Anaphylactic shock: first aid, first aid kit and algorithm of actions

Anaphylaxis

17.02.2017 Before considering the algorithm for the action of providing medical emergency care for anaphylactic shock in adults and children, consider the term "anaphylaxis." Anaphylaxis is a pathological process that develops when an antigen( foreign protein) is introduced and manifests itself as a hypersensitivity to repeated contact with this allergen. This condition is a manifestation of the immediate hypersensitivity, in which the reaction between the antigen and antibodies occurs on the surface of the cells.

Reasons for

The most important condition for the onset of anaphylaxis: is the state of of the body's increased sensitivity( sensitization) to the reintroduction of an alien protein.

Etiology of the .In each living organism, when an alien protein( antigen) is introduced into it, antibodies are produced. They are strictly specific formations and act only against one antigen.

When a reaction occurs between the antigen and antibodies, a large amount of histamine and serotonin is released in the living body, this explains the active reaction that is taking place.

Anaphylactic shock reactions

Anaphylactic reactions of occur violently, involving the vascular apparatus and smooth muscle organs. They are divided into two types:

1. generalized ( anaphylactic shock);
2. localized ( edema, urticaria, bronchial asthma).

A special form is the so-called serum disease, gradually - at a time when the production of antibodies against the introduced antigen( from one to several days) begins - developing after a single injection of a large dose of foreign serum.

Anaphylactic shock

Reintroducing foreign protein into a sensitized organism can lead to a severe condition - anaphylactic shock.

Clinic

The clinical picture of anaphylactic shock varies from person to person and can vary widely. Anaphylactic shock can occur in mild form and manifest as a mild general symptoms( hives, bronchospasm, dyspnea).

Much more often the picture of shock looks more menacing and, if help is not rendered in time, can result in death of the patient.

In the first minutes of anaphylactic shock, blood pressure rises sharply, then starts to decrease and, eventually, drops to zero. Perhaps, severe itching with subsequent hives, swelling of the face and upper limbs. There are paroxysmal pains in the abdomen, nausea, vomiting, diarrhea. Consciousness of the patient is confused, there are convulsions, a sharp increase in body temperature, involuntary bowel movement and urination may occur.

In the absence of emergency care, death comes from suffocation and disruption of the heart.

The main symptoms of

Anaphylactic shock is characterized by the following main symptoms: soon after contact with the allergen( sometimes after a few seconds) the patient becomes restless, pale, complaining of a throbbing headache, dizziness, tinnitus. His body is covered with a cold sweat, he experiences the fear of death.

First emergency aid for anaphylactic shock

• Discontinue the administration of medications.
• Finish the injection site with adrenaline 0.15-0.75 ml 0.1% solution in 2-3 ml isotonic sodium chloride solution.
• Horizontal position, warmers to the feet, head to the side, push the lower jaw, lock the tongue, if possible, start feeding oxygen.
• Immediately enter :

1. Adrenaline 0.1% - 5 ml intravenously strontaneously;
2. Prednisolone 0.5-1 ml per 1 kg of weight, 40-60 ml hydrocortisone or 2.5 ml dexomethasone ( corticosteroids block the antigen-antibody reaction);
3. Cordiamine 2.5% - 2 ml;
4. Caffeine 10% - 2.0( injections of Adrenaline and Caffeine, repeat every 10 minutes until blood pressure increases);
5. with tachycardia 0,05% solution Strophantine or 0,06% solution Korglukona ;
6. antihistamines: Suprastin 2% - 20 ml, Dimedrol 1% - 5.0 ml, Pipolphen 2.5% - 2.0 ml. After 20 minutes, repeat the injection.

• For bronchospasm and ischemic pain - 2.4% - 10.0 ml of Euphyllinum with 10-20 ml of 40% glucose or intramuscularly 2.4% - 3 ml;
• with a significant decrease in blood pressure carefully, slowly - Mesaton 1% - 1.0 ml;
• for CCH phenomena and pulmonary edema - intramuscularly 0.5% - 0.5 ml of Strophantine with 10 ml of 40% glucose or with 10 ml of saline 2.4-10.0 ml, it is possible to inject lasix intravenously 1% -4,8 ampoules;
• with edema, when there is no cardiovascular failure, fast acting diuretics are used: 2% solution of Furasemide intravenously at 0,03-0,05 ml per 1 kg of weight;
• with convulsions and strong agitation: Droperidol 2% - 2.0 ml or Seduxen 0,5-3,5 ml;
• for respiratory failure - intravenously Lobelin 1% - 0.5-1 ml;
• when cardiac arrest is intracardiac injected Adrenaline 0.1% - 1.0 ml or calcium chloride 10% - 1.0 ml. Conduct an indoor massage of the heart and artificial respiration.

