Magnesium in anaphylactic shock algorithm of action. Anaphylactic shock: emergency care algorithm

Any anaphylaxis is considered a severe variety allergic reaction. Only emergency care 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 especially dangerous for human life, emergency care here can save the situation. The pathological process develops quite rapidly - from a few seconds to 2 hours.

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

Often the cause of the development of this pathology is a genetic tendency 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 anaphylactic shock are as follows:

immediate provision of primary care;
rapid ventilation of the room, possible contact with the irritant is excluded;
in some cases, to help the patient, it is only necessary to stop the further administration of a potent drug that provoked such an unexpected reaction;
at the site of the bite or injection;
the open wound is subjected to detailed treatment.

Nurse Procedure

To begin with, the affected allergic person is laid, which involves placing him in vertical position. First aid in case of anaphylactic shock involves raising the patient's legs, turning his head to the side, while it is important to monitor the victim's breathing, his pressure level. Nursing Process consists in forcibly giving an allergy sufferer Suprastin or another antihistamine drug to drink. After the arrival of a competent specialist at the scene, the process further provision resuscitation care is only theoretical. The sister is obliged to explain to the specialist the symptoms of allergic shock that have arisen, to report the onset of a pathological reaction.

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

Step by step rendering algorithm emergency care in anaphylactic shock includes sequential actions:

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

All operational actions in case of anaphylactic shock of a qualified employee should be aimed at stabilizing heart rate the affected allergic person, as well as the return of consciousness to him in a short time. In order for the allergic person to return to normal, he is sent to the 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 upon contact with an aggressive stimulus. If a small child has an anaphylactic shock, what should parents do? First you need to pay attention to the characteristic signs of allergic shock.

The main signs of anaphylaxis

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

unexpected 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:

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

Often the disease manifests itself in the form of 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 rapid resuscitation measures in adults. First aid for anaphylactic shock in allergic children includes the following complex measures:

immediately stop the flow of the prescribed medication;
lay the child down, raising his legs with a pillow, provide the victim with maximum access to fresh air;
nurses are encouraged to work in pairs;
at the immediate site of the injection of the irritant, a cruciform puncture should be made at 6 points around the injection mark;
nurses must comply with the dosage for the urgent introduction of resuscitating drugs to children, for example, the dose of epinephrine for babies is no more than 1 ml;
call a team of resuscitators;
after further stabilization important indicators When emergency care for anaphylactic shock in children is provided, the affected 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 that regulates the procedure for the rapid provision of qualified assistance in case of various forms allergic shock, following which specialists will be able to quickly resuscitate an allergic person. Qualified assistance for anaphylactic shock is aimed at stabilizing the patient's important vital signs, bringing to consciousness.

Medical measures

To avoid recurrence of an anaphylactic attack, the patient is hospitalized for 7 days. Allergics are recommended dosed administration of hormonal medications. With the help of droppers, the patient is given various effective drugs and a certain amount of liquid for quick recovery water-salt balance.

With this form of an allergic reaction, the administration of drugs containing calcium, as well as drugs 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. Little patient prescribed anti-allergic drugs modern generation which have a gentle effect on the growing organism. They have a long shelf life, a smaller 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 in children. This disease does not pass without a trace and in children, leads to the following probable 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 working capacity.

Toone(toaboutds)PaboutMToB- 10:

T78.0 Anaphylactic shock caused by a pathological reaction to food

T85 Complications associated with other internal prosthetic devices

implants and grafts

T63 Toxic effect due to contact with poisonous animals

W57 Biting or stinging by non-venomous insects and other non-poisonous

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, it is characterized by severe disorders of blood circulation, respiration, and the activity of the central nervous system.

TolassandfikaqiI according to the clinical course of anaphylactic shock:

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

2. RecanddandiniratYumoreeteChenande- characterized by the occurrence of repeated state of shock a few hours or days after the onset of clinical improvement. Sometimes relapses of shock are much more severe than initial period they are more resistant to therapy.

3. BUTboRtandinnabouteteChenande- asphyxic variant of shock, in which patients clinical symptoms easily stopped, often does not require the use of any medicines.

FatotaboutRsriWithtoa:

1. A history of drug allergy.

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

3. Use of depot drugs.

4. Polypharmacy.

5. High sensitizing activity of the drug.

6. Prolonged professional contact with drugs.

7. Allergic diseases in history.

8. The presence of ringworm (epidermophytosis), as a source of sensitization to

penicillin.

XaRatotepHsWithandmPtohmswabouttoa(tipihnaboutGabout):

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

Various exanthems;

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 excretion of urine, feces, gases.

EtcandabouteetotandinnohmtolinichestoohmaboutWithlunitsovanandandrevealingetXia:

Frequent thready pulse (on peripheral vessels);

Tachycardia (less often bradycardia, arrhythmia);

Heart sounds are muffled;

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

Respiratory failure (shortness of breath, wheezing breathing with foam from the mouth);

The pupils are dilated and do not react to light.

