Emergency care for anaphylactic shock. Algorithm of actions and features

Anaphylactic shock is the most serious manifestation of an allergic reaction. Any person needs to know and be able to provide emergency first aid in case of anaphylactic shock in order to save the victim. The rate of response of the body directly depends on the route of entry of the allergic substance into the patient's body:

• Parenteral is the intravenous and intramuscular administration of drugs. In this case, anaphylaxis develops at lightning speed.
• Through the dermis. It can be subcutaneous, intradermal injections, various scratches, insect bites.
• Through the respiratory system. Absorption of dust, fumes in which an allergic component is present. In these cases and as described above, the reaction develops more slowly.
• Through the digestive system, i.e. through ingestion. Anaphylaxis appears after 60-120 minutes.

Doctors identify the relationship between the rate of development and the severity of the clinic for anaphylactic shock. Emergency care should be provided immediately.

Help with anaphylaxis

All actions in this condition can be divided into help:

• Pre-medical - it is provided by those who are next to the victim at the time of the onset of the development of an allergic reaction.
• The first medical one is provided by medical personnel of an ambulance or a medical institution if the patient is in the walls of a clinic or hospital.
• Hospital treatment.

Consider in more detail the algorithm for emergency care for anaphylactic shock at the pre-medical stage:

• Lay the individual on a firm, level surface. To improve blood flow to the heart, raise your legs by placing folded clothes or a bag under them.
• Open access to fresh air. If the victim is in the room, then open the window; if on the street, release the chest from excess clothing to facilitate breathing.
• Remove removable dentures by first wrapping your hand in a handkerchief or napkin. Turn your head to the side so that the individual is not choked with vomit. Put a hard object between your teeth in case of cramps.
• If the allergen penetrates as a result of a bite or injection, ice must be applied or a tourniquet applied above the affected area. Such manipulation reduce the rate of absorption of a harmful substance into the blood.

If the victim is in the health care facility or the ambulance arrives, the algorithm for emergency care in case of anaphylactic shock is as follows:

1. A solution of "Adrenaline" is injected, they also cut off the site of ingress of the allergen, after dissolving the drug in sodium chloride.
2. In the absence of the previous drug, the introduction of "Noadrenaline" or "Mesatone" is allowed.
3. Further, hormonal agents are administered - Prednisolone or Hydrocortisone, diluted in sodium chloride, intravenously, by stream or by drop.
4. Spend infusion therapy with sodium chloride.
5. Provide the individual with free breathing. If necessary, give oxygen. Emergency tracheotomy is performed for laryngeal edema.
6. The victim is transported to the hospital.

It is very important at all stages to perform the correct algorithm of emergency care for anaphylactic shock in order to avoid a threat to the patient’s health. In a hospital setting, the patient continues drug therapy, which is already prescribed by the attending doctor. Hormone therapy lasts from five to seven days. Duration of inpatient treatment usually does not exceed seven days. This period of stay in the hospital is due to the fact that after the shock, it can be repeated after two or four days.

Signs of Anaphylaxis

To properly provide first aid for anaphylactic shock, you need to know its manifestations:

• Change of mood, which can be expressed by excitement or oppression, fear of death.
• Feeling of heat.
• Pain syndrome - cramping in the abdomen, constricting in the heart, pulsating in the head.
• Rapid swelling of the face, lips, tongue, nose, ears, upper limbs.
• Itching, rash resembling hives or redness of the dermis.
• Lacrimation, redness of the eyes, secretion of secretions from the nose, dry mouth.
• Dry or barking cough, bronchospasm, shortness of breath.

Further, the following clinical picture develops:

• The pressure drops quite sharply.
• The heart rate increases and can reach 160 beats per minute, while the pulse is barely audible.
• Loss of consciousness.
• Cold sweat.
• Convulsive phenomena are possible.
• The pallor of the dermis.
• Cyanosis of nails, tongue, lips.

In case of failure to provide emergency medical care for anaphylactic shock at this stage, the likelihood of a fatal outcome increases.

