Emergency care for anaphylactic shock of various forms

There is an opinion that allergies, although they cause numerous inconveniences for the patient, are not a life-threatening condition. This is not true.

An allergy can manifest itself in the form of anaphylactic shock, which, if emergency treatment is not provided, can be fatal.

Any person, even those without medical skills, needs to know what to do if anaphylaxis develops. In difficult situations, this will help preserve health and, possibly, life.

Anaphylactic shock concept

Shock is an acute reaction to a variety of allergens. When a compound that is identified by the immune system as foreign appears in the body, the production of special proteins, immunoglobulins E, begins. These antibodies remain in the blood, even if the allergen has already been removed from the body.

If the provocateur re-enters the bloodstream, these proteins combine with its molecules. Immune complexes begin to form. Biologically active compounds - mediators of an allergic reaction (histamine, serotonin) are released into the blood.

The network of small blood vessels becomes more permeable. Blood begins to flow into the mucous membranes and subcutaneous tissue. This leads to the appearance of swelling, thickening of the blood, the blood supply to all organs and tissues is sharply disrupted, and eventually shock develops.

Since there is an outflow of blood, its other name is redistribution.

What allergens can cause shock?

Types of likely irritants:

• various medicines, serums, vaccines, etc.;
• food products, most often nuts, citrus fruits, fish, honey, chocolate, eggs, strawberries, preservatives. Often intolerance is caused by food contaminated with parasites;
• aeroallergens (pollen from plants, trees during the flowering season, dust, mold spores);
• antibiotics, especially the penicillin series;
• painkillers (most often novocaine);
• poison that is injected by insects (bees, wasps, etc.) when bitten;
• saliva, skin scales, fur, fluff of domestic animals;
• irritants at work (formaldehyde, nickel salts, etc.).

A state of shock occurs most quickly when the provocateur enters the body intramuscularly or intravenously. Slower - if the path was through the respiratory tract or skin. After eating, signs of anaphylactic shock are observed after 1-2 hours.

Signs of shock

Among the initial signs, patients name fear of death, skin rashes, and painful itching.

Next, the following organs and systems become involved:

1. On the part of the skin and mucous membranes (in 90% of patients) – swelling of the larynx, lips, eyelids, extremities, the appearance of urticaria.
2. Damage to the respiratory system (in 50% of patients) - difficulty breathing, swelling of the throat, wheezing, cough, hoarse voice, stuffy nose, profuse mucus coming out of it.
3. Blood vessels and heart (in 30-35% of cases) – decreased blood pressure, rapid pulse, weakness, dizziness, and possible fainting.
4. If the central nervous system is damaged, seizures, headaches, and hallucinations may occur.
5. Gastrointestinal tract (in 20-25% of patients) – spasmodic painful sensations in the abdomen, a person feels nauseous, has the urge to vomit, diarrhea, swallowing is impaired.

Forms of anaphylaxis

Depending on the manifestation of the reaction, the forms are differentiated:

1. Typical (develops more often than others). After a sharp release of histamine into the bloodstream, the patient becomes dizzy, blood pressure drops, swelling develops, and itching begins. The skin is pale, the lips are bluish. Weakness, nausea, heart pain, nervous excitement and panic occur.
2. Asphyxial. Breathing is impaired. There is swelling of the throat, shortness of breath, and a stuffy nose. If the patient is not helped, death from suffocation is possible.
3. Brain. There are malfunctions in the functioning of the central nervous system - loss of consciousness, the person has convulsions.
4. Gastrointestinal. The pressure may drop to 80-70/40-30 mmHg, lips and tongue swell, abdominal pain, diarrhea, and vomiting begin.
5. Anaphylaxis provoked by heavy physical exertion. The reaction can be triggered either by excessive loads themselves or by their combination with the consumption of allergenic foods or taking medications. Characterized by the combination of all the above manifestations. The initial sign is a strong decrease in blood pressure.