BUTlGaboutRitm leven moreneitherIanafandlaktiCzechaboutGaboutwaboutka: Heabouttloandnand IPomoschb:

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

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

2. HeaboutXaboutdandmoetcekratandtbdalbnethweePaboutWithtatPleneithereallergenainaboutrganeithergp:

a) at parenteral administration allergen:

Apply a tourniquet (if localization permits) proximal to the insertion site

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

Chop "crosswise" injection site (stinging) 0.18% solution

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

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

the bag must be rinsed with running water;

c) at oral intake allergen, wash the patient's stomach, if possible

his condition.

3. EtcabouttandinwabouttonewmeRaboutatItandI:

a) immediately enter intramuscularly:

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

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

Antihistamines: 1% dimedrol (diphenhydramine) solution, not more than 1.0 ml (etcunitsabouttinRaschaetdalbnethweeetcaboutgressirovaneithereetcaboutcessa) . The use of pipolfen is contraindicated due to its pronounced hypotensive effect!

b) restoration of intravascular volume to begin with intravenous

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

4. Etcabouttandvoallergichestoand IteRapiI:

Prednisolone 90-150 mg intravenous bolus.

5. FROMandmPtohmtandchestoand IteRapiI:

a) while maintaining arterial hypotension, after volume replenishment

circulating blood - vasopressor amines intravenous titrated administration to achieve 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 the

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 injected subcutaneously, with

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

c) when manifesting bronchospastic syndrome shown intravenous inkjet introduction 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-agonists - salbutamol 2.5 - 5.0 mg through a nebulizer;

d) in case of development of cyanosis, dyspnea or dry rales with

auscultation shows oxygen therapy. In case of respiratory arrest, artificial lung ventilation is indicated. With swelling of the larynx - tracheostomy;

e) obligationstelbnthPaboutWithtoyannthtoaboutntRaboutlbperfatnkcandyamidsXaneitherIWithaboutWithtoyanandeat thisRdechnabout- WithaboutWithatdandWithtohWithandWithtewe (andgpeRyahaWithtabouttatseRdechnsWithaboutkrascheneitherthandBUTD)!

PabouttoazaneitherItouhtoWithtRennohGaboutWithPandtalandperqiand: anaphylactic shock - absolute

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

resuscitation and intensive care.

Anaphylactic shock is a common medical emergency that can cause fatal outcome in case of incorrect or untimely assistance. This state is accompanied large quantity negative symptoms, in the event of which it is recommended to immediately call an ambulance team and independently provide first aid before it arrives. There are measures to prevent anaphylactic shock that will help to avoid the recurrence of this condition.

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" in Greek means "defencelessness". This term was first introduced by scientists C. Richet and P. Portier.

This condition occurs in people of all ages with the same prevalence in men and women. The frequency of anaphylactic shock ranges from 1.21 to 14.04% of the population. Lethal anaphylactic shock occurs in 1% of cases and is the cause of death from 500 to 1 thousand patients every year.

Algorithm of actions in the development of Quincke's edema

2 Etiology

Anaphylactic shock is often caused by drugs, insect bites, and food. 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 occurrence of this state are 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
Reason unknown	8	7
Total	118	100

Anaphylactic shock can be caused by any medicines. Most often, it is caused by antibiotics, anti-inflammatory drugs, hormones, serums, vaccines and chemotherapeutic agents. Of the foods, nuts, fish and dairy products, and eggs are common causes.

Algorithm for first aid for an attack of bronchial asthma

3 Types and clinical picture

There are several forms of anaphylactic shock: generalized, hemodynamic, asphyxic, abdominal and cerebral. They are different from each other clinical picture(symptoms). It has three levels of severity:

light;
average;
heavy.

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

The development of the period of precursors is carried out in the first 3-30 minutes after the action of the allergen. AT 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. Often, patients develop urticaria, itching of the skin, difficulty breathing and Quincke's edema. In some cases, this period in patients may be absent.

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

Recovery from shock continues in patients for 3-4 weeks. 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 a decrease in pressure, pain in the heart and arrhythmia. With asphyxia, shortness of breath, pulmonary edema, hoarseness of the voice or swelling of the larynx appear. The abdominal form is characterized by pain in the abdomen 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. Anaphylactic shock is detected when there are several signs:

Symptoms of laryngospasm in children and emergency care

4 5 Help

First aid for anaphylactic shock consists of three stages. Need to call immediately ambulance. Then you should find out from the victim what caused the allergy. If the cause is wool, fluff or dust, then you need to stop the patient's contact with the allergen. If the cause of the allergy is an insect bite or an 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 (antiallergic) drug as soon as possible or to inject adrenaline intramuscularly. After performing these procedures, the patient should be placed on a horizontal surface. The legs should be raised slightly above the head, and the head should be turned to the side.

