EMERGENCY MANAGEMENT OF ANAPHYLACTIC SHOCK

PRESENTED BY HIBA HAMID

GROUP C

What is anaphylaxis??

A manifestation of immediate hypersensitivity in which exposure of a sensitized individual to a specific antigen results in life-threatening respiratory distress, usually followed by vascular collapse and shock, accompanied by pruritis, urticaria, and angioedema.

• Medications, including antibiotics (especially penicillin and sulfa), vaccines, opiates, aspirin, NSAIDs, local anesthetics, intravenous fluids with dextran, and insulin

• Foods, such as nuts, milk, eggs, soy, wheat, and seafood

• Stings by fire ants and Hymenoptera species (eg, bees, wasps, yellow jackets, hornets)

• Latex

• Blood products, including plasma, immunoglobulin, cryoprecipitate, and whole blood

• Idiopathic origins

• Exercise

causes

Physiology of anaphylactic shock

• Anaphylaxis occurs only in those people who have previously been exposed to the allergen.

• Patient is exposed to the allergen, an incubation period follows, antibodies are formed. When the patient is exposed to the same allergen, anaphylactic reaction occurs, sometimes called the exciting or shock dose.

Signs and symptoms

• Signs and symptoms most commonly seen in the skin, gastro-intestinal, respiratory, or circulatory systems.

• A common term used to describe these signs and symptoms is shock.

• Signs and symptoms associated with skin: Generalized pruritus (itching) Urticaria Angioedema

• These signs and symptoms are not too dangerous, but they do have the potential to become life-threatening if they are located in some specific areas.

• Angioedema around the mouth or throat could cause death from airway obstruction.

Gastro-intestinal symptoms:

• Varying degrees of nausea, vomiting, and diarrhea

Respiratory symptoms:

• Sneezing, cough, weakness, tightness in chest, bronchospasm as well.

• Varying degrees of airway obstruction

• Most often due to laryngeal edema, a swelling of the larynx that occurs as a result of an allergic reaction.

• The swelling may be great enough to cause partial or complete obstruction of the airway.

• The most common cause of death in anaphylactic reactions.

Circulatory symptoms:

• May include hypotension, shock, cardiac arrhythmias, and even complete circulatory collapse.

• Also pallor, syncope, tachycardia, and palpitations.

• Diagnosis would be relatively much easier of the signs and symptoms occur immediately after exposure.

• In this situation, almost immediately the patient would feel faint and weak, would begin sweating, and will become anxious and restless

• The patient then develops severe itching sensation as a result of allergic skin reactions. The condition then proceeds through the gastro-intestinal, respiratory, and circulatory stages.

• If the cycle is not stopped, the end result would be death.

• One distinct problem with anaphylactic shock is that, in some cases, the reaction can be so severe that all the signs and symptoms occur at once. In these situations, diagnosis may be more difficult, and death may occur regardless of any treatment.

treatment

Patient with obvious signs and symptoms

• Summon medical assistance• Place patient in a supine position• Administer oxygen• Administer epinephrine (Initial

doses for the management of anaphylaxis are 0.3 to 0.5 mg intramuscularly or 0.1 mg intravenously. These doses should be repeated as necessary until resolution of the event)

• Administer anti-histamine as needed

• Initiate CPR if necessary• Perform emergency

cricothyrotomy if necessary

Patient without signs and symptoms

• Summon medical assistance• Do not administer epinephrine• Place patient in Trendelenburg

position• Provide basic life support as needed• Administer oxygen• Initiate CPR if necessary• Perform emergency cricothyrotomy if

necessary