Severity

There is the following classification:

• Stage 1 is characterized by pressure below normal by 30-40 mmHg (normal pressure ranges from 120-110/90-70 mmHg). The person is excited and may develop a panic attack. The reaction appears within 30 minutes or longer. Therefore, there is a high chance that first aid for anaphylactic shock will be effective when a person is just anticipating the onset of an attack;
• Grade 2 – symptoms develop from 10-15 minutes to 30 minutes. The pressure drops to 90-60/40 mm Hg, loss of consciousness is possible. Also, since there is a reserve of time, there is a good chance of emergency assistance;
• 3rd degree. Anaphylaxis develops within a few minutes, the patient may faint, systolic pressure is in the range of 60-30 mmHg, diastolic pressure is usually not determined. The chances of successful treatment are low.
• 4th degree. It is also called fulminant (fulminant) shock. Develops in a few seconds. The person immediately faints; the pressure cannot be determined. The chances of resuscitation are almost zero. Fortunately, grade 4 is extremely rare.

What to do in case of anaphylactic shock?

At the slightest suspicion that a person is developing anaphylaxis, it is necessary to call an ambulance. Before her arrival, first aid should be provided at home or where the patient’s attack began.

Therefore, you should know the algorithm for providing emergency care for anaphylactic shock. It is also necessary to take into account the fact that two phases of allergic manifestations are likely.

A repeat attack is possible after a period of time from 1 hour to 3 days.

Algorithm of actions before doctors arrive:

1. The patient should lie on his back, his legs should be elevated, placing a pillow, cushion, etc. under them to activate blood flow to the heart. Raise your head if your tongue sinks in, or turn it to the side if vomiting begins.
2. Open windows and vents to allow access to fresh air.
3. Unbutton the person’s clothes, loosen fasteners and belts.
4. If possible, remove the allergen (remove the insect sting from the bite site, do gastric lavage if you are allergic to food). It is recommended to apply a piece of ice to the wound or tighten the tourniquet above the affected area to reduce the rate of penetration of the irritant into the bloodstream.
5. First aid involves the need for adrenaline injections. They should be done immediately, as soon as the first signs of shock appear. A 0.1% solution is administered intramuscularly, intravenously (drip, stream) or subcutaneously. Intravenous administration at home is difficult to provide, so intramuscular injection from the outside into the middle part of the thigh, possibly through clothing, is more often practiced. Dose for adults – 0.3-0.5 ml, for children – 0.1 ml. If there is no immediate effect, repeat injections after 5-10 minutes. The maximum total dosage is 2 ml for adults, 0.5 ml for children. If the pressure drops rapidly and the person is suffocating, it is possible to inject a single volume of 0.5 ml into the area under the tongue. It is very convenient to have a special syringe pen (EpiPen), the contents of which are also injected into the thigh. An insect bite can be injected in a circle with 1 ml of 0.1% adrenaline, making 5-6 injections.

Actions of doctors upon arrival:

1. Adrenaline injections are given if for some reason this has not been done before.
2. Glucocorticoid hormones - dexamethasone, hydrocortisone or prednisolone - are administered intravenously.
3. Provide intravenous infusion of a significant volume of fluid (0.9% sodium chloride solution) to eliminate its deficiency in the bloodstream. For children, the amount is administered at the rate of 20 ml per 1 kg of body, for adults the total volume is up to 1 liter.
4. The patient is provided with oxygen inhalation using a mask. In case of swelling of the larynx and inability to breathe, an emergency tracheotomy is performed.

All these measures continue while the person is being transported to the hospital in the intensive care unit. There they continue to pour in liquid and the necessary solutions. The doctor decides to prescribe antihistamines (Tavegil, Suprastin, Loratadine, Diphenhydramine, Cetirizine, etc.).

To maintain heart function, Dopamine is used, for bronchospasms - Albuterol, Eufillin, for convulsive syndrome - anti-convulsants, etc. The patient usually stays in the hospital for at least 5-7 days, so that there is no risk of missing a possible recurrent attack.