If the child is allergic to any substance that has been touched by inhalation, ingestion, touching, or penetration into the skin, it causes an unusual reaction. Children's allergies are usually harmless and tend to be limited to diathesis, but sometimes they can cause illness and even pose a threat to a child's life.

Anaphylactic shock in children

Anaphylactic shock in a child can develop with food intake, which is allergic to, when immunized, with an insect bite. This powerful allergic reaction to the foreign protein can develop within a few seconds and is a serious condition requiring urgent medical attention. If the first suspicious symptoms occur, stop taking the medication immediately and consult a doctor.

The main signs of a child

1. the child can be restless and frightened;
2. it becomes difficult for him to breathe, he starts to choke;
3. may appear pruritus, the skin becomes bright red;
4. the face of the child can become swollen( especially under the eyes), the skin can appear large red spots called "urticaria";
5. he may have a fit of sneezing;
6. the face of the child can become very pale or ashy-gray;
7. pulse in a child can become weak and frequent;
8. may be very thirsty;
9. the child may complain of dizziness, yawning and mouth-gasping;
10. skin can feel sticky and wet to the touch;
11. he can lose consciousness.

The first emergency aid for anaphylactic shock in children

1. should be taken to the hospital as soon as possible or called an ambulance;
2. need to reassure the child, say that a doctor is going to him, convince him to lie quietly;
3. if the child is difficult to breathe, seat him, give the influx of fresh air;
4. if unconscious, check the child's airways and check for breathing. If you stop breathing, immediately start resuscitation.

Recommendations

If your child does not breathe: breathe for him. Cover his mouth or nose and mouth with his mouth. Generate five separate breaths. Make sure that his chest with each breath is raised. It should be remembered that it is necessary to inhale the air to infants with less force.

If you do not find the pulse of the baby: massage your chest. Find the right place - for the thickness of one finger below the imaginary line connecting the nipples. Press down on the chest at a rate of one hundred clicks per minute.

1. In children older than one year: use only the soft part of the palm, keeping your arm straight. Press 15 times for every two breaths( your hand should be pressed 2.5-3 cm).
2. Infants: use two fingers and press five times for each breath( so that your fingers are squeezed into the child's body by about 2 cm).

If you did not call an ambulance, do it immediately.

Resuscitation measures continue until the "Ambulance" arrives.

First aid for patients with shock and other acute conditions

It should be noted that the first pre-medical care is a complex of urgent, simple actions and activities that need to be carried out at the scene. This assistance can be provided both by strangers and by the injured( self-help).

Often the first first aid helps save a patient's life. This especially applies to situations where one needs to act immediately( bleeding, drowning, suffocation, poisoning with carbon monoxide, etc.).

First aid includes three groups of activities.

1. The first group of includes immediate termination of external damaging factors( electric current, water, fire, chemicals).
2. The second group of is first aid.
3. The third group of - seeking help in the nearest medical institution.

To provide self-help and mutual assistance, it is not necessary to have a first aid kit or any medications, most importantly - be able to to provide this assistance. It is necessary to use improvised means and to know, what to do in each case. This is taught and television, and newspapers, and good books. Therefore, if you have the opportunity to learn something useful, learn - it will never be superfluous. See also additional materials on the first emergency aid for shock.

Treatment of bronchial asthma in children must necessarily be comprehensive. The first thing that the attending physician should achieve is the restoration of bronchial patency.

Algorithm for the provision of emergency care for anaphylactic shock

Eliseev OM(compiler).A guide to emergency and emergency care.- SPb.: Izd. Leyla LLP, 1996

Anaphylactic shock develops more often:

1. in response to parenteral administration of medications such as penicillin, sulfonamides, serums, vaccines, protein preparations, radiopaque substances and the like;
2. for conducting provocative samples with pollen and less often food allergens;
3. may cause anaphylactic shock when bitten by insects.

Symptoms of shock anaphylaxis

The clinical picture of anaphylactic shock develops rapidly. Development time of : a few seconds or minutes after contact with the allergen:

1. depression,
2. drop in blood pressure,
3. appear seizures,
4. involuntary urination.

The fulminant course of anaphylactic shock ends in a fatal outcome. In most patients, the disease begins with a feeling of heat, skin flushing, fear of death, arousal or, conversely, depression, headache, chest pain, suffocation. Sometimes there is an edema of the larynx according to the type of edema of Quincke with stridorous respiration, itching, urticaria, rhinorrhea, dry coughing. Arterial blood pressure drops sharply, the pulse becomes threadlike, maybe a hemorrhagic syndrome with petechial rashes is expressed. Death can come from acute respiratory failure due to bronchospasm and pulmonary edema, acute cardiovascular failure with the development of hypovolemia or cerebral edema.

