painful state.
2. Immunochemical stage. The beginning of this stage is the secondary penetration of the allergic reaction of the element in the body. There is a clear connection of elements with immunoglobulin produced by earlier, after which the fat cells of the connective tissue are degranulated and the release of biologically active components is observed, including histamine, the result of which the external manifestations of the allergic reaction becomes.
3. Pathophysiological stage. At this stage, the active impact of the active components released. This stage is characterized by the occurrence of itching and rash, mucous membranes swells, blood circulation is broken. With such sensitivity to allergens, it is required as quickly as possible delivery of a person to the hospital.

Anaphylactic shock forms can be different, they are accompanied by various features. Depending on the symptoms, such forms of anaphylactic shock are separated:

1. Typical allergic reaction. The symptoms are quite characteristic, in some parts of the body, a rash appears, accompanied by a strong itching. A person begins to feel the feeling of gravity and lobs in the body, as well as pain. This form is accompanied by unfortunate concern, depressed and strong fear of death. The blood system operates with failures, the drop in blood pressure is noted, shortness of breath appears, in rare cases, cases of loss of consciousness are noted and the work of sense organs is disturbed. With further exacerbation of the situation, breathing may be stopped.
2. The hemodynamic form in which the development of all signs is closely related to the blood system.
3. Asphisical form. The pronounced symptoms of the insufficiency of organs and respiratory systems are noted.
4. Abdominal form. All major symptoms of this form are directly related to the abdominal organs. The patient has severe pain in the abdomen, vomiting urges may develop after nausea.
5. Cerebral shape. It is characterized by a violation of the functioning of the central nervous system.

Various forms of anaphylactic shock may have a daily duration or end in a few minutes of full respiratory stop. These and explains the importance of the timely provision of the patient with all the necessary assistance.

Causes of anaphylactic shock

The reasons for the state under consideration can be the most different. It is customary to allocate some of its main reasons:

1. The use of drugs is one of the most common causes of the emergence and development of anaphylactic shock. It can cause antibiotics, in particular penicillin, bicyllin, streptomycin. Often, allergic reactions occur even with the initial introduction of medical preparations, since when a person gets into the body, medicines communicate with protein substances without difficulty and form certain complexes with sensitizing properties. In this case, there is an intensive formation of antibodies.
2. Another group of reasons is due to the fact that the person's pre-organism can already be sensitized, in particular, the cause of this can be food. For example, it is precisely established that in milk it is possible to detect penicillin impurities, the same can be said about some vaccines. In some cases, there is a crossbrospilization, the cause of which is that a plurality of drugs are combined with similar allergenic characteristics.
3. Anaphylactic shock can develop due to the use of some vitamins, in particular, this refers to the vitamins of the group B, as well as carbocrylase.
4. The strongest allergens are considered animals hormones, such as insulin, ACTG and other, as well as iodine preparations and sulfonamides. Also, anaphylactic shock can be caused by blood and some of its components, such as immune serums and anesthetics, common and local action.
5. The cause of anaphylactic shock can be the poisons of various insects that have fallen into the body in the uncens of insects (bumblebees, OS, bees). Various food, such as eggs, nuts, milk and fish can also cause anaphylactic shock.

The fact that does not have a decisive dose of adopted allergen should be taken into account. In the human body, it can penetrate various ways, these can be intracutaneously diagnostic tests used by ointments, inhalations carried out, the use of drugs for injection.

Anaphylactic shock: symptoms

The definition of anaphylactic shock is sufficiently difficult, since the reaction is polymorphic. In each case there are symptoms and they have a close connection with the cause of the state.

According to the nature of the observing symptoms, three forms of anaphylactic shock are distinguished:

1. Lightning form. In such cases, the patient himself does not always have time to understand what is happening to him. After the allergen hit in the blood, the rapid development of the disease occurs. Development time may be limited to two minutes. Of the characteristic symptoms of such a form, you can note the pale of the skin and the occurrence of difficulties in breathing. Sometimes there are all signs of clinical death. The patient suddenly loses consciousness and he develops heart failure. Often the result becomes the death of the patient.
2. Heavy shape. The symptoms of anaphylactic shock are observed after 5-10 minutes after the allergen enters the blood. A person begins to hurt a lot, he chips and feels an acute shortage of air. After the very same symptoms, it is necessary to urgently to the patient first aid. When untouching the first half, the situation may end the death of the patient.
3. Average form. It is observed after half an hour after the allergen is in the blood. In the patient, strong headaches suddenly arise, heat arises, there are quite unpleasant feelings in the chest. Female outcome in such cases is relatively rare.