Prevention

Allergy sufferers must take measures on their own to avoid negative consequences:

• be sure to have adrenaline (single dose) in ampoules and a disposable syringe or disposable syringe pen with you;
• as soon as a person feels an attack approaching, immediately notify everyone around him, ask them to call an ambulance and help him give an injection;
• try to avoid situations where the allergen can enter the body (study the composition of purchased products, do not approach pets with intolerance, etc.);
• When prescribing medications, warn doctors that you are allergic.

Statistics show that in approximately 2% of cases, anaphylaxis is fatal. Therefore, the patient needs to be extremely attentive to his condition. Other people should have an idea of ​​how to properly help a person so that the attack passes without serious consequences.



Source: https://allergiya03.com/zabolevaniya/pomoshh-pri-anafilakticheskom-shoke.html

Anaphylactic shock: symptoms, emergency care, prevention

Update: February 2019

Anaphylactic shock (from the Greek “reverse defense”) is a generalized rapid allergic reaction that threatens human life, since it can develop within a few minutes. The term has been known since 1902 and was first described in dogs.

This pathology occurs in men and women, children and the elderly equally often. Mortality in anaphylactic shock is approximately 1% of all patients.

Causes of anaphylactic shock

Anaphylactic shock can occur due to many factors, be it food, drugs or animals. The main causes of anaphylactic shock:

Allergen group	Main allergens
Medications	Antibiotics – penicillins, cephalosporins, fluoroquinolones, sulfonamides Hormones – insulin, oxytocin, progesterone Contrast agents – barium mixture, iodine-containing Serums – antitetanus, antidiphtheria, antirabies (rabies) Vaccines – anti-influenza, anti-tuberculosis, anti-hepatitis Enzymes – pepsin, chymotrypsin, streptokinase Muscle relaxants – tracrium, norcuron, succinylcholine Nasteroid anti-inflammatory drugs - analgin, amidopyrine Blood substitutes – albulin, polyglucin, reopoliglucin, refortan, stabizol Latex – medical gloves, instruments, catheters
Animals	Insects - bites of bees, wasps, hornets, ants, mosquitoes; ticks, cockroaches, flies, lice, bedbugs, fleas Helminths – roundworms, whipworms, pinworms, Toxocara, Trichinella Pets - wool of cats, dogs, rabbits, guinea pigs, hamsters; feathers of parrots, pigeons, geese, ducks, chickens
Plants	Forbs – ragweed, wheatgrass, nettle, wormwood, dandelion, quinoa Coniferous trees - pine, larch, fir, spruce Flowers – rose, lily, daisy, carnation, gladiolus, orchid Deciduous trees – poplar, birch, maple, linden, hazel, ash Cultivated plants – sunflower, mustard, castor bean, hops, sage, clover
Food	Fruits – citrus fruits, bananas, apples, strawberries, berries, dried fruits Proteins – whole milk and dairy products, eggs, beef Fish products - crayfish, crabs, shrimp, oysters, lobsters, tuna, mackerel Cereals – rice, corn, legumes, wheat, rye Vegetables – red tomatoes, potatoes, celery, carrots Food additives – some dyes, preservatives, flavorings and aroma additives (tartrazine, bisulfites, agar-agar, glutamate) Chocolate, coffee, nuts, wine, champagne

 What happens in the body during shock?

The pathogenesis of the disease is quite complex and consists of three successive stages:

• immunological
• pathochemical
• pathophysiological

The pathology is based on contact of a specific allergen with cells of the immune system, after which specific antibodies (Ig G, Ig E) are released.

These antibodies cause a huge release of inflammatory factors (histamine, heparin, prostaglandins, leukotrienes, and so on).

Typically, any allergic reaction develops only upon repeated contact with the allergen. Anaphylactic shock is dangerous because it can develop even when the allergen first enters the human body.

