Magnesium for anaphylactic shock algorithm of actions. Anaphylactic shock: emergency care algorithm

Any type of anaphylaxis is considered severe. allergic reaction. Only emergency assistance in such a pathological condition will help save the life and fragile health of the injured patient. A condition such as anaphylactic shock is recognized as particularly dangerous to human life; emergency care here can save the situation. The pathological process develops quite rapidly - from a matter of seconds to 2 hours.

Properly provided first aid for anaphylactic shock prevent severe consequences for a patient who has suffered such a condition. From the official medical statistics It follows that 10% of all recorded cases end in the death of the patient. Young people are often most susceptible to this disease.

Often the cause of the development of this pathology is a genetic predisposition to its occurrence. Experts identify the following irritants that can cause anaphylaxis:

during an emergency blood transfusion;
at the next vaccination;
at the time of performing a skin test with the participation of provoking elements.

Immediate assistance

The tactical actions of a nurse in case of anaphylactic shock are as follows:

immediate provision of primary care;
rapid ventilation of the room, possible contacts with the irritant are excluded;
in some cases, to help the patient, you only need to stop further administration of the potent medication that provoked such an unexpected reaction;
at the site of a bite or injection;
the open wound undergoes detailed treatment.

Nurse procedure

To begin with, the patient with allergies is positioned, which involves placing him in vertical position. First aid for anaphylactic shock involves raising the patient's legs, turning the head to the side, and it is important to monitor the victim's breathing and the level of his pressure. Nursing process consists of forcibly giving an allergy sufferer Suprastin or another antihistamine medication to drink. After a competent specialist arrives at the scene of the incident, the process further provision resuscitation assistance is only theoretical. The nurse is obliged to explain to the specialist the symptoms of allergic shock that have arisen and to report the onset of a pathological reaction.

Actions of an experienced nurse for the speedy rehabilitation of the victim

Step-by-step algorithm for rendering emergency care for anaphylactic shock includes the following steps:

first you need to remove the provoking allergen from the body based on the routes of its penetration: it is necessary to pinpoint a direct bite or administer a strong injection with a specially prepared solution of injectable adrenaline, perform gastric lavage, cleanse the intestines with an enema if the aggressive irritant has entered the gastrointestinal tract;
in order to objectively assess important ABC indicators, a visual inspection must be performed;
accurately assess the current consciousness of the injured patient - state of excitability, complete loss of consciousness, periodic anxiety, lethargy;
produce thorough examination external skin for rash, its tone, the nature of the rash;
determine the type of shortness of breath;
count the number of completed breathing movements;
determine the type of pulsation;
if technically possible, produce an ECG.

All operational actions in case of anaphylactic shock of a qualified employee should be aimed at stabilization heart rate the affected allergy sufferer, as well as to return him to consciousness in a short time. In order for the allergy sufferer’s condition to return to normal, he is sent to a clinic, where experienced specialists will monitor all the patient’s vital signs until complete relief.

Similar pathological condition observed not only in adults, but also in children such unexpected reactions may occur when in contact with an aggressive stimulus. If a small child experiences anaphylactic shock, what should parents do? First you need to pay attention to the characteristic signs of allergic shock.

Main signs of anaphylaxis

After contact with an irritant, children may experience early symptoms of this pathology, namely:

sudden fever;
feeling of overwhelming fear;
unpleasant itching on the skin of the face.

As further symptoms indicating the development dangerous pathology, it is worth highlighting the following violations:

laryngeal stenosis of allergic origin;
severe bronchospasm;
severe cardiac arrhythmia;
dyspepsia syndrome;
visible angioedema.

Often the disease manifests itself in the form 2–3 characteristic symptoms, death can occur due to severe hemodynamic insufficiency or asphyxia.

Procedure for helping children

Emergency care for anaphylactic shock in children has many similarities with measures for rapid resuscitation in adults. First aid for anaphylactic shock for children with allergies includes the following comprehensive measures:

stop the prescribed medication immediately;
lay the child down, raising his legs with a pillow, provide the victim with maximum access to fresh air;
nurses are recommended to act in pairs;
at the immediate site of injection of the irritant, you need to make a cross-shaped puncture at 6 points around the injection mark;
nurses need to follow the dosage when urgently administering resuscitating drugs to children, for example, the dose of epinephrine for babies is no more than 1 ml;
call a resuscitation team;
after further stabilization important indicators When emergency care for anaphylactic shock in children is provided, the injured child is hospitalized on a special stretcher to the nearest intensive care unit, where specialists will closely monitor changes in all important indicators of the child.

This is the basic algorithm of action for anaphylactic shock in young children, the symptoms of which are similar to the pathology that occurs in adults. The Ministry of Health has developed a special protocol regulating the procedure for quickly providing qualified assistance in case of various forms allergic shock, following which specialists will be able to quickly resuscitate an allergic person. Qualified care for anaphylactic shock is aimed at stabilizing the patient’s important vital signs and bringing him to consciousness.

Treatment measures

To avoid a recurrence of an anaphylactic attack, the patient is hospitalized in a hospital for 7 days. Dosed administration of hormonal medications is recommended for allergy sufferers. Using droppers, the patient is given various effective drugs and a certain amount of liquid to quick recovery water-salt balance.

With this form of allergic reaction, the administration of drugs containing calcium, as well as medications of the phenothiazine class, is prohibited. Last group medications can have a severe impact on the child's psyche, leading to serious consequences for children who were forced to take these drugs. For a little patient anti-allergenic drugs are prescribed modern generation, which have a gentle effect on the growing organism. They have a long validity period, less set side effects, which is important in the treatment of such a serious pathology of an allergic nature.

Anaphylaxis has a detrimental effect on everything important processes life activity in children. This disease does not go away without a trace in children, leading to the following possible consequences:

dysfunction of the vestibular apparatus;
the appearance of dangerous jaundice;
inflammation of the heart muscle;
development of glomerulonephritis.

Further treatment of allergic shock in children is carried out with the aim of stopping characteristic features diseases in children, restoration of former performance.

TOod(ToOds)POMTOB- 10:

T78.0 Anaphylactic shock caused by an abnormal reaction to food

T85 Complications associated with other internal prosthetic devices,

implants and transplants

T63 Toxic effect caused by contact with poisonous animals

W57 Bite or sting by non-venomous insects and other non-venomous

arthropods

X23 Contact with hornets, wasps and bees

T78 Adverse effects not elsewhere classified ODAfoodleneithere: Anaphylactic shock (AS) - acutely developing, life-threatening pathological process caused by an allergic reaction immediate type when an allergen is introduced into the body, characterized by severe disturbances of blood circulation, respiration, and central activity nervous system.

TOlassAndfIRAqiI according to the clinical course of anaphylactic shock:

1. MolneitherenOWithnohTeheneithere- acute onset, with a rapid, progressive drop in blood pressure, loss of consciousness, and increasing respiratory failure. A distinctive feature of the lightning-fast course of shock is RehAndWithTenTnOWithTbToinTenWithAndVnOuchetcOTAndVOwOToovaTeRApiAnd and progressive development up to a deep coma. Death usually occurs in the first minutes or hours due to damage to vital organs.

2. RetsAnddAndViratYumoreeTewhatnAnde- typical occurrence of repeated state of shock several hours or days after clinical improvement occurs. Sometimes relapses of shock are much more severe than initial period, they are more resistant to therapy.

3. AboRTAndVnOeTewhatnAnde- asphyxial type of shock, in which patients clinical symptoms easy to stop, often does not require the use of any medicines.

FAToTORsriWithToA:

1. History of drug allergies.

2. Long-term use medicinal substances, especially repeated courses.

3. Use of depot drugs.

4. Polypharmacy.

5. High sensitizing activity of the drug.

6. Long-term professional contact with drugs.

7. Allergic diseases in the anamnesis.

8. The presence of dermatomycosis (athlete's foot), as a source of sensitization to

penicillin.