Before the arrival of an ambulance, it is necessary to monitor the condition of the patient's body. You need to measure the pulse and monitor breathing. After the arrival of the ambulance, the medical staff should be told when the allergic reaction began, how much time has passed, what medications were given to the patient.

The provision of emergency first aid consists in the assistance of a nurse in the event of this condition. The nursing process is carried out in preparation for the patient's exit from the state of anaphylactic shock. There is a certain algorithm of actions and tactics of providing assistance:

1. stop the administration of the allergen drug;
2. call a doctor;
3. put the patient on a horizontal surface;
4. make sure the patency respiratory tract;
5. apply cold to the injection site or tourniquet;
6. provide access to fresh air;
7. calm the patient;
8. conduct a nursing examination: measure blood pressure, count the pulse, heart rate and respiratory movements, measure body temperature;
9. prepare drugs for further administration by intravenous or intramuscular route: adrenaline, Prednisolone, antihistamines, Relanium, Berotek;
10. if tracheal intubation is necessary, prepare an air duct and an endotracheal tube;
11. Under the supervision of a doctor, make appointments.

6 Prevention

Measures to prevent anaphylactic shock from drugs are divided into three groups: public, general medical and individual. public measures characterized by the improvement of drug manufacturing technologies, the fight against pollution environment, sale of medicines in pharmacies according to doctor's prescriptions, constant informing the population about adverse allergic reactions to medicines. Individual prevention consists in taking an anamnesis and, in some cases, using skin tests and methods laboratory diagnostics. General medical measures are as follows:

1. reasonable prescribing of drugs;
2. Prevention of simultaneous appointment a large number medicines;
3. diagnosis and treatment of fungal diseases;
4. an indication of the patient's intolerance to drugs in the card or in the medical history;
5. use of disposable syringes and needles when performing manipulations;
6. observation of patients for half an hour after injection;
7. Provision of treatment rooms with anti-shock kits.

In order to avoid the recurrence of anaphylactic shock, preventive measures are needed. With a food allergy, the allergen must be excluded from the diet, observe hypoallergenic diet and treat pathologies of the gastrointestinal tract. In case of increased sensitivity to insect bites, it is recommended not to go to markets, not to walk barefoot on the grass, not to use perfume (as they attract insects), not to take medicines that have propolis in their composition, and to have anti-shock kit in the pharmacy.

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Anaphylactic shock (AS) is a complex of body dysfunctions that occurs as a result of repeated exposure to an allergen and manifests itself in a number of symptoms, among which circulatory disorders occupy a leading place.

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 with food or with breathing, or with injections or stings by insects.

AS never occurs at the first contact, since at this moment only sensitization of the body occurs - a kind of tuning of the immune system to the appropriate 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 through the wall of the capillaries into the tissues, the secretion of mucus 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 ultra-low numbers.

The most common allergens in the case of anaphylactic shock are drugs prescribed in accordance with the 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 more often than others provoke adverse 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 remedy 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 master 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 no signs of damage to other organs and systems;
asthmatic (asphyxic) - with powerful bronchospasm and rapidly increasing respiratory failure;
cerebral, proceeding with severe damage to the structures of the brain and spinal cord;
abdominal, in which there are serious violations of the abdominal organs;
also allocate a form that proceeds with vivid symptoms from 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 is disturbed slightly, blood pressure falls slightly.

Possible skin manifestations allergies - itching, rash, urticaria, as well as sore throat, cough, up to Quincke's edema. The patient is agitated or, on the contrary, sluggish, sometimes there is a fear of death.

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

Loss of consciousness does not occur immediately or it may not happen at all. There are common phenomena of anaphylaxis:

itching, rash;
rhinitis, conjunctivitis;
angioedema;
voice changes up to its disappearance;
cough, asthma attacks;
pain in the abdomen and heart area.

With anaphylactic shock of the 3rd degree, the patient quickly loses consciousness. The pressure drops to 60-40 mm Hg. Frequent symptom - seizure due to severe CNS damage. Cold sticky sweat, cyanosis of the lips, dilated pupils are noted. Cardiac activity is weakened, the pulse is irregular, weak. With this degree of shock, the patient's chances of survival are very small, even with timely assistance.

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

The specificity of the disease is such that sometimes a specialist has practically no time for a detailed clarification of the circumstances, life history and allergies in the past. The score in many cases goes not even for minutes - for fractions of seconds.

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

the appearance of the patient;
hemodynamic parameters;
respiratory functions;

followed by prompt treatment.

Treatment and emergency care for anaphylactic shock

Shock is, perhaps, the only pathological condition where even a minute 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 for shock relief.

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

With drug anaphylaxis or shock caused by insect stings, the site of penetration of the allergen is chipped with adrenaline and ice is applied. This reduces the rate of absorption of the harmful substance.