Among the symptoms of a general nature should be allocated:

1. The appearance of redness on the skin, urticaria arises, on the skin the eath.
2. The respiratory symptoms can be attributed to shortness of breath, strong noise with breathing, edema in the upper respiratory tract, asthmatic seizures, itching sensations in the nose and cough attacks.
3. Cardiovascular symptoms include discomfort of heartbeat, frequent pulse. It seems that the heart is ready to "jump out" from the chest, it seems to turn into it. A severe pain begins for the sternum and loss of consciousness is possible.
4. Gastrointestinal symptoms are characterized by nausea, vomiting in combination with a liquid chair, spasms in the stomach and bloody streaks in the vomit masses.
5. Neurological symptoms can be described as a sense of anxiety, strong excitement, panic, as well as constant anxiety.

As a rule, anaphylactic shock is accompanied by a combination of a variety of symptoms. They are extremely rarely manifested separately.

The first symptoms of anaphylactic shock

Such symptoms are observed most often in the current after the introduction of allergen. Depending on how quickly the symptoms are discovered, it can be judged so heavy that will be a shock state. The harder the shock itself proceeds, the more difficult will be the forecast of the further clinical picture. Many cases of the occurrence of death after the first effect of the drug are known.

Various variations of the clinical picture of the shock under consideration are possible, but the most dangerous symptom, which is quite difficult to predict in a timely manner, is the rapid collapse of the heart. At the very beginning of the development of the process, the patient feels general weakness, there are tickling sensations in the field of the face, also rolled in the chest, on the palms and soles of the legs. Subsequently, there is a rapid unfolding of a clinical picture. Weakness is sharply intensified, on its background there is pressure behind the sternum, the patient is beginning to pursue various phobias, poorly eliminated. The patient is suddenly sharply pale, it allocates cold sweat in large quantities, abdominal pain arise. Often there is a rapid drop in blood pressure, the pulse at the same time is readier and weakens, involuntary urinary incontinence and defecation are possible.

In some cases, the initial symptoms of the test of the shock in patients were ringing in the ears, itching throughout the body, rash on the body, conjunctivitis, ears, tongue, language, and after which the collapse of the heart and loss of consciousness were observed.

The initial symptoms of the shock under consideration may have different variability, but there is always a very bad common state of a sick person. At the same time urgently need to provide him with a qualified ambulance care.

The clinical picture of the anaphylactic shock is quite stormy. In the chest, constraints and pressure feels, breathing makes it difficult and a person feels weakness. The person begins to hurt and spin the head very much, in all body there is a strong heat. The man is sick, his eyesight worsens, the tongue and limbs do not make ears. The skin across the body begins to clamp and edema appear on it.

Symptoms after anaphylactic shock

After the anaphylactic shock is onset, patients are frightened and show strong anxiety. They breathe quite noisy and their breathing can be heard at a distance. The activity of the heart and blood vessels after transferred shock significantly deteriorates, the blood pressure decreases sharply, the pulse is readier and becomes a filamentary, it is not good. The patient is sharply and quickly pale, cyanosis and acricyanosis appear. Possible microcirculation disorders in heavy forms, if earlier the patient marked ischemic heart disease, the development of coronary insufficiency is possible. The clinical picture at the same time is significantly dragged.

After anaphylactic shock, spasms of smooth muscles are possible, the result of which the bronchi spasm becomes. The insufficiency of the respiratory organs may be due to the angioedema edema of the larynx. The respiratory tract is subject to obstruction, which is combined with hypertension of lungs and increasing vessel permeability. The result can be psychomotor arousal, turning into adamise, as well as in the eaters. Possible loss of consciousness, accompanied by involuntary urine and defecation. Research using an electrocardiogram allows you to identify malfunctions of cardiac rhythms, overloading various parts of the heart and coronary failure. The heart can spontaneously stop due to a very heavy, rapid shock. Female outcome is marked in each tenth of anaphylactic shock.

Anaphylactic shock: first aid

It should be understood that assistance in anaphylactic shock is divided into prefabricated, medical and inpatient treatment. It is allowed to provide a predetermined assistance to people who were directly proximity to the victim at the moment when allergic reactions were launched. The first thing they should be done to cause ambulance.