Algorithm of first aid and first steps of the nurse!

1) discontinuation of the administration of drugs or other allergens, the application of the harness proximal to the site of administration of the allergen;

2) assistance should be provided on site: for this purpose, the patient must be laid and the tongue fixed to prevent asphyxiation;

3) inject 0.5 ml of a 0.1% solution of adrenaline subcutaneously at the site of injection of the allergen( or at the site of the bite) and intravenously drip 1 ml of a 0.1% solution of epinephrine. If the blood pressure remains low, after 10-15 minutes, the injection of the adrenaline solution should be repeated;

4) corticosteroids are of great importance for the removal of patients from anaphylactic shock. Prednisolone should be administered in a vein at a dose of 75-150 mg or more; dexamethasone - 4-20 mg; hydrocortisone - 150-300 mg;if it is impossible to administer corticosteroids into the vein, they can be administered intramuscularly;

5) administer antihistamines: pipolfen - 2-4 ml of 2.5% solution subcutaneously, suprastin - 2-4 ml of 2% solution or dimedrol - 5 ml of 1% solution;

6) with asphyxiation and choking enter 10-20 ml of a 2.4% solution of euphyllin intravenously, alupent - 1-2 ml of 0,05% solution, andazrin - 2 ml of 0.5% solution subcutaneously;

7) if corriglikon appears, 1 ml of 0.06 solution in isotonic solution of sodium chloride , lasix ( furosemide) 40-60 mg intravenously strontaneously rapidly in isotonic solution of sodium chloride ;

8) if an allergic reaction has developed to the introduction of penicillin , inject 1000000 ED penicillinase into 2 ml isotonic solution of sodium chloride ;

9) administration of sodium bicarbonate - 200 ml of 4% solution and anti-shock liquids.

If necessary, carry out resuscitation measures, including closed heart massage, artificial respiration, intubation of the bronchi. With edema of the larynx - tracheostomy.

After excretion of the patient from anaphylactic shock should continue the introduction of desensitizing drugs, corticosteroids.desintoxication, dehydration agents for 7-10 days.

Algorithm and standard of emergency care for anaphylactic shock with a description in stages

An ordinary person, without medical education and without the availability of special medicines, will not be able to provide assistance in full. This is due to the fact that emergency care requires a clear algorithm of action and a clear sequence of the introduction of certain medications. This complete algorithm of actions can be performed only by a resuscitator or an ambulance team.

First-aid first aid,

First aid, which can be performed by a person without appropriate training, should begin with a doctor's call to provide qualified assistance.

Anaphylactic shock should also be followed by an ordinary set of first aid measures that will be aimed at checking airway patency and ensuring fresh air intake A( airway) and B( Breathing).You can, for example, lay a man on his side, turn his head to the side, remove dentures to avoid vomiting and tongue. In case of seizures, you need to hold your head and prevent trauma to the tongue. The remaining stages( C - Circulation and bleeding, D - Disability, E - Expose / environment) without medical education are difficult to conduct.

Algorithm of medical care

The algorithm of actions implies not only a certain set of medicines, but their strict sequence. In any critical condition, arbitrary, untimely or incorrect administration of medications can worsen a person's condition. First of all, medicines should be used, which will restore the vital functions of the body, such as breathing, blood pressure and heartbeat.

With anaphylactic shock, the introduction of drugs intravenously, then intramuscularly and only then orally. Intravenous administration of drugs allows for a quick result.

Introduction of epinephrine

Emergency care should begin with an intramuscular injection of an adrenaline solution. It should be remembered that it is advisable to introduce small amounts of adrenaline for faster effect in different parts of the body. It is this drug that has a powerful vasoconstrictor effect, its injection prevents further deterioration of cardiac and respiratory activity. After the adrenaline is administered, blood pressure is normalized, breathing and pulse are improved.

An additional stimulating effect can be achieved by administering a solution of caffeine or cordiamine.

Introduction of euphyllin

To restore airway patency and eliminate spasm, a solution of euphyllin is used. This drug is quickly eliminated spasm of smooth muscles of the bronchial tree. When the patency of the airways is restored, a person feels some improvement.

Introduction of steroid hormones

In the case of anaphylactic shock, the necessary component is the introduction of steroid hormones( prednisolone, dexamethasone).These drugs reduce the swelling of the tissues, the amount of pulmonary secretion, as well as the manifestations of oxygen deficiency of the tissues of the whole organism. In addition, steroid hormones have a pronounced ability to inhibit immune reactions, including allergic ones. To strengthen the antiallergic effect itself, antihistamine solutions( tavegil, suprastin, tavegil) are administered.