Risk Factors for Anaphylactic Shock

The development of anaphylaxis is more difficult when it occurs after intravenous injection. The severity of the condition will depend on the frequency and duration of exposure to the allergen, as well as on the time of the first signs of the body's response. The presence of anaphylaxis in the past will aggravate the situation each time. In addition, risk factors include:

1. Floor. In men, most often this reaction develops from an insect bite, and in women, when taking aspirin-containing drugs or in contact with latex.
2. The presence in the history of allergic pathologies.
3. Age. In children, anaphylaxis mainly develops as a result of taking certain foods. In adults - on drugs and bee stings.

Causes of Anaphylaxis

There are several main factors that can lead to an allergic reaction of such a force, while it is important to correctly and timely provide emergency care for anaphylactic shock. Among the main reasons are the following:

1. Medicines Quite often, anaphylaxis develops on the use of antibacterial agents, for example, antibiotics of the aminoglycoside group. It should be remembered that penicillin is found in many foods, for example, in frozen meat or milk. A person using them is at risk of an allergic reaction. Taking aspirin, muscle relaxants during surgery, anesthetics in the treatment of teeth also provoke the occurrence of shock. Cases of severe reactions to the administration of certain vaccines are known.
2. The poison of flying insects. A bright allergy develops on the bite of wasps or bees, as well as in the case of apitherapy.
3. Food. Of these, it should be distinguished: fish, shellfish, nuts. In the younger generation - this is soy, eggs and cow's milk.
4. Aeroallergens. In people sensitive to pollen of flowering plants, during the pollination season, the risk of anaphylaxis is high.

Anaphylactic shock: emergency care: nurse action algorithm

Due to the fact that in most cases anaphylaxis occurs with the introduction of drugs parenterally, first aid is provided by nurses in treatment rooms. Their manipulations in this condition can be divided into independent ones, which are carried out in the presence of a doctor. In the first case, urgent measures are as follows:

• Initially stop administering the drug. If a shock reaction occurred at the time of the injection into the vein, then the needle is left in it. A dropper or syringe is changed, a new syringe with the necessary preparation is attached to the needle to provide emergency care. If progression of symptoms is observed, then the nurse performs cardiopulmonary resuscitation, performing all the actions according to the current protocol.
• If anaphylaxis occurs after an insect bite, then the sting is quickly removed with tweezers. Ice is applied to the wound site. Apply a tourniquet or dressing above the bite site. The maximum time that you can safely hold the harness is twenty-five minutes.
• The patient should be put on his back and turned his head to the side. To facilitate breathing, open a window or window, free the chest from excess clothing. If necessary, carry out oxygen therapy.

Further, with anaphylactic shock, the emergency care of a nurse is to take measures to stabilize the patient's condition:

• Continue to extract the allergen, taking measures that will depend on the method of its ingestion into the body: chop off the place of penetration of the allergen using the Adrenaline solution, put an enema, rinse the stomach. The last two manipulations are indicated when an allergic substance enters the digestive tract.
• The following examinations are carried out in order to find out what harm has been done to the health of the victim: they assess the level of consciousness, examine the dermis, measure the pulse, blood pressure, temperature, check breathing and establish the type of shortness of breath.

The emergency care algorithm for anaphylactic shock of a nurse under the supervision of a doctor:

• Introduces intravenously using a dropper, "Adrenaline", diluted in saline.
• Adds “Dexamethasone” or “Prednisolone” to the drip system.
• Antihistamines ("Diphenhydramine", "Suprastin" or "Tavegil") are administered after compensation of the patient's condition.
• Carries out infusion therapy using sodium bicarbonate and reopoliklyukin.

In the event of respiratory failure, the nurse prepares medical devices for intubation and helps the doctor to carry out this manipulation.

Anaphylactic shock: protocol. Medical treatment at the stage of emergency ambulance

The response in the form of an acute allergic reaction of a systemic nature to repeated contact with an allergen, which is accompanied by hemodynamic and other disorders, as well as leading to a life threat, is called anaphylactic shock. The emergency care protocol in this condition is a normative document that spells out the requirements for how to provide medical care to a patient in a health care facility.

The approaches, methods and manipulations for the diagnosis, treatment tactics depending on the severity and course of the disease, including surgical and non-drug treatment, as well as preventive measures are presented. The protocols are reviewed every three years or in the case of the latest diagnostic and treatment methods using drugs with a higher level of evidence. Consider a list of essential drugs for anaphylactic shock.