After that, immediately enter intravenously:

adrenaline (stream or drip);
dopamine (drip);
infusion solutions to correct fluid deficiency;
glucocorticoid drugs;
calcium chloride;
antihistamines - clemastine, diphenhydramine, etc. (introduced 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 of actions of parents in the development of anaphylactic shock in children is schematically shown below:

In some forms of anaphylactic shock, unfortunately, even immediately 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 them, which will contain everything necessary to stop an attack. In this simple way, you can greatly increase the chances of your own salvation.

Gennady Bozbey, medical commentator, 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.

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

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

Emergency care for anaphylactic shock

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

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 the pulse, pressure and set the respiratory rate.

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

Urgent care
An acute allergic reaction requires immediate medical attention:

exclude patient contact with the allergen;
relax smooth muscle body;
restore breathing and circulation.

Emergency care for anaphylactic shock involves the phased 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 a 0.1% solution of adrenaline hydrochloride is diluted to 10 ml with saline;

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

The introduction of glucocorticoids for the relief of anaphylactic shock. Prednisolone at a dosage of 90-120 mg. or dexamethasone at a dosage of 12-16 mg .;

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

In severe cases, patients may need artificial ventilation lung and closed heart 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 the normal range, then the introduction of adrenaline is suspended.

Hormones and histamine blockers provide elimination of the consequences of allergies within 1-3 days. For 2 weeks, the patient is given desensitizing therapy.

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

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

The reaction to an allergen usually occurs in 3 forms:

Classic anaphylactic shock. The condition entails a rapid onset of weakness, 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 shock. Usually occurs after taking medical preparations. 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 rash, increased sweating, decreased blood pressure, pain syndrome and impaired consciousness 30-60 minutes after exposure to the allergen.

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

analysis of the anamnesis of life (determination of a tendency to drug intolerance, food allergies in a patient, his parents and other relatives) and patient 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:

avoid contact with irritants;
take medicines according to the recommendations of the attending physician;
take a shower daily;
carry out regular wet cleaning of the premises.

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

"Algorithm for the provision of emergency care for anaphylactic shock" (Appendix 1).

I order:

The chief doctor - the head of the health department of Omsk Storozhenko A.E., the chief doctors of regional medical institutions, the chief doctors of the Central District Hospital to ensure:
1. Attestation medical workers to provide emergency care for anaphylactic shock annually and when applying for a job (Appendix 1, p. 6).
2. Monthly control of the full set of medicines and equipment necessary for the diagnosis and treatment of anaphylactic shock in all medical and preventive units (Appendix 1, p. p. 4, 5).
3. Quarterly knowledge control medical personnel to provide emergency care for anaphylactic shock (Appendix 1, p. 6).
Director regional center advanced training of healthcare workers Levakhina B.V.:
1. Include clinical and emergency care issues in anaphylactic shock in accordance with the approved algorithm in the program of all postgraduate training cycles (Appendix 1).
Deputy head of GUZAO, chairman attestation commission Lust S.V.:
1. To ask the rector of the OGMA, Professor Novikov A.I. include the issues of the clinic, diagnosis, treatment of anaphylactic shock, in accordance with the approved algorithm, in the program of all postgraduate training cycles (Appendix 1).
2. To ask the chairman of the State Commission for Licensing and Accreditation of Medical and Pharmaceutical Activities Kotenko S.V. be guided by the approved algorithm for the diagnosis and treatment of anaphylactic shock when licensing medical facilities (Appendix 1).
3. Organize, together with the main specialists, the preparation and publication of "Algorithms for the provision of emergency care for life-threatening people in therapeutic, surgical practice" for pediatricians, general practitioners, obstetrician-gynecologists, surgeons and doctors of other specialties. By 07/01/2001.
To impose control over the execution of this Order on the deputy. Head of GUZO Oleinik E.N., Yunyaeva N.A.

Head of the Chief

management

V.A. Samoilov

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

ALGORITHM FOR PROVIDING EMERGENCY AID IN ANAPHILACTIC SHOCK

Section 1. ANAPHILACTIC SHOCK

ANAPHILACTIC SHOCK (ASH) - life threatening systemic reaction organism, caused by allergic (mediated by Ig E) reactions of the body in response to the introduction of drugs, food products, on stings of insects, bees and snakes. The method of penetration of the antigen into the body and its amount do not affect the rate and severity of AD development.

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

AS prevention

When prescribing any drug, clarify whether there have been previous allergic reactions to medicines, food products. Pay attention to heredity for allergies.
Assess the need to prescribe a particular drug (exclude polypharmacy).
If possible, administer drugs slowly and in dilution.
If you are allergic to a particular drug, its use and the use of drugs in this group are strictly prohibited.
Availability in the room where injections are carried out, necessary equipment and emergency medicines.
Knowledge of the clinic staff, tactics and algorithm of emergency care in AS.

Diagnosis of AS

The clinical symptomatology of AS is characterized by a sudden deterioration in the child's condition 1–30 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: discoloration of the skin or cyanosis of the mucous membranes, acrocyanosis, possible coldness of the extremities, a sudden sensation of feeling hot and / or itching, urticaria, tissue edema (Quincke's edema) of any localization may occur.