Elimination of the allergen

The next necessary stage of emergency care after the normalization of pressure and respiration is the elimination of the action of the allergen. In the case of anaphylactic shock, it can be a food product, an inhaled aerosol of a substance, an insect bite or the administration of a drug. To stop the further development of anaphylactic shock, it is necessary to extract the insect's sting from the skin, wash the stomach if an allergen has got together with the food product, use an oxygen mask if the situation is provoked by an aerosol.

Assistance in the hospital

It should be understood that after the first urgent measures for anaphylactic shock, assistance does not end. For further treatment, it is required to hospitalize a person in the hospital to continue treatment.

In a hospital environment, treatment can be prescribed:

1. massive infusion therapy with crystalloid and colloidal solutions;
2. with drugs that stabilize cardiac and respiratory activity;
3. and also without fail - a course of tableted antiallergic drugs( fexofenadine, desloratadine).

Emergency care can only end when the respiratory and cardiac system is fully restored. The algorithm of further treatment provides in the future a thorough elucidation of the cause( specific allergen), which caused the development of an emergency situation, to prevent the re-development of anaphylactic shock.

First-aid kit for anaphylactic shock and new order

The first-aid kit for anaphylactic shock should be fully staffed in accordance with the new order of the Ministry of Health of the Russian Federation. The first-aid kit should always be freely available for possible use for the intended purpose.

Order No. 291 of 23.11.2000

Order No. 291 details all stages of medical care: from the pre-hospital stage to the stage of providing qualified medical care in a hospital. The algorithm for the diagnosis of anaphylactic shock and, more importantly, measures for its prevention are described in detail. Order No. 291 describes the step-by-step actions of a person, without special medical skills, in the process of rendering assistance at the pre-medical level.

In the anaphylactic state, not only the speed, but also the order of actions is important. This is why Order No. 291 clearly delineates the algorithm of the primary and secondary actions of the medical officer. The indicative composition of the first aid kit is also indicated, which should be available in all medical institutions.

Order No. 626 of 04.09.2006

Order No. 626 clearly regulates medical manipulations and the frequency of their use in anaphylactic shock. At the same time, Order No. 626 does not specify which points the doctor should perform, and which, for example, the paramedic. This can lead to inconsistent actions and complicate the provision of emergency care. The above information is a certain standard of action, created on the basis of foreign trends. The composition of the first aid kit under order No. 291 is very approximate and inaccurate.

Composition, kit and styling of the first aid kit for anaphylactic shock

In 2014, an attempt was made to improve, to a greater extent, the process of preparing for emergency measures in case of anaphylactic shock. The contents of the first-aid kit are detailed, indicating not only preparations , but also consumables. The presence of such components is envisaged:

1. epinephrine - for local chipping and intramuscular injection to provide an almost instantaneous vasoconstrictor effect;
2. glucocorticosteroids ( prednisolone) - to create a powerful systemic decongestant, antiallergic and immunosuppressive action;
3. antihistamines as a solution for intravenous administration( first generation, such as tavegil or suprastin) - for maximally rapid antiallergic effect;
4. second antihistamine preparation( dimedrol ) - to enhance the action of tavegil and suprastin, as well as for sedation( calming) of a person;
5. eufillin ( bronchodilator) - to eliminate spasm of bronchi;
6. consumables : syringes, the volume of which must correspond to the available solutions;cotton wool and gauze;ethanol;
7. venous ( more often cubital or subclavian) catheter - for permanent access to the vein;
8. physiological solution for the application of solutions at the stage of secondary care.
9. medicines.

The composition of the first aid kit 2014 does not provide for the presence( and subsequent use) of diazepam( an agent depressing the nervous system) and an oxygen mask. The new order does not regulate medicines for the stages of emergency care.

In case of anaphylactic shock, the above medicines should be used immediately. Therefore, in any office there should be a completed first-aid kit, then anaphylactic shock, suddenly arose in humans, will be successfully stopped.

Video

Emergency care for anaphylactic shock

Source

The recommendations in this article are based on official authoritative sources:

1. http: //otekam.net/vnezapnie/ aptechka-pri-anafilakticheskom-shoke-i-novyj-prikaz.html .
2. Related Videos.
3. Eliseev OM(compiler).A guide to emergency and emergency care.- SPb.: Izd."Leyla" LLP, 1996.
4. G.Nasgov. Official and traditional medicine. The most detailed encyclopedia.- Moscow: Izd-vo Eksmo, 2012.