Emergency care is provided using the following medicines for intravenous and intramuscular administration:

• "Epinephrine" 0.1%;
• "Norepinephrine";
• Prednisolone 3%;
• Hydrocortisone 2.5%;
• "Sodium chloride";
• "Dopamine" 4%;
• "Clemastine";
• "Diphenhydramine" 1%;
• "Chloropyramine."

These drugs are used for any form of anaphylaxis, i.e. the probability of their use is one hundred percent. The following is a list of additional medications that may be needed when providing emergency care for anaphylactic shock:

• Aminophylline 2.4%;
• Dextrose 5%;
• "Ventolin" in ampoules;
• "Furosemide";
• Potassium chloride + Sodium chloride + Calcium chloride;
• Potassium chloride + Sodium chloride + Sodium acetate.

Using the above medicines, doctors provide emergency treatment in an institution with anaphylactic shock. The standard for its provision is approved by order of the Ministry of Health of Russia and is a sequential list of necessary measures (diagnostic and therapeutic) that are used in a specific clinical situation.

First Aid Kit for Anaphylaxis

In recent years, doctors quite often have to deal with allergic reactions of various types. The Russian Ministry of Health has developed and approved several documents that set out the standard for emergency care for anaphylactic shock, where the algorithm of actions is fully described and the composition of the package is approved. The latter must be present in the procedural, dental and some other rooms of the medical institution. Updating and replenishing it is carried out as necessary. The first-aid kit includes medicines:

• "Epinephrine" 0.1% - the drug is administered intramuscularly, exerting a quick effect on the heart and blood vessels, or used to chise the place where the allergic substance has penetrated;
• "Aminophylline" 2.4% - relieves bronchospasm, improves blood circulation of small vessels;
• "Prednisolone" 3% - anti-shock effect;
• "Diphenhydramine" 1% - antihistamine activity, has a sedative effect, blocks the production of histamine;
• "Chloropyramine" or "Clemastine" - an anti-allergic agent;
• "Sodium chloride" - administered intravenously, helps relieve intoxication and restore water-salt balance. And also it is used for diluting medicines and subsequent administration with a dropper;
• ethyl alcohol or alcohol wipes.

In addition to the above medicines, to provide assistance with anaphylactic shock in the laying of emergency care, there must be detailed instructions and medical products:

• syringes of different volumes;
• harness;
• cotton wool;
• gauze or bandage;
• adhesive plaster;
• solution infusion system;
• catheter for veins;
• sterile gloves.

Anaphylactic shock in children

As a result of the ingestion of an allergen, for example, an insect bite, a drug, food, an immediate reaction of the body is observed, as a result of which the central nervous system, respiratory organs and the circulatory system are affected. There are two types of the course of this pathology associated with respiratory and vascular insufficiency. The clinical manifestations in the first case are as follows:

• tingling pain in the heart;
• weakness that appeared suddenly;
• feeling of lack of air;
• chest compression
• cough;
• an attack of fear, panic.

In the second case, the signs are manifested by a sudden worsening of the condition, which is accompanied by general weakness, tinnitus, pallor of the skin, a sharp decrease in pressure, a threadlike pulse, a weak heartbeat, convulsions. Loss of consciousness is possible with untimely help. In the case of joining to anaphylactic shock of heart failure, an adverse outcome is possible.

Forms of anaphylaxis in children

Depending on the lesion of a particular organ or system, the following symptoms of anaphylactic shock are distinguished. Emergency care and drugs used to provide it will depend on the form of anaphylaxis:

1. Asphyxial. Symptoms appear suddenly and progress rapidly. Clinic: swelling of the tongue, lips, areas near the eyes, choking, decreased pressure to critical values, whistling while breathing, dry cough.
2. Hemodynamic. There is a violation of the heart rhythm, a slight decrease in blood pressure, severity and pain in the sternum, a decrease in heart rate, pallor of the skin, lethargy, worsening of general well-being, and profuse sweating.
3. Cerebral In this case, there are epileptic seizures, convulsions, cyanosis of the dermis, lack of response to external stimuli, respiratory arrest and cardiac activity.
4. Abdominal. With this form of anaphylaxis, abdominal pain, vomiting, nausea, and possibly hemorrhage inside the abdominal cavity are noted.
5. Typical. Rashes appear on various parts of the body, the skin becomes reddish, and the face swells.