Symptoms of anaphylactic shock

Variants of the course of the disease:

• Malignant (fulminant) - characterized by a very rapid development of acute cardiovascular and respiratory failure in the patient, despite the therapy. The outcome in 90% of cases is fatal.
• Prolonged - develops with the introduction of long-acting drugs (for example, bicillin), so intensive therapy and monitoring of the patient must be extended to several days.
• Abortion is the easiest option; the patient’s condition is not in danger. Anaphylactic shock is easily relieved and does not cause residual effects.
• Recurrent - characterized by repeated episodes of this condition due to the fact that the allergen continues to enter the body without the knowledge of the patient.

In the process of developing symptoms of the disease, doctors distinguish three periods:

Initially, patients feel general weakness, dizziness, nausea, headache, and rashes on the skin and mucous membranes in the form of hives (blisters) may appear. The patient complains of a feeling of anxiety, discomfort, lack of air, numbness of the face and hands, deterioration of vision and hearing.

It is characterized by loss of consciousness, a drop in blood pressure, general pallor, increased heart rate (tachycardia), noisy breathing, cyanosis of the lips and extremities, cold sticky sweat, cessation of urine output or, conversely, urinary incontinence, itching.

May continue for several days. Patients remain weak, dizzy, and lack of appetite.

Severity of the condition

Mild course	Moderate	Severe course
Arterial pressure	Decreases to 90/60 mm Hg	Decreases to 60/40 mm Hg	Not determined
Precursor period	10-15 minutes	2-5 minutes	Seconds
Loss of consciousness	Momentary fainting	10-20 minutes	More than 30 minutes
Effect of treatment	Treats well	The effect is delayed, requires long-term observation	No effect

For mild flow

Precursors for mild shock usually develop within 10-15 minutes:

• skin itching, erythema, urticaria rash
• feeling of heat and burning throughout the body
• if the larynx swells, the voice becomes hoarse, even aphonic
• Quincke's edema of various localizations

A person manages to complain to others about his feelings during mild anaphylactic shock:

• They feel headache, dizziness, chest pain, decreased vision, general weakness, lack of air, fear of death, tinnitus, numbness of the tongue, lips, fingers, pain in the lower back, in the abdomen.
• There is cyanotic or pale skin on the face.
• Some people may have bronchospasm - wheezing can be heard at a distance, difficulty breathing.
• In most cases, vomiting, diarrhea, abdominal pain, involuntary urination or defecation occur.
• But even then, patients lose consciousness.
• Pressure is sharply reduced, thready pulse, muffled heart sounds, tachycardia

For moderate cases

Harbingers:

• As well as in mild cases, general weakness, dizziness, anxiety, fear, vomiting, heart pain, suffocation, Quincke's edema, urticaria, cold sticky sweat, cyanosis of the lips, pallor of the skin, dilated pupils, involuntary defecation and urination.
• Often - tonic and clonic convulsions, followed by loss of consciousness.
• Low or undetectable blood pressure, tachycardia or bradycardia, thready pulse, muffled heart sounds.
• Rarely - gastrointestinal, nosebleeds, uterine bleeding.

Severe course

The rapid development of shock does not give the patient time to complain about his sensations, since loss of consciousness occurs within a few seconds. A person needs immediate medical attention, otherwise sudden death occurs.

The patient has severe pallor, foam at the mouth, large drops of sweat on the forehead, diffuse cyanosis of the skin, dilated pupils, tonic and clonic convulsions, wheezing breathing with prolonged exhalation, blood pressure is not determined, heart sounds are not heard, the pulse is thready, almost palpable.