First prefigure aid for anaphylactic shock

The first prefiguration assistance in anaphylactic shock includes:

1. The patient stacked on the back, a smooth horizontal surface should be located under it. His legs should be located above the level of the whole body, so it should be placed as a roller or another subject. It is required to ensure the inflow of blood to the patient's heart.
2. To ensure the inflow of fresh air to the patient, you need to open the window or window.
3. On the victim, it should be unbutted with clothes, it will help to achieve the required level of freedom when breathing.
4. It is recommended to carefully track down so that there was nothing in the mouth, which could prevent his full breathing. If a person in the mouth has removable prostheses, it is necessary to remove them. If there is a chance of the vast of the language in a sick person, you need to turn his head aside and try to place it a little higher. If convulsive movements have a victim, it is recommended to put a pre-prepared object between the jaws.
5. In that case, the fact of penetration into the body of the patient causing an allergic reaction of the substance due to the bite of an insect or injection with a medical device, follows the area of \u200b\u200bthe injection or bite to perform the imposition of a harness, it also makes sense to limit the allergen access to the blood to use ice overlapping to this Place.

In addition, all the time before the ambulance must be carefully monitored to monitor the patient's condition. Special attention will be paid to its breathing, pulse and pressure change. If there is an antihistamine tool, you must convince it to accept it. To this, they will fit the Tuese, phenkarol and suprastin. After the ambulance team arrives, it is necessary to give them complete information regarding the exact time of the beginning in a patient described by the reaction, its available symptoms, aid that was provided.

First medical care for anaphylactic shock

The first medical care for the development of anaphylactic shock in a patient is in a stationary medical institution or an ambulance brigade. Medical assistance includes the following steps:

1. The patient must be administered an adrenalinealine solution, a concentration of 0.1%. You can enter the solution both intravenously and intramuscularly, as well as under the skin of the patient, depending on the circumstances. In the event that an anaphylaxis is observed after conducting injections of intravenous or other type, as well as after insect bite, it is recommended to apply the adrenaline solution to the place of penetration of allergen. The concentration is as follows: one milliliter of adrenaline for ten milliliters of the solution. Up to six points in a circle, 0.2 millilita per point.
2. If the allergen penetrates the body in a different way, adrenaline still needs to be administered, since it is a direct histamine antagonist. The drug guarantees the narrowing of blood vessels and reduces the permeability of the walls of these vessels. In addition, it increases pressure. Similar to this media are Meston and Noradrenalin. They are allowed to apply in cases where adrenaline is not at hand, but it is necessary to provide first aid for anaphylactic shock. Adrenaline can not take more than two milliliters. The dose is best to enter fractionally, to ensure the uniformity of the action provided.
3. In addition to adrenaline, the patient recommends the introduction of glucocorticoid hormones. This is hydrocortisone, dexamethasone, prednisone. It is best if intravenous administration can be administered drip or stroke. Gifting the milking should be with a solution of sodium chloride.
4. Mandatory administration of a large volume of liquid intravenously. This is due to the nature of anaphylactic shock, which is based on the sharp lack of fluid in the blood stream. There are certain differences in the rate of introducing a solution to children and adults. An adult human solution can be entered faster than the child.
5. When providing a patient emergency medical care for anaphylactic shock, he must be provided with oxygen inhalation through a mask and free breathing. During the edema, the larynx should be made of emergency tracheotomy.

If possible, establish intravenous access, the patient introduces fluid in the first stages of providing medical care to it. Introduction continues when transporting it to a medical institution with emergency and resuscitation departments.

First aid kit for anaphylactic shock

A full-fledged set of first-aid kit in anaphylactic shock involves the presence of the following drugs:

• prednisone, the action of which is aimed at eliminating all signs of shock, since the drug is similar to the substances produced by the human body;
• antihistamine, anti-allergic action, which prevents the production of histamine organism, hormone, which is responsible for such allergic reactions in the body;
• adrenaline, the action of which is aimed at the functioning of the muscles of the heart;
• eufillin, a tool that helps expand bronths, as well as capillaries, which helps to improve blood oxygen saturation;
• dIMEDROL - antihistamine, characterized by the effect of calm;
• in addition, the first-aid kit should include concomitant materials, such as bandages, wool, alcohol, syringes, catheters and saline, all that is required for the introduction of patients with drugs.

The first-aid kit with the described list of drugs should be in each medical office for conducting procedures, as well as in medical offices at various enterprises. The composition of the aid kit must constantly replenish in accordance with the latest recommendations of the Ministry of Health.

Treatment of anaphylactic shock

Treat the anaphylactic shock should be started immediately after a suspicion of this state arose. It should be started with the fact that stop taking drugs that caused the development of this process. If the needle stayed in Vienna. It is best to eliminate the syringe and through the needle to continue holding therapy. If the problem is in the bite of an insect, it should be removed by his sting.