XARAToTernsWithAndmPTohmswOToA(TipihnOGO):

Change in skin color (skin hyperemia or pallor, cyanosis);

Various exanthemas;

Swelling of the eyelids, face, nasal mucosa;

Cold clammy sweat;

Sneezing, coughing, itching;

lacrimation;

Clonic convulsions of the limbs (sometimes convulsive seizures);

Motor restlessness;

"fear of death";

Involuntary release of urine, feces, gases.

EtcAndabouteToTAndVnohmTolinichesToohmaboutWithlunitsovanAndAndrevealingeTXia:

Frequent thread-like pulse (on peripheral vessels);

Tachycardia (less often bradycardia, arrhythmia);

Heart sounds are muffled;

Blood pressure decreases quickly (in severe cases, lower pressure is not determined). In relatively mild cases arterial pressure does not drop below critical level 90-80 mm Hg. Art. In the first minutes, sometimes blood pressure may rise slightly;

Breathing disorders (shortness of breath, difficulty wheezing with foam at the mouth);

The pupils are dilated and do not respond to light.

AlGORitm lecheneitherIAnAfAndlakyouCzechOGOwOka: NeOTloandnand IPomoschb:

1. Place the patient in the Trendelenburg position: with the leg end raised,

turn his head to the side, protrude the lower jaw to prevent tongue retraction, asphyxia and prevent aspiration of vomit. Provide fresh air or administer oxygen therapy.

2. NeaboutXOdAndmoetcecrATAndTbdalbnethweePOWithTatPleneithereallergenAVOrgAneitherzm:

a) when parenteral administration allergen:

Apply a tourniquet (if localization allows) proximal to the injection site

allergen for 30 minutes, without squeezing the arteries (every 10 minutes, loosen the tourniquet for 1-2 minutes);

Prick the injection site (sting) “crosswise” with a 0.18% solution

Adrenaline (epinephrine) 0.5 ml in 5.0 ml isotonic sodium chloride solution and apply ice to it (TeRApiIPeRingo naznAwhatneitherI!) .

b) when instilling an allergenic medication into the nasal passages and conjunctival

the bag must be rinsed with running water;

c) when orally allergen, rinse the patient’s stomach, if possible

his condition.

3. EtcOTAndinwOTonewmeROatITAndI:

a) immediately administer intramuscularly:

Adrenaline solution 0.3 - 0.5 ml (no more than 1.0 ml). Re-introduction

adrenaline is carried out at intervals of 5 - 20 minutes, controlling blood pressure;

Antihistamines: 1% solution of diphenhydramine (diphenhydramine) no more than 1.0 ml (etcunitsOTVRAschAeTdalbnethweeetcOgressirovaneithereetcOtsessA) . The use of pipolfen is contraindicated due to its pronounced hypotensive effect!

b) begin restoration of intravascular volume with intravenous

infusion therapy 0.9% sodium chloride solution with an injection volume of at least 1 liter. In the absence of hemodynamic stabilization in the first 10 minutes, depending on the severity of shock, a colloidal solution (pentastarch) of 1-4 ml/kg/min is reintroduced. The volume and speed of infusion therapy is determined by the value of blood pressure, central venous pressure and the patient’s condition.

4. EtcOTAndvoallergichesToand ITeRApiI:

Prednisolone 90-150 mg intravenous bolus.

5. WITHAndmPTohmTAndchesToand ITeRApiI:

a) with persisting arterial hypotension, after volume replenishment

circulating blood - vasopressor amines intravenous titrated administration until systolic blood pressure ≥ 90 mm Hg: dopamine intravenous drip at a rate of 4-10 mcg/kg/min, but not more than 15-20 mcg/kg/min (200 mg dopamine on

400 ml of 0.9% sodium chloride solution or 5% dextrose solution) - infusion is carried out with

speed 2-11 drops per minute;

b) with the development of bradycardia, a 0.1% solution of atropine 0.5 ml is administered subcutaneously;

if necessary, administer the same dose again after 5-10 minutes;

c) during manifestation bronchospastic syndrome intravenous is indicated jet injection 2.4% solution of aminophylline (aminophylline) 1.0 ml (not more than 10.0 ml) per 20 ml of isotonic sodium chloride solution; or inhalation administration of β2-adrenergic agonists - salbutamol 2.5 - 5.0 mg via nebulizer;

d) in case of development of cyanosis, dyspnea or dry wheezing during

Auscultation indicates oxygen therapy. In case of respiratory arrest, artificial ventilation of the lungs is indicated. For laryngeal edema - tracheostomy;

d) obligationsTelbnthPOWithTohnnthToOnTROlbbehindfatNKtsAndyamidsXAneitherIWithOWithTohnAndI eat everythingRdechnO- WithOWithatdAndWithTOuchWithAndWithTeWe (AndzmeRyayahAWithTOTatseRdechnsWithOcrAscheneitherthAndAD)!

POToazaneitherITouhToWithTRennOuchGOWithPAndTalAndbehindqiAnd: anaphylactic shock - absolute

indication for hospitalization of patients after stabilization of their condition in the department

resuscitation and intensive care.

Anaphylactic shock is a common emergency condition that can cause death in case of incorrect or untimely assistance. This condition is accompanied big amount negative symptoms, if they occur, it is recommended to immediately call an ambulance and provide first aid yourself before it arrives. There are measures to prevent anaphylactic shock that will help prevent the condition from recurring.

1 Anaphylactic shock

Anaphylactic shock is a generalized allergic reaction of an immediate type, which is accompanied by a decrease in blood pressure and impaired blood supply. internal organs. The term "anaphylaxis" translated from Greek means "defenselessness." This term was first introduced by scientists C. Richet and P. Portier.

This condition occurs in people of all ages, with equal prevalence in men and women. The incidence of anaphylactic shock ranges from 1.21 to 14.04% of the population. Fatal anaphylactic shock occurs in 1% of cases and causes the death of 500 to 1 thousand patients every year.

Algorithm of actions for the development of Quincke's edema

2 Etiology

Anaphylactic shock is often caused by drugs, insect bites, and foods. Rarely, it occurs when in contact with latex and when performing physical activity. In some cases, the cause of anaphylactic shock cannot be determined. Possible reasons The occurrence of this condition is indicated in the table:

Cause	Number of patients	%
Medicines	40	34
Insect bites	28	24
Products	22	18
10	8
Latex	9	8
SIT (specific immunotherapy)	1	1
Cause unknown	8	7
Total	118	100

Anaphylactic shock can be caused by any medicines. It is most often caused by antibiotics, anti-inflammatories, hormones, serums, vaccines and chemotherapy. Among food products, common causes are nuts, fish and dairy products, and eggs.

First aid algorithm for an attack of bronchial asthma

3 Types and clinical picture

There are several forms of anaphylactic shock: generalized, hemodynamic, asphyxial, abdominal and cerebral. They are different from each other clinical picture(symptoms). Has three degrees of severity:

light;
average;
heavy.

The most common is the generalized form of anaphylactic shock. The generalized form is sometimes called typical. This form has three stages of development: the period of precursors, the period of height and the period of recovery from shock.

The development of the precursor period occurs in the first 3-30 minutes after the action of the allergen. IN in rare cases this stage develops within two hours. The period of precursors is characterized by the appearance of anxiety, chills, asthenia and dizziness, tinnitus, decreased vision, numbness of the fingers, tongue, lips, pain in the lower back and abdomen. Patients often develop urticaria, itching of the skin, difficulty breathing and Quincke's edema. In some cases, patients may not have this period.