Cardiovascular symptoms: fast, weak pulse and arrhythmias, pain in the heart area, lowering blood pressure below age norm up to collapse. The norm of systolic blood pressure in children older than 3 years: 90 + 2n (n - age in years).

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

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

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

Emergency care for AS is carried out at the site of shock, by persons who are 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 therapeutic measures depends on their rapid, comprehensive and simultaneous implementation.

Section 2. EMERGENCY PRE-HOSPITAL CARE(FAP, REGIONAL HOSPITAL)

Basic therapy

If possible, involve 1-3 people who have the skill of providing emergency care for help (medical worker, veterinary worker, livestock specialist, teacher, up to parents).
Through an intermediary, call a more experienced honey. employee and inform the CRH doctor about the suspicion of an anaphylactic reaction (the phone number of the CRH doctor on duty and the intensive care doctor should be available).
Assess the patient's condition, complaints. Measure the pulse, blood pressure (BP), temperature (put a thermometer). Assess the nature of shortness of breath, the prevalence of cyanosis. Examine the skin and mucous membranes. With a decrease in blood pressure by 20% of the age norm - to suspect the development of an anaphylactic reaction.
Put cold on the injection or bite site.
With subcutaneous injection of the drug that caused shock, chop the injection site with a crosswise injection of 0.3-0.5 ml of adrenaline solution (1 ml of 0.1% adrenaline solution diluted in 3-5 ml of physiological saline).
Inject a 0.1% solution of adrenaline 0.1 ml / year of life, but not more than 1 ml per 10 ml of saline (in / vein, s / c, into the muscles of the bottom of the mouth - under the tongue).
Replenishment of the volume of circulating blood (VCC) saline at a rate of 20 - 40 ml / kg per hour (if it is impossible to provide given speed through one vein, infusion into 2-3 veins at the same time). When the blood pressure rises, reduce the infusion rate by 2-3 times.
Glucocorticoids: prednisolone 5 - 10 mg / kg or hydrocortisone (solucortef) 10 - 15 mg / c or methylprednisolone (salt - medrol, prednol) 10 - 30 mg / kg. If necessary, repeat after 2 - 4 hours.
With persistent hypotension reintroduction adrenaline at the same dose after 20 minutes up to 3 times per hour.

Secondary Therapy

Hyposensitizing agents (diphenhydramine 1% solution 0.1 ml / kg, not more than 5 ml).
With bronchospasm 1 - 2 doses of salbutamol (berotek) with an interval of 20 minutes, no more than 8 doses, or eufillin intravenously 2.4% solution of 1 ml / year of life, no more than 10 ml.
With convulsions in / venously slowly under the control of blood pressure and pulse diazepam (or seduxen, relanium, sibazon) 0.5% solution 0.05 - 0.1 ml / kg no more than 2 ml.
Constant monitoring of vital body functions (BP, pulse, respiration) with an interval of 5-10 minutes. Be ready to conduct cardiopulmonary resuscitation during the development of terminal states.
Emergency call of the resuscitator on oneself, transportation accompanied by the resuscitator with intensive care on the road and readiness for 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 administration of the drug and the dose.

Section 3. EMERGENCY CARE IN THE HOSPITAL STAGE(CRH, CSTO AND OTHER LPU)

Basic therapy

Performed by the one who was the first to be at the scene of what happened, as a rule, honey. sister.

Stop the administration of the drug that caused shock if the needle is in the vein, do not remove it and carry out therapy through this needle.
Note the time when the allergen enters the body, the appearance of complaints and the first clinical manifestations allergic reaction.
If possible, involve 1-3 people from the surrounding medical staff to help.
Through an intermediary, call the doctor of the department and the resuscitator (there must be a resuscitation phone).
Place the patient in horizontal position with raised toe. Cover warmly. Lay your head on one side, push the jaw forward with the retraction of the tongue.
Assess the patient's condition, complaints. Measure the pulse, blood pressure (BP), temperature (put a thermometer). Examine the skin and mucous membranes. With a decrease in systolic blood pressure by 20% of the age norm, suspect the development of an anaphylactic reaction.
Provide fresh air or oxygen. In case of violation of the rhythm of breathing or its difficulty, carry out artificial ventilation of the lungs (ALV).
Apply a tourniquet to the site above the injection, if possible.
Put ice on the injection site.
When introducing an allergic drug into the nose or eyes, rinse them with water and drip a 0.1% solution of adrenaline 1 - 2 drops.
For subcutaneous administration of the drug that caused shock, chop the injection site with a crosswise injection of 0.3-0.5 ml of adrenaline solution (1 ml of 0.1% adrenaline solution diluted in 10 ml of physiological saline).
Before the doctor arrives, prepare a system for intravenous infusions with 400 ml of saline, a bottle of saline for diluting drugs, 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, it is injected intravenously in a stream with a saline solution of 0.1% adrenaline 0.1 ml per year of life, but not more than 1 ml hypotension - repeat b/c 20 min.
Replenishment of BCC with saline at a rate of 20 - 40 ml / kg per hour. (if it is impossible to provide this speed through one vein, carry out infusions into 2-3 veins at the same time). With a rise in blood pressure by 20% or normalization of pressure, the infusion rate decreases. With persistent arterial hypotension, 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 drugs are administered intravenously, if necessary, the central vein is catheterized).