Then it is necessary to accurately determine the penetration time of the allergen into the body. This should take into account the general suction of the patient and consider the initial clinical phenomena. Then you need to carefully put the patient and raise its limbs. The head is sure to turn into one of the parties, the lower jaw to push forward. This is a measure of preventing the swallowing of its language and asphyxia by the masses of vomiting. If you have dentures, they should also be removed. For a general assessment of the patient's condition, he should hear it, find out what it complains, to measure his pressure. It is required to take into account the overall character of the patient's shortness. Then you need to consider the skin of the patient. With a decrease in blood pressure, 20% there is a possibility of further development of shock.

Be sure to provide oxygen access to the patient. After that, the imposition of a harness into place of the subsequent introduction of the solution is carried out. The place of injection is imposed by ice. Be sure to make injections with syringes or systemically. This is necessary for high-quality troubleshooting.

If necessary, enter the medicine through the eyes and the nose must first rinse them. Then enter two drops of adrenaline. When subcutaneous administration, an adrenaline solution is used by a concentration of 0.1%. It is divorced in saline. The system must be prepared in advance before the doctor's arrival. Intravenous infusion involves the introduction of a solution with a volume of 400 milliliters. In case of difficult, puncture should be injected into the field of soft tissues under the tongue.

Initially, glucocorticosteroids are introduced drip, and then drip. Most often prednisone is applied. Once the diphroll is used, the concentration of 1%, then Tueva. All injections are intramuscular.

Principles of treatment of anaphylactic shock

Anaphylactic shock or anaphylaxis is a borderline state, which is characterized by an acute form of flow. Without the impact of external factors, this condition does not disappear. Help the patient should be immediately appreciated, otherwise the sad finale is inevitable.

Most often, the shock is caused by re-contact with the component to which the human body is not located. In such cases, the allergic reaction is a frequent outcome due to the high sensitivity of the human body. Such a condition can be provoked by various substances, allergens of protein or polysaccharide origin, as well as compounds that turn into allergens after contact with the proteins of the human body.

Treatment of anaphylactic shock: drugs

The list of drugs for the treatment of anaphylactic shock may have this kind:

• prednisone, the drug of antisoke action on a hormone-based basis, significantly reduces the risk of shock development and provides acts from the first minute after the injection;
• antihistamine preparations, in particular Tueva or Supratin, capable of eliminating the susceptibility of histamine receptors, which is a basic substance that is distinguished into blood after the development of an allergic reaction;
• hormonal drug adrenaline is required to stabilize the functioning of the heart in difficult conditions;
• dimedrol, antihistamine drug whose action is double: it contributes to blocking the further development of allergic reactions and provides suppression of excess nervous excitation.

In addition to the specified means at hand, it is constantly necessary to keep the desired syringes, alcohol for wiping the skin before administering injections, cotton wool, march and rubber harnesses, tanks with salvory for intravenous injections.

Prevention of anaphylactic shock

The prevention of anaphylactic shock comes down to complying with the following recommendations:

1. At hand, it should always be preparations, with which one can effectively provide first aid for anaphylactic shock. In addition, it is necessary to be able to use the automatic injector, with which adrenaline is introduced.
2. Special methods for protection against insect bites should be resorted. You do not need to wear clothes with a predominance of bright tones, you should not use perfume without the need, there is no immature fruit on the street.
3. If possible, strive to avoid unnecessary contacts with potential allergens. To do this, you need to be able to promptly and correctly assess the purchased food and components that are included in their composition.
4. If there is a need for eating outside the house, it is necessary to make sure that it does not contain allergens in its composition.
5. When in the production premises, contact with various skin allergens should be avoided.
6. Periodically, prophylactic diagnostic studies should be carried out with the use of radiocontrase substances. At the same time, it is necessary to preliminary administration of the ranitide, prednisolone, diphenhydramine and dexamethasone.

With severe forms of anaphylactic reactions, it is not necessary to use beta blockers. If there is a similar need to use the drugs of another group.

Anaphylactic shock is an acute and extremely severe allergic reaction, developing as a result of re-entering the allergen organism.

Anaphylactic shock is manifested by a sharp decline in pressure, violation of consciousness, symptoms of local allergic phenomena (skin swelling, dermatitis, urticaria, bronchospasm, etc.) in severe cases may develop a coma.

Anaphylactic shock is usually evolving ranging from 1-2 to 15-30 minutes from the moment of contact with the allergen and often it may end to death, with non-appealation of fast and competent medical care.

Causes

Anaphylactic shock occurs as a result of re-introduction into the body of a substance, which is a strong allergen for it.

