ANAPHYLAXIS SHOCK

ANAPHYLAXIS Bagian Anestesi FK UNISSULA SemarangDEFINITIONThe European Academy of Allergology and Clinical Immunology Nomenclature Committee:

ANAPHYLAXIS is a SEVERE, LIFE-THREATENING, GENERALISED or SYSTEMIC HYPERSENSITIVITY REACTION

RAPIDLY, LIFE-THREATENING AIRWAY AND/OR BREATHING AND/OR CIRCULATION PROBLEMS

Usually associated with skin and mucosal change

American Heart Association:

ANAPHYLAXIS is a SEVERE, SYSTEMIC ALLERGIC REACTION characterized by multisystem involvement, include skin, airway, vascular system & GI tract

The shorter the interval between exposure & reaction, the more likely the reaction is to be severe

PATOPHYSIOLOGYIg-E binds to theAntigen activatesreceptors mast cells & basophile histamine vasodilation, contraction of bronchialsmooth muscles >>, leakage of fluid from blood vessels >> and cause heart muscle depression

ETIOLOGYPharmacologic agentsAntibioticNSAIDContrast agents ivLatexStinging insect Hymenoptera Bees, hornetFoods Peanut Seafood

MORTALITYRisk factor ATOPIC, ASTHMA

Time course for fatal reaction:Food : 30-35 minInsect stings: 10-15 mini.v. drugs : 5 min

RECOGNITION

A-B-C-D-E APPROACHAIRWAY PROBLEMS airway swelling, hoarseness, stridorBREATHING PROBLEMS shortness of breath, wheeze, cyanosisCIRCULATION PROBLEMS signs of shocks cardiac arrestDISABILITY PROBLEMS anxious, confusion, agitation, loss of consciousnessEXPOSURE PROBLEMS urticaria, angioedem

TREATMENTRECOGNITION Call HELP Initial assessment ABCDE approach ADRENALINE Follow-upPts positioningLow BP flat with or without leg elevationA-B problems sit upUnconscious recovery positionPregnant pt LLD to prevent caval compressionREMOVE the trigger if possible

Oxygen High flow rateEpinephrinei.m administration dose: 0.3-0.5 mg every 15-20 mini.v administrationdose: 0.1 mg slowly over 5 min; infusion 1-4 mcg/minFluid resuscitation Isotonic crystalloidAntihistamine diphenhydramine 25-50 mgCorticosteroid

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