There are 5 clinical forms of pathology:

• Asphyxial - in this form, patients have symptoms of respiratory failure and bronchospasm (shortness of breath, difficulty breathing, hoarseness), often developing Quincke's edema (swelling of the larynx until breathing stops completely);
• Abdominal - the predominant symptom is abdominal pain, simulating symptoms of acute appendicitis or perforated gastric ulcer (due to spasm of intestinal smooth muscles), vomiting, diarrhea;
• Cerebral - a feature of this form is the development of edema of the brain and meninges, manifested in the form of convulsions, nausea, vomiting that does not bring relief, a state of stupor or coma;
• Hemodynamic - the first symptom is pain in the heart area, reminiscent of myocardial infarction and a sharp drop in blood pressure;
• Generalized (typical) – occurs in most cases, includes all common manifestations of the disease.

Diagnosis of anaphylactic shock

Diagnosis of the pathology must be carried out as quickly as possible, so the prognosis for the patient’s life largely depends on the doctor’s experience. Anaphylactic shock is easily confused with other diseases; the main factor in making a diagnosis is the correct history taking!

• A general blood test reveals anemia (decrease in the number of red blood cells), leukocytosis (increase in white blood cells) with eosinophilia (increase in eosinophils).
• A biochemical blood test determines an increase in liver enzymes (AST, ALT, alkaline phosphatase, bilirubin), and kidney tests (creatinine, urea).
• A plain chest x-ray reveals interstitial pulmonary edema.
• Enzyme immunoassay is used to detect specific antibodies (Ig G, Ig E).
• If the patient finds it difficult to answer, after which he develops an allergic reaction, he is recommended to consult an allergist with allergy tests.

Pre-medical first aid - algorithm of actions for anaphylactic shock

• Lay the patient on a flat surface, raise his legs (for example, place a blanket rolled up under them);
• Turn your head to one side to prevent aspiration of vomit, remove dentures from your mouth;
• Provide a flow of fresh air into the room (open a window, door);
• Take measures to stop the entry of the allergen into the victim’s body - remove the sting with poison, apply an ice pack to the bite or injection site, apply a pressure bandage above the bite site, and so on.
• Feel the patient's pulse: first on the wrist, if it is absent, then on the carotid or femoral arteries. If there is no pulse, begin performing indirect cardiac massage - clasp your hands and place them on the middle part of the sternum, apply rhythmic points 4-5 cm deep;
• Check if the patient is breathing: see if there are movements of the chest, apply a mirror to the patient’s mouth. If there is no breathing, it is recommended to begin artificial respiration by inhaling air into the patient’s mouth or nose through a napkin or handkerchief;
• Call an ambulance or transport the patient yourself to the nearest hospital.

Emergency care algorithm for anaphylactic shock (medical care)

• Monitoring vital functions - measuring blood pressure and pulse, determining oxygen saturation, electrocardiography.

Source: http://zdravotvet.ru/anafilakticheskij-shok-simptomy-neotlozhnaya-pomoshh-profilaktika/

Anaphylactic shock - how to recognize it and save a person

Hello, dear readers of the KtoNaNovenkogo.ru blog.

A passerby on the street, a roommate, an employee at work, or a loved one may suddenly fall to the floor and begin to suffocate.

Therefore, it is imperative to know how anaphylactic shock manifests itself, what it is, and how to quickly help a person in such an emergency situation.

Anaphylactic shock is...

Anaphylactic shock is a type of allergic reaction that occurs instantly and immediately puts a person in a serious condition. It can be fatal.

It develops after the allergen re-enters the body, which entails spasm of muscles and bronchi, decreased blood pressure, and dysfunction of the central nervous system.

Substances that can provoke anaphylactic shock are divided into 4 groups:

1. food products (wheat, peanuts, chocolate, milk, citrus fruits, soybeans, corn, eggs, dyes and additives);
2. plant origin (poplar fluff, flowers with a pungent odor);
3. poison (after the bite of a snake, bees, wasps);
4. medications (anti-inflammatory drugs, analgesics, antibiotics, muscle relaxants, radiocontrast agents, blood substitutes, immune serums, penicillin group).