In case of primary contact with this substance, the body without the manifestation of any symptoms produces increased sensitivity and accite \u200b\u200bthe antibodies to this substance. But re-contact with the allergen, even in its minimum quantities, due to the finished antibodies available in the body gives a violent and pronounced reaction. Such an organism reaction most often occurs on:

• introduction of alien protein, serum
• antibiotics
• anesthetics and drugs for anesthesia
• other medicines (both in Vienna and in the muscle inside through the mouth)
• diagnostic Preparations (X-ray Cutter)
• with insect bite
• and even when receiving some foods (seafood, citruses, spices)

With anaphylactic shock, the amount of allergen can be very small, sometimes enough drops of medication or spoons of the product. But the more the dose, the stronger and the shock will be longer.

The allergic reaction is based on massive separation from sensitized cells (higher sensitive) special substances - histamine, serotonin and others, which are guilty of anaphylactic shock.

Views

Anaphylactic shock can occur in several types:

• preferably, the skin and mucous membranes with phenomena of the skin, sharp redness, urticule or swelling
• damage to the nervous system with headaches, nausea, impaired sensitivity, manifestations of epileptic and loss of consciousness,
• defeat the respiratory system with a chopping and asphyxia, swelling of the larynx or small bronchi,
• heart damage with signs of cardiogenic shock or acute myocardial infarction

Symptoms of anaphylactic shock

According to the severity of symptoms, anaphylactic shock can be from light to extremely severe with death, it depends on how quickly the pressure is reduced and the work of the brain is disturbed due to hypoxia (lack of oxygen).

With light manifestations, the symptoms of anaphylactic shock can last from a few minutes to two hours and manifest

• blunt leather
• strong itching and sneezing,
• mucous discharge from the nose,
• in throat with dizziness,
• headache
• reduced pressure and tachycardia.

There may be a feeling of heat around the body, the unpleasant feelings in the abdomen and chest, a sharp weakness and tuming consciousness.

At the average degree of shock may occur

• bubbles on the skin or angioedema edema (quinque)
• conjunctivitis or Stomatitis phenomena
• heart pain with sharp heartbeats, arrhythmias and a sharp decline in pressure.
• patients feel sharp weakness and dizziness
• violated vision, there may be excitement or inhibition, fear of death and trembling
• sticky sweat, clamping body, noise in ears and head, fainting
• there may be a spasm of bronchi with a respiratory impairment, the bloating of the belly with nausea or vomiting, a sharp pain in the stomach, impaired urination.

With severe anaphylactic shock, almost instantly develops

• vascular collapse with a sharp decrease in pressure, a formation or a dead paleness, the filamental character of the pulse, almost zero pressure
• there is a loss of consciousness with the expansion of pupils, involuntary tendering of urine and feces, lack of reactions to external stimuli
• gradually disappears the pulse, the pressure ceases to register
• stop breathing and cardiac activity, clinical death comes

Diagnostics

The diagnosis is made on the basis of data on the introduction of the drug (contact with the allergen) and immediate start of the reaction.

The state of the anaphylactic shock is critical - the diagnosis establishes an ambulance or resuscator. Anaphylactic shock can be similar to other anaphylactic reactions (swelling of quinque or acute urticule), but the basis of the process is one, as well as a helping measures.

Treatment of anaphylactic shock

The beginning of treatment is necessary in place by any person - a physician or not a physician, professional assistance is provided by doctors ambulance and resuscitation doctors.

First aid for anaphylactic shock

• ambulance call
• if there is no breathing and heartbeat - indirect heart massage and artificial respiration
• if a person is conscious, it is necessary to put it on the side, unbuttoning all the clothes and belts, under the feet put a pillow or anything so that they are raised
• stop the admission of allergen (when the insect bite or the administration of the drug - the harness to the limb, the removal of food from the mouth)

Medical assistance - at the place of assistance, before delivery to the hospital,

• the place of injection or bite is necessary to whipped with a solution of adrenaline intramuscularly or subcutaneously (adult 0.5 ml of 0.1% solution, children over 6 years old - 0.3 ml of 0.1% RR) and put ice,
• subcutaneously introduce caffeine solutions, Cordiamine
• prednisolone or hydrocortisone injections are also necessary.

As heties, adrenaline and hormones are repeated in the hospital, antagonists of medical drugs during drug allergies are introduced, the introduction of antihistamine agents, solutions of chloride or calcium gluconate are used. With bronchospasm, Ehuchillin is introduced, with a larynx swelling - the intubation or tracheotomy is shown.

Further therapy is carried out taking into account violations of cardiac activity, respiratory disorders or metabolic disorders.

Complications and forecast

The main complication is the fatal outcome when delaying with assistance. With timely events, complete cure from shock is possible, but the deadlines from the shock state range from several hours to several days.