Loss of consciousness, low blood pressure, tachycardia, pale skin, shortness of breath, involuntary urination and defecation, a decrease in urine output characterize the height of the period. The duration of this period depends on the severity of the condition. The severity of anaphylactic shock is determined by several criteria, they are presented in the table:

It takes 3-4 weeks for patients to recover from shock. Patients have headache, weakness and memory loss. It is during this period that patients may develop a heart attack, disorders cerebral circulation, lesions of the central nervous system, Quincke's edema, urticaria and other pathologies.

The hemodynamic form is characterized by low blood pressure, pain in the heart and arrhythmia. With the asphyxial form, shortness of breath, pulmonary edema, hoarseness or laryngeal edema appear. The abdominal form is characterized by pain in the abdominal area and occurs with allergies after eating. Cerebral form manifests itself in the form of convulsions and stunned consciousness.

To provide assistance, it is necessary to correctly determine that the patient has this particular emergency condition. Anaphylactic shock is detected when several signs are present:

Symptoms of laryngospasm in children and emergency care

4 5 Providing assistance

First aid for anaphylactic shock consists of three stages. You must call immediately ambulance. Then you should ask the victim what caused the allergy. If the cause is wool, fluff or dust, then the patient must stop contacting the allergen. If the cause of the allergy is an insect bite or injection, it is recommended to lubricate the wound antiseptic or apply a tourniquet above the wound.

It is recommended to give the victim an antihistamine (anti-allergy) drug as quickly as possible or inject adrenaline intramuscularly. After performing these procedures, the patient should be placed on a horizontal surface. Your legs should be raised slightly higher than your head, and your head should be turned to the side.

Before the ambulance arrives, it is necessary to monitor the condition of the patient’s body. You need to take your pulse and monitor your breathing. After the ambulance team arrives, the medical personnel must be told when the allergic reaction began, how much time has passed, and what medications the patient was given.

Providing emergency first aid involves helping a nurse when this condition occurs. The nursing process is carried out in preparation for the patient's recovery from anaphylactic shock. There is a certain algorithm of actions and tactics for providing assistance:

1. stop administering the allergen drug;
2. call a doctor;
3. place the patient on a horizontal surface;
4. make sure it's passable respiratory tract;
5. apply cold to the injection site or a tourniquet;
6. provide access to fresh air;
7. calm the patient;
8. conduct nursing examinations: measure blood pressure, count pulse, heart rate and respiratory movements, measure body temperature;
9. prepare medications for further administration intravenously or intramuscularly: adrenaline, Prednisolone, antihistamines, Relanium, Berotec;
10. if tracheal intubation is necessary, prepare an airway and endotracheal tube;
11. Carry out prescriptions under the supervision of a doctor.

6 Prevention

Measures to prevent anaphylactic shock from drugs are divided into three groups: public, general medical and individual. Public measures characterized by improved technologies for the manufacture of medicines, the fight against pollution environment, sale of medicines in pharmacies according to doctors’ prescriptions, constant informing of the population about adverse allergic reactions to medicines. Individual prevention consists of taking a medical history and, in some cases, using skin tests and methods laboratory diagnostics. General medical measures are as follows:

1. justified prescription of drugs;
2. avoidance of simultaneous administration large quantity medicines;
3. diagnosis and treatment of fungal diseases;
4. indication of the patient’s drug intolerance in the chart or medical history;
5. use of disposable syringes and needles when performing manipulations;
6. monitoring patients for half an hour after the injection;
7. provision of treatment rooms with anti-shock kits.

To avoid recurrence of anaphylactic shock, preventive measures are needed. If you have a food allergy, you need to exclude the allergen from your diet and follow hypoallergenic diet and treat gastrointestinal pathologies. If you are hypersensitive to insect bites, it is recommended not to visit markets, not to walk barefoot on the grass, not to wear perfume (as they attract insects), not to take medications that contain propolis, and to have anti-shock kit in the first aid kit.

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Anaphylactic shock (AS) is a complex of dysfunctions of the body that occurs as a result of repeated exposure to an allergen and is manifested by a number of symptoms, among which the leading place is occupied by circulatory disorders.

Table of contents: Causes and development of anaphylactic shock Symptoms of anaphylactic shock Diagnosis of anaphylactic shock Algorithm of actions for anaphylactic shock

AS is a systemic allergic reaction. It occurs upon contact with an allergen that enters the body either through food, or through breathing, or through injection or insect stings.

AS never occurs upon first contact, since at this moment only sensitization of the body occurs - a kind of adjustment of the immune system to the corresponding substance.

The second hit of the allergen causes a powerful reaction of the immune system, during which the blood vessels, the liquid part of the blood penetrates the capillary wall into the tissue, mucus secretion increases, bronchospasm occurs, etc.

These disorders lead to a decrease in the volume of circulating blood, which entails a deterioration in the pumping function of the heart and a drop in blood pressure to extremely low levels.

The most common allergens in cases of anaphylactic shock are medications prescribed according to indications.

It is useless to accuse doctors of negligence in this case, since no one can foresee the presence of an allergy to a particular drug. There are a number of medications that are more likely to cause unwanted reactions, and before using them, doctors are required to conduct a test (for example, novocaine). But in the author’s practice there was a case of anaphylactic shock to suprastin - a drug used specifically for the treatment of allergies! And it is impossible to foresee such a phenomenon. That is why every health worker (and not only!) should be able to quickly recognize the signs of AS and have first aid skills.

The clinical picture of AS depends on the form in which it manifests itself. There are 5 types in total:

hemodynamic - acute onset with a critical drop in blood pressure and without signs of damage to other organs and systems;
asthmatic (asphyxial) - with powerful bronchospasm and rapidly increasing respiratory failure;
cerebral, occurring with severe damage to the structures of the brain and spinal cord;
abdominal, in which there are serious disorders of the abdominal organs;
They also distinguish a form that occurs with vivid symptoms of the skin and mucous membranes.

Features of symptoms depending on the degree of anaphylactic shock

Anaphylactic shock of the 1st degree is its most favorable form. Hemodynamics are slightly disturbed, blood pressure drops slightly.

Possible skin manifestations allergies - itching, rash, urticaria, as well as sore throat, cough, even angioedema. The patient is excited or, on the contrary, lethargic, sometimes there is a fear of death.

Shock of the second severity is characterized by a more serious decrease in hemodynamic parameters in the form of hypotension up to 90-60/40 mm Hg.

Loss of consciousness does not occur immediately or may not occur at all. Common symptoms of anaphylaxis are noted:

itching, rash;
rhinitis, conjunctivitis;
Quincke's edema;
changes in voice until it disappears;
cough, asthma attacks;
pain in the abdomen and heart area.

With grade 3 anaphylactic shock, the patient quickly loses consciousness. The pressure drops to 60-40 mm Hg. Common symptom - seizure due to severe damage to the central nervous system. Cold sticky sweat, bluish lips, and dilated pupils are noted. Cardiac activity is weakened, the pulse is irregular and weak. At this degree of shock, the patient's chances of survival are very low even with timely assistance.

In case of shock of the 4th degree, the phenomena of anaphylaxis increase at lightning speed, literally “on the needle.” Already at the moment of introduction of the allergen, blood pressure drops almost instantly to zero, the person loses consciousness, bronchospasm, pulmonary edema and acute respiratory failure increase. This form quickly leads to comatose state and death of the patient, despite intensive therapeutic measures.

The specificity of the disease is such that sometimes a specialist has practically no time to thoroughly clarify the circumstances, life history and past allergies. In many cases, the count is not even for minutes - for fractions of seconds.

That is why most often the doctor can only find out in a few words what happened, with the patient himself or those around him, and also evaluate objective data:

appearance of the patient;
hemodynamic parameters;
respiratory functions;

then promptly prescribe treatment.