For example , a person is allergic to oranges, but he doesn’t know about it yet. Trying citrus for the first time, and there is no reaction. When he buys and eats for the second time, the antibodies in his blood begin to fight the antigens (allergen).

Due to this reaction, active substances are released : serotonin (what is it?), histamine, bradykinin. They increase the permeability of vascular walls and cause muscle spasms.

Blood accumulates on the periphery of the arms and legs, which is why blood pressure drops. Liquid, nutrients and oxygen do not enter the cells of organs, including the brain. This provokes loss of consciousness.

Main symptoms of anaphylactic shock

When it occurs, symptoms are divided into 2 categories, depending on the stage.

The first stage is characterized by:

1. temperature increase;
2. burning;
3. itching;
4. the skin turns red or pale;
5. arms, legs, face become numb and tingling;
6. lips and tongue become swollen;
7. running from the eyes and nose;
8. sneezing;
9. it is difficult to breathe, you can hear a whistle;
10. feeling of a lump in the throat;
11. abdominal pain, nausea.

Already having such symptoms of precursors, it is worth immediately providing assistance to the person .

If this does not happen, the second stage of anaphylactic shock occurs :

1. severe weakness;
2. dizziness;
3. loss of consciousness;
4. pallor;
5. dyspnea;
6. cold sweat;
7. ringing and noise in the ears;
8. feeling of fear of death;
9. convulsions.

Depending on which system of the body the allergen affects more, the symptoms are classified into :

1. Respiratory – suffocation due to swelling of the mucous membrane.
2. Cardiac – acute myocardium and infarction may occur.
3. Cerebral – convulsions, nausea, headache, possible involuntary urination.
4. Skin - itching, Quincke's edema, urticaria.

Urgent Care

If there is a person in front of you who is having anaphylactic shock, emergency care means urgently calling an ambulance .

Over the phone, calmly and clearly explain what the symptoms are so that the medical staff is prepared for the situation.

After this, the patient needs to be transferred to a flat, hard surface, turn his head to the side and raise his legs .

Since vomiting often occurs during shock, in this position a person will not be able to choke on the masses. If the attack occurs indoors, you need to open the windows to access oxygen.

Remember to constantly check your pulse and breathing, as these functions are often impaired. To take your pulse, place two fingers firmly against the carotid artery or wrist.

Normally, the pulse should be smooth, full, from 60 to 90 beats per minute.

If the pulse is very weak or absent, you need to do chest compressions. If there is no breathing - the chest does not rise up and down - we proceed to artificial .

You can mouth-to-nose or mouth-to-nose using a damp cloth or napkin.

In parallel with these actions, you need to take a look at the skin . Perhaps the reason for this condition will be noticeable.

Such actions will not improve a person’s health, but will help gain time and wait for an ambulance. Only qualified medical personnel can completely correct the situation.

First aid

If anaphylactic shock is diagnosed, then first aid is the administration of adrenaline . Only he is able to counteract the allergen and the body’s acute reaction with lightning speed. If the patient can barely breathe, you need to give an injection under the root of the tongue.

When an allergic reaction is caused by a bite, the drug is injected into the vicinity of this red dot so that the poison does not spread further. If the affected area is on one arm, then adrenaline is also injected into the other.

Manipulation with the syringe must be done slowly so as not to cause a disturbance in the heart rhythm, or even a complete stop.

The drug should quickly relieve swelling of the airways. If this does not happen, then intubation or tracheotomy is performed - a hole is made through the neck and larynx, a tube is inserted so that the person can breathe through it.

After the patient’s condition has stabilized, doctors are restoring health with the help of suprastin and diphenhydramine - antihistamines that do not affect blood pressure and do not cause drug allergies.

Specialists cannot immediately send the patient home without diagnosis in order to prevent recurrence of shock. To do this, you need to establish the type of allergen , because this is not always an obvious bee sting.

The allergen could be some component from a complex dish, or a smell on the street.