Continued replenishment of the BCC. 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 arterial hypotension or tachycardia persists against the background of epinephrine titration, they switch to titration of norepinephrine solution 0.05 μg / kg / min. until the desired effect is obtained.
Dimedrol 1% solution 0.05 - 0.1 ml / kg, not more than 5 ml.
With bronchospasm 1-2 doses of Berotek (Salbutamol) with an interval of 15-20 minutes, but not more than 8 doses, or eufillin 5-6 mg/kg single dose for 20 minutes, then titration with 0.5 mg/kg/h in saline.
With convulsions - diazepam 0.5% solution of 0.05 - 0.1 ml / kg under the control of blood pressure and pulse.
With unstable hemodynamics and / or an increase in respiratory failure, the patient is transferred to PVL with a high peak inspiratory pressure (15 - 25 cm of water column), PEEP - 5 cm of water column, and an oxygen concentration of 60 - 100%.
The introduction 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 basic therapy, because. 12 to 24 hours after the first reaction, a delayed-type reaction may be observed.
Notify (for the CRH) to the RCC ODKB (tel.: 33-43-45, 33-45-47) or OKB (tel. 23-03-36, 24-10-71) and agree on treatment and management tactics.
Examine the patient: complete blood count, ECG, lung radiography, PAC, blood protein, potassium, sodium, calcium, glucose, urea, creatinine.
Control of vital functions (monitoring).
Control of psychoneurological status.
diuresis control.
After transfer to the specialized department, discharge from the hospital no earlier than 12-15 days after the shock. In the future, the control of the allergist in a month.

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

Adrenaline solution 0.1% - 1 ml N 10 amp.
Saline solution (0.9% sodium solution chloride) bottles of 400 ml N 5.
Glucocorticoids (prednisolone or hydrocortisone) in N 10 ampoules.
Dimedrol 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 airway for ventilation.
System for intravenous infusions.
Syringes 2 ml and 5 ml N 10.
Harness.
Cotton wool, bandage.
Alcohol.
Vessel with ice.

Section 5. ALGORITHM OF URGENT MEASURES WHENANAPHILACTIC SHOCK

Organizational events

Primary Therapy

Secondary Therapy

1. Stop the administration of the drug that caused shock, if the needle in the vein is not removed, connect the syringe with saline and carry out therapy through this needle.

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

3. Lay the patient in a horizontal position with a raised foot end. Cover warmly. lay your head down
sideways, push the jaw forward with the retraction of the tongue.

4. Measure the pulse, blood pressure, put a thermometer.

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

6. Conduct an examination of the skin.

7. Provide fresh air or give oxygen. With severe respiratory failure - IVL.

8. Put ice on the injection site.

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

1. For subcutaneous administration of the drug that caused shock, chop the injection site with 0.3 - 0.5 ml of adrenaline solution in each prick (1 ml of 0.1% adrenaline solution diluted in 10 ml of physiological saline).

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

3. Intravenous 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 BCC with saline 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 decreases.

6. Prednisolone 5 - 10 mg/kg

1. Dimedrol 1% solution 0.1 ml/kg, not more than 5 ml.

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

3. With persistent arterial hypotension or tachycardia - norepinephrine solution 0.05 ml / kg / min until the desired effect is obtained.

4. With bronchospasm 1 - 2 inhalations of Berotek (salbutamol) with an interval of 15 - 20 minutes. Eufillin 2.4% solution 1 ml / year of life - single dose for 20 minutes, then titration 0.5 mg / kg / hour.

Section 6. ANAPHILACTIC SHOCK CREDIT QUESTIONS

For medical workers of all specialties upon employment, thereafter annually.

Definition of the concept. Krivtsova L.A. - professor, d.m.s. - OGMA
Chernyshev A.K. - professor, d.m.s. - OGMA
Dorofeeva L.K. - Assoc. PhD - OGMA
Ktenidi L.I. - chief freelance anesthesiologist-resuscitator, head. otd. OKB
Golavsky S.A. - chief freelance pediatric anesthesiologist-resuscitator GUZAO, head. otd. OKB
Elgina L.P. - chief pediatrician of GUZAO - doctor of the highest qualification category
Gusarov A.I. - chief therapist of GUZAO, Ph.D.

AT modern medicine the concept of "shock" defines a set of reactions human body on the superstrong influence of exogenous and endogenous origin. Anaphylactic shock (AFS) is an immediate type of reaction to an allergen entering the body.