Treatment and emergency care for anaphylactic shock

Shock is perhaps the only pathological condition where even a minute's delay in providing assistance can deprive the patient of any chance of recovery. Therefore, in any treatment room there is special styling, which contains all the drugs necessary to relieve shock.

First, you should completely stop the allergen from entering the body - stop administering the drug, prevent inhalation of pollen (just bring it into the room), remove the food to which the allergy began, remove the insect sting, etc.

In case of drug anaphylaxis or shock caused by an insect sting, the site of penetration of the allergen is injected with adrenaline and ice is applied. This allows you to reduce the rate of absorption of the harmful substance.

After this, the following is immediately administered intravenously:

adrenaline (stream or drip);
dopamine (drip);
infusion solutions to correct fluid deficiency;
glucocorticoid drugs;
calcium chloride;
antihistamines - clemastine, diphenhydramine, etc. (injected into the muscle).

Surgical treatment is used only in cases of laryngeal edema, when it is necessary to urgently open the airways. In this case, the doctor performs a cricoconicotomy or tracheotomy - an opening in the anterior wall of the larynx or trachea through which the patient can breathe.

The algorithm for parents’ actions during the development of anaphylactic shock in children is shown schematically below:

In some forms of anaphylactic shock, unfortunately, even immediate treatment health care may be ineffective. Alas, doctors are not omnipotent, but most often people still survive thanks to their efforts.

However, each repeated case of AS is more severe than the previous one, so people prone to anaphylaxis are advised to carry a first aid kit with everything they need to stop the attack. In this simple way you can greatly increase the chances of your own salvation.

Gennady Bozbey, medical columnist, emergency doctor

Anaphylactic shock is an acute allergic reaction that is life-threatening. About 10-20% of anaphylaxis cases are fatal. The condition develops with increased sensitivity (sensitization) of the body to the allergen.

The reaction to the allergen does not have an exact time of manifestation, most often within 5-30 minutes. In some cases painful symptoms appear 6-12 hours after the allergen hits the skin or mucous membranes.

The pathological condition can cause circulatory problems, muscle spasms, pressure drop, oxygen deficiency and loss of consciousness.

Emergency care for anaphylactic shock

First aid
When the first signs of anaphylactic shock appear, you should immediately call an ambulance. The patient is placed in a horizontal position.

There is no need to raise your head on the pillow, this can further impede the blood supply to the brain. It is recommended to remove dentures in advance. If possible, you need to measure your pulse, blood pressure and establish your breathing rate.

Before the arrival of specialists, it is necessary to take measures to eliminate the impact of the allergen, for example, ventilate the room, stop administering the drug (when the medication caused an acute reaction). It is possible to apply a tourniquet above the injection or bite site.

Urgent medical care
An acute allergic reaction requires immediate medical attention:

exclude patient contact with the allergen;
relax smooth muscles bodies;
restore breathing and blood circulation.

Emergency care for anaphylactic shock involves the gradual introduction of a number of drugs. The algorithm of actions for anaphylactic shock is:

Ensure airway patency;

Subcutaneous or intravenous administration adrenaline to eliminate acute respiratory failure, 1 ml of 0.1% solution of adrenaline hydrochloride is diluted to 10 ml with saline;

Inject the injection site or bite with a 0.1% solution of adrenaline, 0.3-0.5 ml;

Administration of glucocorticoids to relieve anaphylactic shock. Prednisolone in a dosage of 90-120 mg. or dexamethasone at a dosage of 12-16 mg;

Introduction antihistamines in order to lower blood pressure, relieve spasms from the bronchi and reduce the level of swelling of the lungs. First by injection, then in tablets (tavegil, suprastin, diphenhydramine).

In severe cases, patients may need artificial ventilation lungs and closed cardiac massage. When providing emergency care, doctors may resort to catheterization central vein, tracheostomy or injection of adrenaline into the heart.

Further treatment
After overcoming acute manifestations pathology, the doctor prescribes treatment in an intensive care unit or intensive care unit. If the pressure can be kept within normal limits, then the administration of adrenaline is suspended.

Hormones and histamine blockers eliminate the effects of allergies within 1-3 days. The patient undergoes desensitizing therapy for 2 weeks.

A typical sign of anaphylaxis is the occurrence acute reaction after repeated interaction with the irritating substance. This means that after the first contact with an allergen, anaphylactic shock in children and adults usually does not occur.

Anaphylactic shock develops due to the production of special substances that provoke inflammatory processes. The release of these elements leads to the release of basophils, histamine from the cells of the immune system.

Factors such as:

taking a number of medications ( penicillin antibiotics, antimicrobial agents, hormonal or painkillers);
use of anti-diphtheria, anti-tetanus serum;
excessive production of pancreatic hormones (insulin), parathyroid glands(parathyroid hormone);
contact with poison on the skin, saliva of animals, including insects and snakes;
vaccination (use of medicinal substances based on cells of the immune system and drugs to combat bacterial diseases of the nervous system, bronchial asthma and viral pathologies that are transmitted by airborne droplets);
eating certain foods or spices (legumes, fish, eggs, nuts, seafood or fruits);
undergoing radiography when iodine-containing contrast agents become dangerous;
erroneous use of blood substitutes, transfusion of inappropriate blood.

The reaction to an allergen usually occurs in 3 forms:

Classic anaphylactic shock. The condition entails a rapid onset of weakness and loss of consciousness. With this form of manifestation of shock, the patient does not have time to recognize the main signs of pathology due to rapid offensive disorders of consciousness;
Subacute variant of the course of shock. Usually occurs after taking medical supplies. The first manifestations can be noted 1-3 minutes after injection or 10-20 minutes after ingestion. There is dizziness, difficulty breathing and loss of consciousness;
Anaphylactoid reaction. Causes a rash, increased sweating, decreased blood pressure, pain syndrome and impaired consciousness 30-60 minutes after interaction with the allergen.

The onset of anaphylaxis can be accurately determined after a series of studies:

analysis of the life history (establishing a tendency to drug intolerance, food allergies in the patient, his parents and other relatives) and the patient’s complaints (checking symptoms);
medical examination;
blood test;
skin allergy testing;
ECG, blood pressure measurement.

To reduce the risk of an acute allergic reaction, you must adhere to the following rules:

exclude contact with irritants;
take medications according to the recommendations of the attending physician;
take a shower daily;
Carry out regular wet cleaning of the living space.

In order to increase the efficiency of emergency care and treatment of patients with anaphylactic shock, taking into account therapeutic and diagnostic modern technologies I affirm:

"Algorithm for providing emergency care for anaphylactic shock" (Appendix 1).

I order:

The chief physician - head of the Omsk health department A.E. Storozhenko, the chief physicians of regional treatment and preventive institutions, the chief physicians of the Central District Hospital should be provided with:
1. Certification medical workers for the provision of emergency care for anaphylactic shock annually and upon hiring (Appendix 1, p. 6).
2. Monthly monitoring of the full range of medications and equipment necessary for the diagnosis and treatment of anaphylactic shock in all medical and preventive departments (Appendix 1, pp. 4, 5).
3. Quarterly knowledge control medical personnel on providing emergency care for anaphylactic shock (Appendix 1, p. 6).
To the director regional center advanced training of healthcare workers Levakhin B.V.:
1. Include clinical and emergency care issues for anaphylactic shock in accordance with the approved algorithm in the program of all cycles of postgraduate training (Appendix 1).
Deputy head of GUZAO, chairman certification commission Lust S.V.:
1. Ask the rector of OGMA, Professor A.I. Novikov. include clinical issues, diagnosis, and treatment of anaphylactic shock, in accordance with the approved algorithm, into the program of all cycles of postgraduate training (Appendix 1).
2. To ask the Chairman of the State Commission for Licensing and Accreditation of Medical and Pharmaceutical Activities Kotenko S.V. when licensing health care facilities, be guided by the approved algorithm for the diagnosis and treatment of anaphylactic shock (Appendix 1).
3. Organize, together with the main specialists, the preparation and publication of “Algorithms for providing emergency care for life-threatening situations in therapeutic and surgical practice” for pediatricians, therapists, obstetricians-gynecologists, surgeons and doctors of other specialties. By 07/01/2001.
Control over the implementation of this Order is assigned to the deputy. Head of GUZO Oleinik E.N., Yunyaeva N.A.