Examined using:

1. blood test for immunoglobulin E;
2. provocative tests;
3. Patch test is a patch test with chemical allergens.

After the diagnostic result, we can say with high accuracy what caused it and prescribe treatment aimed at restoring the body.

Consequences of anaphylactic shock

If a person was provided timely emergency assistance, which was successful, after which the patient still underwent additional treatment, there may still be chronic disorders :

1. since during anaphylactic shock blood did not flow to the heart, it may hurt for a long time after the situation;
2. chronic low blood pressure;
3. constant fatigue and slowness.

Anaphylactic shock can also cause :

1. irregular nausea and vomiting;
2. pain in the joints, abdomen and chest;
3. myocarditis;
4. neuritis;
5. diffuse damage to the central nervous system.

Therefore, it is important to see a doctor , even if you managed to survive a seizure on your own. All consequences are removed with the help of well-chosen therapy.

Knowing what anaphylactic shock is, everyone will want to protect themselves from such a situation. But there are no exact recommendations that must be followed to avoid such a violent reaction of the body.

At risk are people who already know they are allergic to something. They are more sensitive to other stimuli.

Therefore, you need to beware of the possibility of getting anaphylactic shock. For example, do not go to the apiary, do not try new exotic fruits, close the windows when there is poplar fluff.

The risk group also includes people who have been ill:

1. eczema:
2. asthma;
3. mastocytosis;
4. allergic rhinitis.

You need to be careful when taking medications that are prescribed to treat other diseases. Maintain the exact dose and do not exceed it. The doctor should also be informed about the patient’s tendency to allergies.

In our home medicine cabinets we have tablets for headaches and fever, but adrenaline will also come in handy. Especially if a person from a risk group lives in the apartment.

Such a drug should definitely be in the first aid kit of institutions and institutions, but in practice this is not always the case. Therefore, this can be controlled and corrected.

It is worth improving your knowledge, which can be very useful in emergency situations.

Marina Domasenko

Good luck to you! See you soon on the blog pages KtoNaNovenkogo.ru

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Source: https://KtoNaNovenkogo.ru/voprosy-i-otvety/anafilakticheskij-shok-chto-ehto-takoe-simptomy-pervaya-pomoshch.html

First aid for anaphylactic shock

Anaphylactic (allergic) shock is rightfully considered the most dangerous manifestation of allergies. It is advisable for every person, even those without medical education, to know what to do in case of anaphylactic shock, since this can play a decisive role in saving their own life or the life of someone around them.

Allergic shock refers to the so-called immediate hypersensitivity reactions and develops in allergic people when any substance that has become an allergen for that person re-enters their body. Even knowing and clearly following the algorithm of actions for anaphylactic shock, it is not always possible to save the patient’s life, extremely severe pathological processes develop in his body so quickly.

Content

Causes and forms of anaphylactic shock

It is believed that most often anaphylactic shock develops in response to repeated exposure to the following types of allergens:

• Medicines based on protein molecules (drugs for desensitization for allergies, antidote serums, some vaccines, insulin preparations, etc.);
• Antibiotics, especially penicillin and others with a similar structure. Unfortunately, so-called “cross-allergy” occurs, when antibodies to one substance recognize another, similar in structure, as an allergen and trigger a hypersensitivity reaction.
• Painkillers, especially novocaine and its analogues;
• Poisons of stinging hymenoptera insects (bees, wasps);
• Rarely - food allergens.

It is advisable to know and remember this, since sometimes it is possible to collect an anamnesis and obtain information both about the presence of allergies in the patient and about the episode of the entry of a potential allergen into his body.

The rate of development of an anaphylactic reaction largely depends on how the allergen entered the human body.