At the same time, the reaction in anaphylactic shock is the most severe allergic reaction with the most severe course. This condition is dangerous in that even with an average and mild degree severity counts for minutes, and without proper pre-medical and subsequent specialized medical care, anaphylactic shock can be fatal.

Reasons for the development of anaphylactic shock

The cause of anaphylactic shock is one - the ingress of an allergen into the human body. At the same time, allergens that can provoke such a reaction are divided into four groups in medicine:

foodstuffs,
medicines,
plants.

Poisons

A few decades ago, it was believed that anaphylactic shock could occur solely from the ingestion of poisons, 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 AFSh have begun to be recorded more and more often, the percentage of development of such an allergic reaction from poisoning, in relation to total number anaphylactic shocks, dropped sharply. This does not mean at all that hymenoptera and snakes have begun to bite people less - in absolute terms, the number of such cases remains at the same level.

food products

The number of recorded AFS arising from contact or consumption of food products has increased significantly in recent years. This is explained by the growing 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 strong allergic reaction is caused by nutritional supplements, flavor enhancers and colorants. So for your own safety, in choosing food products, you should give preference to natural names.
As in the case of poisons, acute allergies with subsequent development of anaphylactic shock can develop even after the first contact with the allergen, which is sufficient incentive for a cautious attitude to new elements of one's own diet.

Medicines

Development of AFS in last years more and more often they are fixed when using medicines, and 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 sera, 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 provoked by medications, it is especially important to strictly adhere to all doctor's prescriptions and conduct skin testing of prescribed drugs.

Plants

Ingestion of allergens plant origin quite often becomes the cause of simple allergies. Many have experienced all the “charms” of poplar fluff or the flowering of pungent plants. Basically, serious complication an allergic reaction and the development of anaphylactic shock from plant allergens is a rather rare phenomenon, but the presence of an allergy to plants is additional factor risk.

Anaphylactic shock: symptoms

The symptomatology of AFSh develops over a certain period of time, which for convenience is divided into three periods:

period of harbingers
peak period,
recovery period from shock.

Period of harbingers

During this period, a person, first of all, has a sharp reaction at the site of the allergen lesion. It is expressed in the form of swelling, edema and itching with external influence damaging substance, or in the form of sharp pain, nausea, vomiting and shortness of breath when the allergen enters the body. In addition, a harbinger of the development of anaphylactic shock is sharp drop blood pressure levels, a feeling of discomfort and anxiety in a person.

peak period

During next period development of anaphylaxis, the patient's blood pressure continues to fall, loss of consciousness is very likely, cyanosis of the extremities and lips, cold sweat, tachycardia and breathing noises appear. It is here that qualified medical care plays a critical role, which will stop further development AFSh.

Recovery from anaphylactic shock

The final stage of anaphylaxis is the longest in time. It may continue for several days. Patients during this period 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 according to the severity of the course

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 stopping the shock reaction. For clarity, we present the characteristics of the severity of anaphylaxis in the form of a table:

AFS flow form	Light	Medium	heavy
Symptoms	Itching at the site of the allergen lesion, a rash on the skin, a burning sensation of the skin, Quincke's edema is possible. At the same time, the person’s condition allows him to complain about the symptoms, which makes it possible to provide timely assistance.	To mild symptoms forms are added suffocation, cold sweat, pain in the heart, dilated pupils. 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 his relatives 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 not determined, the pulse is weakly palpable. Observed hard breath with a characteristic elongated exhalation, convulsions, foam from the mouth, cyanosis of the entire skin. A momentary lack of emergency assistance leads to death.
Blood pressure level	90/60mmHg	60/40mmHg	Not defined.
The duration of the period of harbingers	Up to half an hour, which allows you to carefully assess the situation and provide the necessary assistance.	The period of precursors is swift, not exceeding five minutes in duration.	Up to one minute.
Duration of unconsciousness	In most cases, there is fainting with immediate awakening.	In an unconscious state, the victim is up to half an hour.	The patient instantly loses consciousness and does not get out of this state.
Difficulty in stopping AFS	With the proper level of emergency medical care, anaphylaxis is treated quickly and effectively without significant consequences.	Effective emergency care is key. At the same time, overcoming anaphylaxis is slow. After leaving AFS, the patient needs medical supervision over a long period.	Even high-quality emergency care does not give results in all cases. The death rate is extremely high.

Emergency care for anaphylactic shock: an algorithm

The symptoms of anaphylactic shock are quite clear and knowing them, it is possible to determine this diagnosis in a patient with a fairly high degree of certainty. The list of actions upon detection of a victim with anaphylaxis is quite wide, but knowing it and exactly following the algorithm of emergency care for anaphylactic shock, the chances of waiting for doctors and saving the life of the victim increase significantly.