Chief of the Main

management

V.A. Samoilov

APPENDIX TO THE ORDER OF GUZAO DATED NOVEMBER 23, 2000 N 291

ALGORITHM FOR PROVIDING EMERGENCY CARE IN ANAPHYLACTIC SHOCK

Section 1. ANAPHYLACTIC SHOCK

ANAPHYLACTIC SHOCK (AS) - life-threatening systemic reaction the body, caused by allergic (Ig E-mediated) reactions of the body in response to the administration of medicinal substances, food products, for insect, bee and snake bites. The method of penetration of the antigen into the body and its quantity do not affect the speed and severity of AS development.

In an anaphylactoid reaction, the stimulating factor, after entering the body, acts on non-immunological activating systems. It is clinically impossible to distinguish anaphylactic reactions from anaphylactoid reactions.

Prevention of AS

When prescribing any medication, check whether you have previously had allergic reactions to medications or food products. Pay attention to the heredity of allergies.
Assess the need to prescribe a particular drug (exclude polypharmacy).
If possible, administer medications slowly and in dilution.
If you are allergic to a specific drug, its use and the use of drugs from this group are strictly prohibited.
Availability in the room where injections are performed, necessary equipment and emergency medicines.
Knowledge of the clinic staff, tactics and algorithm for providing emergency care for AS.

Diagnostics of AS

Clinical symptoms of AS are characterized by a sudden deterioration in the child’s condition 1 to 30 minutes after exposure to the allergen.

Early clinical manifestations of AS are associated with damage to the skin, cardiovascular, respiratory and nervous systems and the gastrointestinal tract.

Skin symptoms: changes in skin color or cyanosis of the mucous membranes, acrocyanosis, possible coldness of the extremities, sudden sensation of heat and/or itching, possible appearance of urticaria, tissue swelling (Quincke's edema) of any localization.

Cardiovascular symptoms: fast, weak pulse and arrhythmias, pain in the heart area, lower blood pressure age norm up to the point of collapse. The norm for systolic blood pressure in children over 3 years of age: 90 + 2p (n is age in years).

Respiratory symptoms: chest tightness, hoarseness, wheezing and arrhythmic breathing, cough, shortness of breath.

Neurological symptoms: anxiety, a feeling of fear, quickly followed by depression of consciousness, up to its loss (coma), convulsions are possible.

Gastrointestinal symptoms: sharp pains in the stomach, nausea, vomiting.

Emergency care for AS is carried out at the site of shock, by persons nearby (preferably 2 - 3 people), without waiting for the development of an advanced or terminal stage of the disease, strictly in accordance with the algorithm below. The effectiveness of treatment measures depends on their rapid, comprehensive and simultaneous implementation.

Section 2. EMERGENCY CARE AT THE PREHOSPITAL STAGE(FAP, DISTRICT HOSPITAL)

Basic therapy

If possible, involve 1 - 3 people who have the skill of providing emergency care (medical worker, veterinarian, livestock specialist, teacher, even parents).
Call a more experienced honey through an intermediary. employee and inform the doctor of the central district hospital about the suspicion of an anaphylactic reaction (the telephone number of the doctor on duty at the central district hospital and the intensive care physician should be available).
Assess the patient's condition and complaints. Measure pulse, blood pressure (BP), temperature (put a thermometer). Assess the nature of shortness of breath and the prevalence of cyanosis. Conduct an examination of the skin and mucous membranes. If blood pressure decreases by 20% of the age norm, suspect the development of an anaphylactic reaction.
Apply ice to the injection or bite site.
When administering a drug that caused shock subcutaneously, prick the injection site crosswise with 0.3 - 0.5 ml of adrenaline solution (dilute 1 ml of 0.1% adrenaline solution in 3 - 5 ml of physiological solution).
Introduce a 0.1% solution of adrenaline 0.1 ml/year of life, but not more than 1 ml per 10 ml of physiological solution (iv, s/c, into the muscles of the floor of the mouth - under the tongue).
Replenishment of circulating blood volume (CBV) saline solution at a rate of 20 - 40 ml/kg per hour (if it is impossible to provide given speed through one vein, carry out infusions into 2 - 3 veins at the same time). If blood pressure rises, reduce the infusion rate by 2-3 times.
Glucocorticoids: prednisolone 5 - 10 mg/kg or hydrocortisone (solucortef) 10 - 15 mg/k or methylprednisolone (salt - medrol, prednol) 10 - 30 mg/kg. If necessary, repeat after 2 - 4 hours.
If hypotension persists reintroduction adrenaline in the same dose after 20 minutes up to 3 times an hour.

Secondary therapy

Hyposensitizing agents (diphenhydramine 1% solution 0.1 ml/kg, no more than 5 ml).
For bronchospasm, 1 - 2 doses of salbutamol (Beroteka) with an interval of 20 minutes, no more than 8 doses, or intravenous aminophylline 2.4% solution 1 ml/year of life, no more than 10 ml.
For convulsions, diazepam (or Seduxen, Relanium, Sibazon) 0.5% solution 0.05 - 0.1 ml/kg, no more than 2 ml, slowly intravenously under the control of blood pressure and pulse.
Constant monitoring of the vital functions of the body (blood pressure, pulse, breathing) at intervals of 5 - 10 minutes. Be ready to carry out cardiopulmonary resuscitation during the development of terminal conditions.
Emergency call of a resuscitator for yourself, transportation accompanied by a resuscitator with intensive care on the road and readiness to perform cardiopulmonary resuscitation. Contraindications for transportation:
- systolic blood pressure below 80 mm Hg. Art.
- convulsions
- uncontrolled respiratory failure
- terminal state

In the accompanying sheet, indicate: passport data, the cause of the anaphylactic reaction and the time of its occurrence, the assistance provided, indicating the time of drug administration and dose.

Section 3. EMERGENCY CARE AT THE HOSPITAL STAGE(CRH, CSTO AND OTHER healthcare facilities)

Basic therapy

It is carried out by the one who was first at the scene of the incident, as a rule, honey. sister.

Stop administering the drug that caused shock, if the needle is in the vein, do not remove it and administer therapy through this needle.
Note the time the allergen entered the body, the appearance of complaints and the first clinical manifestations allergic reaction.
If possible, involve 1-3 people from the surrounding medical personnel for assistance.
Through an intermediary, call the department doctor and resuscitator (there must be a telephone number for the intensive care unit).
Place the patient in horizontal position with a raised foot end. Cover warmly. Place your head to one side, push your jaw forward while your tongue retracts.
Assess the patient's condition and complaints. Measure pulse, blood pressure (BP), temperature (put a thermometer). Conduct an examination of the skin and mucous membranes. If systolic blood pressure decreases by 20% of the age norm, suspect the development of an anaphylactic reaction.
Provide fresh air or oxygen. If the breathing rhythm is disturbed or difficult, perform artificial ventilation (ALV).
Apply a tourniquet to the site above the drug injection, if possible.
Place ice on the injection site.
When introducing an allergic drug into the nose or eyes, rinse them with water and drip 1-2 drops of a 0.1% adrenaline solution.
When administering a drug that caused shock subcutaneously, prick the injection site crosswise with 0.3 - 0.5 ml of adrenaline solution (dilute 1 ml of 0.1% adrenaline solution in 10 ml of physiological solution).
Before the doctor arrives, prepare an intravenous infusion system with 400 ml of saline solution, a bottle of saline solution for diluting medications, 2 ml and 5 ml syringes 5 - 6 pieces, ampoules with adrenaline, glucocorticoids (prednisolone or hydrocortisone, solu-medrol, prednol), diphenhydramine .
At the doctor’s command, 0.1 ml of adrenaline is administered intravenously in a saline solution in a stream of 0.1% adrenaline per year of life, but not more than 1 ml (if it is impossible to administer intravenously, it is possible to inject into the muscles of the floor of the mouth - under the tongue or subcutaneously), if the hypotension - repeat h/w 20 min.
Replenishment of the bcc with physiological solution at a rate of 20 - 40 ml/kg per hour. (if it is impossible to provide this speed through one vein, infusion into 2 - 3 veins simultaneously). When blood pressure rises by 20% or pressure normalizes, the infusion rate is reduced. If arterial hypotension persists, continue infusion therapy at the same rate and evaluate the results every 5 to 10 minutes.
Glucocorticoids: prednisolone 5 - 10 mg/kg or hydrocortisone (solucortef) 10 - 15 mg/kg, methylprednisolone (solu-medrol, prednol) 10 - 30 mg/kg. If necessary, repeat after 2 - 4 hours.
Transportation to the intensive care unit accompanied by a resuscitator with constant infusion and monitoring of vital functions.