• With the parenteral (intravenous and intramuscular) route of administration, the most rapid development of anaphylaxis is observed;
• When allergen molecules enter through the skin (insect bite, intradermal and subcutaneous injections, scratches) as well as through the respiratory tract (inhalation of fumes or dust containing allergen molecules), shock does not develop so quickly;
• When an allergen enters the body through the digestive tract (by ingestion), anaphylactic reactions develop rarely and not immediately, sometimes one and a half to two hours after eating.

There is a linear relationship between the rate of development of allergic shock and its severity. The following forms of anaphylactic shock are distinguished:

1. Fulminant (fulminant) shock – develops instantly, within a few seconds after the allergen enters the patient’s body. This form of shock more often than others leads to death, since it is the most severe and leaves practically no time for others to help the patient, especially if the shock has developed outside the walls of a medical institution.
2. The acute form of anaphylactic shock develops within a period of several minutes to half an hour, which gives the patient time to seek help and even receive it. Therefore, the mortality rate for this form of anaphylaxis is significantly lower.
3. The subacute form of anaphylactic shock develops gradually, over half an hour or longer, the patient has time to feel some symptoms of the impending disaster, and sometimes it is possible to begin providing assistance before its onset.

So, in the case of the development of acute and subacute forms of anaphylactic shock, the patient may experience some warning symptoms.

↑ Return to contents

Signs of anaphylactic shock

So, what are the signs of anaphylactic shock? Let's list them in order.

Premonitory symptoms:

• Skin symptoms: itching, a rapidly spreading urticaria-type rash, or a draining rash, or severe redness of the skin.
• Quincke's edema: rapid development of swelling of the lips, ears, tongue, hands, feet and face.
• Feeling hot;

Source: https://allergolife.ru/pervaya-pomoshh-pri-anafilakticheskom-shoke/

Anaphylactic shock: emergency care, algorithm of actions 2018

In modern medicine, the concept of “shock” is defined as a set of reactions of the human body to the extremely strong influence of factors 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 moderate and mild severity, minutes count, 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:

• poisons,
• 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 the development of such an allergic reaction from poisoning, in relation to the total number of anaphylactic shocks, has sharply decreased.

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, food additives, flavor enhancers and dyes cause a severe allergic reaction.

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.

The development of AFS in recent years has increasingly been recorded with the use of 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.

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

Ingestion of plant allergens quite often causes simple allergies. Many have experienced all the “delights” of poplar fluff or the flowering of pungently smelling plants.

In principle, serious complications of an allergic reaction and the development of anaphylactic shock from plant allergens are quite rare, but the presence of an allergy to plants is an additional risk factor.

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, edema and itching when exposed to external agents, or in the form of severe pain, nausea, vomiting and difficulty breathing when the allergen enters the body.

In addition, a harbinger of the development of anaphylactic shock is a sharp drop in blood pressure, a feeling of discomfort and anxiety in a person.

During the next period of 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 noise when breathing appear. This is where qualified medical care plays a critical role, which will stop the further development of APS.

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, and 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.	Mild symptoms include suffocation, cold sweat, heart pain, and 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 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. Heavy breathing with a characteristic prolonged exhalation, convulsions, foam at the mouth, and cyanosis of the entire skin are observed. 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, there is a fainting state 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 requires medical supervision for a long period.	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.

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 is best felt at the wrist, carotid and femoral arteries. 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.

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

In parallel with this, diagnostics should be carried out in a medical institution 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 accurately determine the allergen and draw up the correct scheme for further restorative therapy.

Consequences of anaphylactic shock

Anaphylaxis, even after timely and high-quality treatment, quite often causes chronic disorders in the body that make themselves felt to a person over a long period of 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 damage to the 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.

This is not about questioning medical prescriptions, but about strictly following the prescribed treatment regimen and performing any injections only after 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 presence in hospitals and medical centers of an 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.

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 in difficult situations will prevent you from panicking and, perhaps, will save someone’s life.

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Source: https://www.spacehealth.ru/articles/polezno-znat/anafilakticheskiy-shok-neotlozhnaya-pomoshch-algoritm-deystviy-2018/