First of all, in case of anaphylactic shock, you need to call an ambulance team, indicating to the dispatcher the alleged diagnosis and the symptoms recorded.
Following this (ideally, an ambulance is called by one person, and the second is already providing first aid), the victim must be laid on a flat hard surface, raise his legs and turn his head to the side. This will prevent choking with vomit. If the patient with AFS is indoors, open the windows for active ventilation.

Check breathing and pulse. Breathing is determined by the movements of the chest. If it is not fixed, we bring a mirror to our mouth, which should fog up. If breathing is not possible, begin mouth-to-mouth or mouth-to-nose artificial respiration using a damp piece of cloth. In parallel with this, we check the presence of a pulse. It is best felt on the wrist, carotid and femoral artery. In the absence of a pulse, you need to start doing an indirect heart massage.

In addition, along with resuscitation, it is necessary to stop, if possible, the effect of the allergen on the body: squeeze out the sting of the insect and apply a tourniquet above the bite site to prevent the allergen from spreading 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 in anaphylactic shock, and to transfer the patient to the hands of the medical team.

First aid for anaphylactic shock

The first resuscitation action in AFS is the immediate administration of adrenaline, an anti-allergic drug with immediate effect, into the body. To slow down the absorption of the allergen, they cut off the bite site (if the allergen is the poison of reptiles or insects). In parallel with this, adrenaline is injected into the opposite limb. An effective method for severely difficult breathing is also the introduction of adrenaline under the root of the tongue. Moreover, 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 aforementioned administration of adrenaline. But if the injection does not work and there is an increase in respiratory failure, intubation, conicotomy or tracheostomy is performed - procedures to open the airways to provide air access.

Further medical care for anaphylaxis involves a standard set of resuscitation actions: the introduction of glucocorticoids, therapy antihistamines that do not bring down blood pressure and do not cause an allergic reaction (suprastin and diphenhydramine), and inhalations with humidified oxygen.

At the same time, under the conditions medical institution diagnostics aimed at determining the allergen that caused AFS should be carried out. It includes a number of specific studies:

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

Together with the consultation of 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 rehabilitation therapy.

Consequences of anaphylactic shock

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

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

In addition, the transferred anaphylactic shock can cause further neuritis, myocarditis, diffuse lesions CNS, 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 made aware that you have suffered anaphylactic shock.

Prevention of anaphylactic shock

Prevention of anaphylaxis is a very broad and not fully understood issue. There is no specific list of actions that will exclude 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 experienced such an allergic reaction.

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

Also at risk of anaphylaxis include people who are ill or have had the following diseases:

asthma,
allergic rhinitis,
mastocytosis,
eczema.

They are highly likely to develop AFS due to contact with food and medical contrast agents, which are used for visual enhancement in radiological examinations. At the same time, the likelihood of developing anaphylaxis from poisoning with poisons and medicines 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 not about questioning medical prescriptions, but about strictly following the prescribed treatment regimen and making any injections only after skin tests. In addition, every doctor, when prescribing any medication, should be aware of drugs that can cause cross-allergic reactions in order to exclude the possibility of developing anaphylaxis for this reason.

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

In the home first-aid kit, it is worth having adrenaline injectors - disposable injections of adrenaline, which are sold already in a ready-to-use form. 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 first-aid kits is quite common in the West, but it has not yet taken root in our country. Although in places of constant congestion of people: in schools, places of mass 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 the skills of resuscitation procedures: chest compressions and artificial respiration. Most of us studied these techniques in school or in universities, but due attention is not paid to this issue. At the same time, such knowledge difficult situations prevent you from panicking and possibly save someone's life.

Reactions to an allergen do 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 disorders, muscle spasms, pressure drops, oxygen deficiency and loss of consciousness.

Emergency care for anaphylactic shock

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

Urgent 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 circulation.

Emergency care for anaphylactic shock involves the phased 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 a 0.1% solution of adrenaline hydrochloride is diluted to 10 ml with saline;

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

The introduction of glucocorticoids for the relief of anaphylactic shock. Prednisolone at a dosage of 90-120 mg. or dexamethasone at a dosage of 12-16 mg .;

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

In severe cases, patients may require mechanical ventilation and chest compressions. When providing emergency care, doctors may resort to central venous catheterization, tracheostomy, or the introduction of adrenaline 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 the normal range, then the introduction of adrenaline is suspended.

Hormones and histamine blockers provide elimination of the consequences of allergies within 1-3 days. For 2 weeks, the patient is given desensitizing therapy.

The reasons

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 the allergen, anaphylactic shock in children and adults usually does not manifest itself.

Factors such as:

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

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 a local drug;
stomach ache;
lowering blood pressure;
anxiety;
violation 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, 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 variant 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 pressure, pain syndrome and impaired consciousness 30-60 minutes after interaction with the allergen.

Diagnosis of anaphylactic shock

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

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

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Prevention of anaphylactic shock

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

avoid contact with irritants;
take medicines according to the recommendations of the attending physician;
take a shower daily;
carry out regular wet cleaning of the premises.