Secondary therapy

It is carried out, as a rule, in the intensive care unit (all medications are administered intravenously, if necessary, the central vein is catheterized).

Continued replenishment of blood volume. The speed depends on the degree of normalization of blood pressure.
Adrenaline is a constant infusion. The rate also depends on the degree of normalization of blood pressure: 0.005 - 0.05 mcg/kg/min. If, while titrating adrenaline, arterial hypotension or tachycardia persists, switch to titrating a solution of norepinephrine 0.05 mcg/kg/min. until the desired effect is achieved.
Diphenhydramine 1% solution 0.05 - 0.1 ml/kg, no more than 5 ml.
For bronchospasm, 1 - 2 doses of Berotek (salbutamol) with an interval of 15 - 20 minutes, but not more than 8 doses, or aminophylline 5 - 6 mg/kg single dose for 20 minutes, then titrate to 0.5 mg/kg/hour in saline.
For convulsions - diazepam 0.5% solution 0.05 - 0.1 ml/kg under the control of blood pressure and pulse.
In case of unstable hemodynamics and/or increasing respiratory failure, transfer the patient to PVL with a high peak inspiratory pressure (15 - 25 cm water column), PEEP - 5 cm water column, oxygen concentration 60 - 100%.
The administration of sedatives before intubation and during convulsions should be very careful, as they reduce blood pressure. Diazepam, fentanyl, calypsol are recommended.
Mandatory hospitalization in the intensive care unit even with effective primary therapy, because 12 - 24 hours after the first reaction, a delayed type reaction may be observed.
Report (for the Central District Hospital) to the RCC CSCH (tel.: 33-43-45, 33-45-47) or OKB (tel. 23-03-36, 24-10-71) and agree on treatment and management tactics.
Conduct an examination of the patient: complete blood count, ECG, chest X-ray, PAC, blood protein, potassium, sodium, calcium, glucose, urea, creatinine.
Control of vital functions (monitoring).
Monitoring of psychoneurological status.
Diuresis control.
After transfer to a specialized department, discharge from the hospital no earlier than 12 - 15 days after shock. Subsequently, follow-up with an allergist every month.

Section 4. LIST OF MEDICINES AND EQUIPMENT BTREATMENT ROOMS REQUIRED FOR TREATMENTANAPHYLACTIC SHOCK

Adrenaline solution 0.1% - 1 ml N 10 amp.
Saline solution (0.9% sodium solution chloride) bottles 400 ml N 5.
Glucocorticoids (prednisolone or hydrocortisone) in ampoules N 10.
Diphenhydramine 1% solution - 1 ml N 10 amp.
Eufillin 2.4% solution - 10 ml N 10 amp. or salbutamol for inhalation N 1.
Diazepam 0.5% solution 5 - 2 ml. - 2 - 3 amp.
Oxygen mask or S-shaped air duct for mechanical ventilation.
System for intravenous infusions.
Syringes 2 ml and 5 ml N 10.
Tourniquet.
Cotton wool, bandage.
Alcohol.
Ice container.

Section 5. ALGORITHM FOR EMERGENCY ACTIONS IN CASE OFANAPHYLACTIC SHOCK

Organizational events

Primary therapy

Secondary therapy

1. Stop administering the drug that caused shock, if the needle in the vein is not removed, connect a syringe with saline solution and administer therapy through this needle.

2. Notify the intensive care unit doctor (tel.__).

3. Place the patient in a horizontal position with the leg end raised. Cover warmly. Lay your head
to one side, push the jaw forward while the tongue retracts.

4. Measure pulse, blood pressure, place a thermometer.

5. Apply a tourniquet to the site above the drug injection, if possible.

6. Inspect the skin.

7. Provide fresh air or oxygen. In case of severe respiratory failure - mechanical ventilation.

8. Place ice on the injection site.

9. Prepare a system for intravenous infusions with 400 ml of physiological solution 2.5 and 10 ml syringes 5 - 6 pieces, ampoules with adrenaline, dimerol, prednisolone.

1. When administering a drug that caused shock subcutaneously, inject crosswise into the injection site with 0.3 - 0.5 ml of adrenaline solution in each injection (dilute 1 ml of 0.1% adrenaline solution in 10 ml of physiological solution).

2. When introducing an allergic drug into the nose or eyes, rinse them with water and drip 1 - 2 drops of 0.1% solution of adrenaline.

H. IV bolus 0.1% solution of adrenaline 0.1 ml/year of life, but not more than 1 ml. shaft 15 - 20 minutes.

4. Replenishment of the bcc with physiological solution at a rate of 20 - 40 ml/kg/hour

5. When blood pressure rises by 20% of the age norm or blood pressure normalizes, the infusion rate is reduced.

6. Prednisolone 5 - 10 mg/kg

1. Diphenhydramine 1% solution 0.1 ml/kg, no more than 5 ml.

2. Adrenaline continuous infusion at a rate of 0.005 - 0.05 ml/kg/min.

H. If arterial hypotension or tachycardia persists, norepinephrine solution 0.05 ml/kg/min until the desired effect is obtained.

4. For bronchospasm, 1 - 2 inhalations of Berotek (salbutamol) with an interval of 15 - 20 minutes. Eufillin 2.4% solution 1 ml/year of life - one-time in 20 minutes, then titrated to 0.5 mg/kg/hour.

Section 6. QUESTIONS FOR TESTING ON ANAPHYLACTIC SHOCK

For medical workers of all specialties upon hiring, and annually thereafter.

Definition of the concept. Krivtsova L.A. - Professor, Doctor of Medical Sciences - OGMA
Chernyshev A.K. - professor, doctor of medical sciences - OGMA
Dorofeeva L.K. - Associate Professor Ph.D. - OGMA
Ktenidi L.I. - chief freelance anesthesiologist-resuscitator, head. dept. OKB
Golavsky S.A. - chief freelance pediatric anesthesiologist-resuscitator of GUZAO, head. dept. OKB
Elgina L.P. - chief pediatrician of GUZAO - doctor of the highest qualification category
Gusarov A.I. - chief therapist of GUZAO, Ph.D.

IN modern medicine the concept of “shock” defines a set of reactions human body to the extremely strong influence of exogenous and endogenous origin. Anaphylactic shock (AS) is an immediate reaction to an allergen entering the body.

At the same time, the reaction with anaphylactic shock is the most severe allergic reaction with the most severe course. This condition is dangerous because even with average and mild degree Minutes count in severity, and without proper pre-medical and subsequent specialized medical care, anaphylactic shock can cause death.