In addition to the above symptoms, others may also arise, for example, fear, anxiety, involuntary urination or defecation. Knowing the forms of allergic reactions to provide emergency care for anaphylactic shock, it will not be difficult.

The mechanism of development of anaphylaxis: causes

The development of a pathological condition occurs in several stages. The primary ingestion of an allergen into a baby’s body is regarded by the immune system as a foreign body and immunoglobulins are produced to it, that is, special antibodies. She remembers them, as a result, the body's sensitivity to this allergic substance is formed. A secondary contact with him provokes an allergic reaction, as immune cells begin to synthesize histamines. They cause itching, swelling and other changes in the baby's body. In the case of their increased production, anaphylaxis occurs. The disease develops as a result of a repeated attack of an allergen, which include:

• Medicines Quite often, this reaction gives the body in response to the introduction of antibiotics and immunobiological preparations (serums, vaccines). However, other medications can provoke anaphylaxis.
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Assistance should be given immediately. If anaphylactic shock has occurred in children, the algorithm for emergency care is as follows:

1. Discontinue the administration of the drug that provoked this condition.
2. Put the baby on a hard and even surface, raise his lower limbs.
3. Cover with a warm blanket.
4. Body overlay warmers.
5. Turn your head to one side.
6. Carry out oxygen therapy to eliminate oxygen starvation of tissues.
7. Chop crosswise with a solution of Adrenaline diluted in Sodium Chloride, the injection site.
8. Apply a bandage or tourniquet above the area of ​​penetration of the allergic substance.
9. If the medicine that caused the allergy was injected into the eyes or nose, they are washed with water and a solution of Adrenaline and Hydrocortisone is instilled.
10. Simultaneously with the previous manipulations, the drug “Adrenaline” is administered into any part of the body at a rate as indicated in paragraph 7 every ten to fifteen minutes until the child's condition improves. With progressive deterioration, Norepinephrine dissolved in glucose is administered intravenously.
11. Hormonal drugs are administered intravenously: Hydrocortisone or Prednisolone. If necessary, the introduction is repeated no earlier than 60 minutes.
12. In case of obstructive syndrome with anaphylactic shock, emergency care consists in the jet injection of “Eufillin”, taking it per kilogram of the baby’s weight 3-4 mg.
13. Antihistamines are administered intramuscularly. Solution "Suprastin" or "Tavegil."
14. In heart failure, Korglikon dissolved in glucose is slowly injected intravenously.

Hospitalization is necessary in any circumstances, as a possible repetition of the shock state. In a hospital, all of the above manipulations continue. When breathing stops, connect to a ventilator.

Prevention of anaphylactic shock in a child

To prevent the occurrence of such a condition in the baby, parents are recommended:

• Learn to provide first aid emergency care for anaphylactic shock in children.
• Have access to the medicines that are required to provide it.
• Try to protect the child from insect bites, that is, do not give him fruit, sweets on the street and don’t wear very bright clothes.
• Exclude products that contribute to the development of allergic reactions.
• The room where the baby is regularly ventilated, remove objects collecting dust (soft toys, carpets, furniture covers and more), do wet cleaning daily.
• Take medication only as directed by a doctor, exclude self-medication.

Emergency care for anaphylaxis at the dentist's appointment

A doctor who performs dental procedures helps the patient by finding the initial signs of anaphylactic shock. Emergency care in dentistry is as follows:

• Urgent measures are taken to stop contact with an allergic substance: remove filling or other material from the tooth, rinse the oral cavity, and wash away the dental products from the teeth.
• If the patient's blood pressure drops sharply or he faints, then he is laid on his back and the lower jaw is pushed forward or his head is turned to one side. This is done to avoid asphyxiation with sunken tongue and vomit.
• Next, they begin the introduction of drugs to increase blood pressure, antiallergic, hormonal, bronchodilators, anticonvulsants and analgesics, depending on the condition of the patient and the severity of symptoms.

The patient’s life will depend on the timeliness of the actions of the medical worker and the quality of emergency care. Therefore, in each medical institution, the chief physician issues an order “Anaphylactic shock - emergency care”, which describes in detail the algorithm of actions and the composition of the first-aid kit, necessary for taking measures in the event of such a condition.