Causes of anaphylactic shock

There is only one cause of anaphylactic shock – the entry of an allergen into the human body. Moreover, allergens that can provoke such a reaction are divided in medicine into four groups:

food products,
medicines,
plants.

Poisons

A few decades ago, it was believed that anaphylactic shock could occur exclusively from poisons entering the body, mainly from snake and insect bites. Most often, in addition to reptiles, such a development of the situation was observed with the bites of wasps and bees, often numerous. But since recently other causes of AFS have increasingly begun to be recorded, the percentage of development of such an allergic reaction from poisoning, in relation to total number anaphylactic shocks decreased sharply. This does not mean that people have become less likely to be bitten by hymenoptera and snakes - in absolute terms, the number of such cases remains at the same level.

Food products

The number of recorded APS resulting from contact or consumption of food products has increased significantly in recent years. This is explained by the growing volume of use of various fertilizers and products to improve the quality of products. Moreover, allergies with the subsequent development of anaphylactic shock can be caused by quite harmless, at first glance, things: wheat, milk, eggs, nuts. But in most cases, a severe allergic reaction is caused by nutritional supplements, flavor enhancers and dyes. So for your own safety, when choosing food products, you should give preference to natural names.
As in the case of poisons, acute allergies with the subsequent development of anaphylactic shock can develop even after the first contact with the allergen, which is a sufficient incentive to be careful about new elements of your own diet.

Medicines

Development of AFS in last years are increasingly being recorded when using medications, often very harmless at first glance. In medicine, a fairly extensive database has been collected, according to which an acute allergic reaction can be caused by drugs of the penicillin group, immune serums, and blood substitutes. What this is connected with remains a mystery, since the same penicillin has been known in medicine for a very long time.

To minimize the risk of developing anaphylactic shock caused by medications, it is especially important to strictly adhere to all doctor’s instructions and conduct skin testing of prescribed medications.

Plants

Allergens entering the body plant origin Quite often it causes simple allergies. Many have experienced all the “delights” of poplar fluff or the flowering of pungently smelling plants. Basically, serious complication an allergic reaction and the development of anaphylactic shock from plant allergens is a fairly rare phenomenon, but the presence of an allergy to plants is additional factor risk.

Anaphylactic shock: symptoms

The symptoms of APS develop over a certain period of time, which for convenience is divided into three periods:

period of harbingers,
peak period
period of recovery from shock.

Precursor period

During this period, a person first of all experiences a sharp reaction at the site of the allergen. It is expressed in the form of swelling, swelling and itching with external influence damaging substance, or in the form of severe pain, nausea, vomiting and difficulty breathing when the allergen enters the body. In addition, a precursor to the development of anaphylactic shock is sharp drop blood pressure level, a person’s feeling of discomfort and anxiety.

High period

During next period development of anaphylaxis, the patient’s blood pressure continues to fall, loss of consciousness is very likely, cyanosis of the limbs and lips, cold sweat, tachycardia and breathing noises appear. This is where qualified medical care plays a critical role in stopping further development AFS.

Period of recovery from anaphylactic shock

The final stage of anaphylaxis is the longest. It can last for several days. During this period, patients continue to feel general weakness, apathy, lack of appetite. At the same time, the symptoms of anaphylactic shock characteristic of the first two periods gradually begin to disappear. Consciousness comes to a person.

Classification of anaphylactic shock by severity

In addition, anaphylactic shock is divided into three types, depending on the severity of the course. Each of them is characterized by certain symptoms and the difficulty of relieving the shock reaction. For clarity, we present a description of the severity of anaphylaxis in the form of a table:

Form of AFS flow	Lightweight	Average	Heavy
Symptoms	Itching at the site of allergen damage, skin rash, burning sensation of the skin, possible Quincke's edema. At the same time, a person’s condition allows him to complain about symptoms, which makes it possible to provide timely assistance.	TO mild symptoms forms of suffocation, cold sweat, heart pain, dilated pupils are added. In some cases, the development of anaphylactic shock may be accompanied by nasal, gastrointestinal and uterine bleeding. Often a person experiences problems with speech and loses consciousness, which is why he cannot notify loved ones about his condition.	In severe form, anaphylactic shock develops very rapidly. Seconds count. Within a minute after being hit by an allergen, a person loses consciousness, blood pressure is practically undetectable, and the pulse is weakly palpable. Observed hard breath with a characteristic prolonged exhalation, convulsions, foam at the mouth, cyanosis of the entire skin. The immediate lack of emergency assistance leads to death.
Blood pressure level	90/60mmHg	60/40mmHg	Not determined.
Duration of the precursor period	Up to half an hour, which allows you to weigh the situation and provide the necessary assistance.	The period of precursors is rapid, lasting no more than five minutes.	Up to one minute.
Duration of unconsciousness	In most cases it is observed fainting with immediate awakening.	The victim remains unconscious for up to half an hour.	The patient immediately loses consciousness and does not come out of this state.
Difficulty in relieving AFS	With the proper level of emergency medical care, treatment of anaphylaxis is quick and effective without significant consequences.	Effective emergency care is key. At the same time, overcoming anaphylaxis is slow. After leaving the AFS, the patient needs medical supervision over a long period of time.	Even high-quality emergency care does not produce results in all cases. The fatality rate is extremely high.

Emergency care for anaphylactic shock: algorithm

The symptoms of anaphylactic shock are quite clear and knowing them, one can determine this diagnosis in the patient with a fairly high degree of confidence. The list of actions to take when detecting a victim with anaphylaxis is quite wide, but knowing it and accurately following the emergency care algorithm for anaphylactic shock, the chances of waiting for doctors and saving the victim’s life increase significantly.

First of all, in case of anaphylactic shock, you need to call an ambulance, indicating to the dispatcher the suspected diagnosis and recorded symptoms.
After this (ideally, one person calls an ambulance, and the second already provides first aid), the victim needs to be laid on a flat, hard surface, legs raised and head turned to the side. This will prevent you from choking on vomit. If a patient with APS is indoors, open the windows for active ventilation.

We check breathing and pulse. Breathing is determined by the movements of the chest. If it does not fixate, we bring a mirror to our mouth, which should fog up. If there is no breathing, you need to start doing mouth-to-mouth or mouth-to-nose artificial respiration using a damp piece of cloth. At the same time, we check for a pulse. It can best be felt on the wrist, sleepy and femoral artery. If there is no pulse, you need to start doing chest compressions.

In addition, along with resuscitation measures, it is necessary to stop, if possible, the effect of the allergen on the body: squeeze out the insect sting and apply a tourniquet above the bite site to prevent the spread of the allergen through the circulatory system. Ice should be applied to the site of the allergen lesion, if it is on the skin.
In most cases, such pre-medical therapy will make it possible to save time, which is extremely expensive during anaphylactic shock, and transfer the patient to the hands of a medical team.

First aid for anaphylactic shock

The first resuscitation action for AFS is the immediate administration of adrenaline, an antiallergic drug with immediate effect, into the body. To slow down the absorption of the allergen, it is used to inject the bite site (if the allergen is reptile or insect venom). At the same time, adrenaline is injected into the opposite limb. An effective method for severely difficult breathing is also the injection of adrenaline under the root of the tongue. However, all these injections must be carried out very slowly so as not to cause arrhythmia.

Laryngeal edema, which often accompanies anaphylactic shock, is overcome by the above-mentioned administration of adrenaline. But if the injection does not produce results and an increase in respiratory failure is observed, intubation, conicotomy or tracheostomy are performed - procedures to open the airways to ensure air access.

Further medical care for anaphylaxis involves a standard set of resuscitation actions: administration of glucocorticoids, therapy antihistamines, which do not lower blood pressure and do not cause an allergic reaction (suprastin and diphenhydramine), and inhalation with humidified oxygen.

In parallel with this, in conditions medical institution Diagnostics should be carried out aimed at identifying the allergen that caused APS. This includes a number of specific studies:

Patch test – skin patch testing;
blood test for immunoglobulin E, which is closely related to the mechanism of atopic allergic reactions;
skin and provocative tests.

Together with a consultation with an allergist, the results of these tests will allow you to determine the allergen with a high degree of accuracy and draw up the correct scheme for further restorative therapy.

Consequences of anaphylactic shock

Anaphylaxis, even after timely and quality treatment, quite often causes chronic disorders in the body, which make themselves felt to the person throughout long period time. In particular, the following consequences are most often recorded:

persistently low blood pressure;
chronic pain in the heart area that occurs due to prolonged ischemia;
chronic fatigue, lethargy and lethargy.

In addition, anaphylactic shock can cause further neuritis, myocarditis, diffuse lesions Central nervous system, as well as irregular pain in the joints, chest and abdomen, nausea and vomiting.
All these consequences are eliminated with the help of drug therapy, for which the doctor must be informed that you have suffered anaphylactic shock.

Prevention of anaphylactic shock

Prevention of anaphylaxis is a very broad issue and at the same time not fully studied. There is no specific list of actions that will eliminate the possibility of AFS. It is only possible to reduce the likelihood of anaphylaxis and be ready to provide qualified assistance to someone who has such an allergic reaction.

First of all, you need to remember that allergy sufferers are most susceptible to APS, regardless of what substance they are allergic to. It is this category of people who need to be especially careful, protecting themselves as much as possible from exposure to allergenic substances.

Also at risk for anaphylaxis are people who have or have had the following diseases:

asthma,
allergic rhinitis,
mastocytosis,
eczema.

They have a high likelihood of developing AFS due to contact with food and medical contrast agents, which are used for visual enhancement in radiological studies. At the same time, the likelihood of developing anaphylaxis from poisoning with poisons and medications in this group of people is at a normal level.

Secondly, you need to be as careful as possible when taking medications. It's about It’s not about questioning medical prescriptions, but about strictly following the prescribed treatment regimen and performing any injections only after performing skin tests. In addition, every doctor, when prescribing any medication, must remember about drugs that can cause cross-allergic reactions in order to eliminate the possibility of developing anaphylaxis for this reason.

On the part of medical personnel, the prevention of anaphylactic shock consists of knowledge of the principles of care for AFS and the availability in hospitals and medical centers anti-shock first aid kit with the necessary minimum of drugs for emergency treatment.

In your home medicine cabinet it is worth having adrenaline injectors - one-time injections of adrenaline, which are sold ready-to-use. Even one injection of the drug can play a key role in saving a person’s life in many situations, including anaphylactic shock. The practice of having adrenaline in home first aid kits is quite common in the West, but has not yet taken root here. Although in places where there are constant crowds of people: in schools, places of public events, anti-shock first aid kits will definitely not be superfluous.

Not only for anaphylaxis, but also in many other cases, it would be useful to have skills in resuscitation procedures: chest compressions and artificial respiration. Most of us studied these techniques at school or in universities, but due attention is not paid to this issue. At the same time, such knowledge difficult situations They will prevent you from panicking and, perhaps, save someone’s life.

The reaction to the allergen does not have an exact time of manifestation, most often within 5-30 minutes. In some cases, painful symptoms appear 6-12 hours after the allergen comes into contact with the skin or mucous membranes.

The pathological condition can cause circulatory problems, muscle spasms, drop in pressure, oxygen deficiency and loss of consciousness.

Emergency care for anaphylactic shock

First aid
When the first signs of anaphylactic shock appear, you should immediately call an ambulance. The patient is placed in a horizontal position.

Urgent medical care
An acute allergic reaction requires immediate medical attention:

exclude patient contact with the allergen;
relax the smooth muscles of the body;
restore breathing and blood circulation.

Emergency care for anaphylactic shock involves the gradual introduction of a number of drugs. The algorithm of actions for anaphylactic shock is:

Ensure airway patency;

Subcutaneous or intravenous administration of adrenaline to eliminate acute respiratory failure, 1 ml of 0.1% solution of adrenaline hydrochloride is diluted to 10 ml with saline;

Inject the injection site or bite with a 0.1% solution of adrenaline, 0.3-0.5 ml;

Administration of glucocorticoids to relieve anaphylactic shock. Prednisolone in a dosage of 90-120 mg. or dexamethasone at a dosage of 12-16 mg;

The introduction of antihistamines to lower blood pressure, relieve spasms from the bronchi and reduce the level of swelling of the lungs. First by injection, then in tablets (tavegil, suprastin, diphenhydramine).

In severe cases, patients may require artificial ventilation and closed cardiac massage. When providing emergency care, doctors may resort to central venous catheterization, tracheostomy, or injection of epinephrine into the heart.

Further treatment
After overcoming the acute manifestations of the pathology, the doctor prescribes treatment in an intensive care unit or intensive care unit. If the pressure can be kept within normal limits, then the administration of adrenaline is suspended.

Hormones and histamine blockers eliminate the effects of allergies within 1-3 days. The patient undergoes desensitizing therapy for 2 weeks.

Causes

A typical sign of anaphylaxis is the occurrence of an acute reaction after repeated exposure to an irritating substance. This means that after the first contact with an allergen, anaphylactic shock in children and adults usually does not occur.

Factors such as:

taking a number of medications (penicillin antibiotics, antimicrobial agents, hormonal or painkillers);
use of anti-diphtheria, anti-tetanus serum;
excessive production of pancreatic hormones (insulin), parathyroid glands (parathyroid hormone);
contact with poison on the skin, saliva of animals, including insects and snakes;
vaccination (the use of medicinal substances based on cells of the immune system and drugs to combat bacterial diseases of the nervous system, bronchial asthma and viral pathologies that are transmitted by airborne droplets);
eating certain foods or spices (legumes, fish, eggs, nuts, seafood or fruits);
undergoing radiography when iodine-containing contrast agents become dangerous;
erroneous use of blood substitutes, transfusion of inappropriate blood.

Symptoms of anaphylactic shock

itching on the skin and mucous membranes;
nasal discharge;
nausea, vomiting;
cyanosis and coldness of the skin;
dyspnea;
swelling of the larynx;
redness of the skin in the bite area, exposure to local medicine;
stomach ache;
decreased blood pressure;
anxiety;
disturbance of urination and defecation;
bronchospasm, difficult and hoarse breathing;
convulsions;
loss of consciousness.

The reaction to an allergen usually occurs in 3 forms:

Classic anaphylactic shock. The condition entails a rapid onset of weakness and loss of consciousness. With this form of manifestation of shock, the patient does not have time to recognize the main signs of pathology due to the rapid onset of a disorder of consciousness;
Subacute version of the course of shock. Usually occurs after taking medications. The first manifestations can be noted 1-3 minutes after injection or 10-20 minutes after ingestion. There is dizziness, difficulty breathing and loss of consciousness;
Anaphylactoid reaction. Causes a rash, increased sweating, decreased blood pressure, pain and impaired consciousness 30-60 minutes after interaction with the allergen.

Diagnosis of anaphylactic shock

The onset of anaphylaxis can be accurately determined after a series of studies:

analysis of the life history (establishing a tendency to drug intolerance, food allergies in the patient, his parents and other relatives) and the patient’s complaints (checking symptoms);
medical examination;
blood test;
skin allergy testing;
ECG, blood pressure measurement.

Video

Prevention of anaphylactic shock

To reduce the risk of an acute allergic reaction, you must adhere to the following rules:

exclude contact with irritants;
take medications according to the recommendations of the attending physician;
take a shower daily;
Carry out regular wet cleaning of the living space.