Anaphylactic shock

The reasons

Symptoms of anaphylactic shock

Diagnostics

Treatment of anaphylactic shock

Complications and prognosis

Anaphylactic shock is an acute and extremely severe allergic reaction that develops as a result of repeated ingestion of an allergen.

Anaphylactic shock is manifested by a sharp decrease in pressure, impaired consciousness, symptoms of local allergic phenomena (skin swelling, dermatitis, urticaria, bronchospasm, etc.) in severe cases, coma can develop.

Anaphylactic shock usually develops from 1-2 to 15-30 minutes from the moment of contact with the allergen and can often end in death, with failure to provide prompt and competent medical care.

The reasons

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Anaphylactic shock occurs as a result of the repeated injection into the body of a substance that is a strong allergen for it.

During the initial contact with this substance, the body, without showing any symptoms, develops an increased sensitivity and accumulates antibodies to this substance. But repeated contact with the allergen, even in its minimum amounts, due to the ready-made antibodies in the body, gives a violent and pronounced reaction. This body reaction most often occurs on:

introduction of foreign protein, sera

  • antibiotics
  • anesthetics and anesthetics
  • other medications (both in the vein and in the muscle, by mouth)
  • diagnostic preparations (x-ray contrast)
  • with insect bites
  • and even when taking some food (seafood, citrus, spices)

In anaphylactic shock, the amount of allergen can be quite small, sometimes a drop of medication or a spoon of the product is enough. But the greater the dose, the stronger and longer the shock will be.

The basis of the allergic reaction is a massive release from sensitized cells (hypersensitive) of special substances – histamine, serotonin and others, which are responsible for the manifestations of anaphylactic shock.

Anaphylactic shock can occur in several forms:

mainly affects the skin and mucous membranes with symptoms of itching of the skin, sharp redness, hives or angioedema

damage to the nervous system with headaches, nausea, sensitivity disorders, manifestations of the type of epileptic and loss of consciousness,

lesion of the respiratory system with asphyxiation and asphyxia, edema of the larynx or small bronchi,

heart disease with signs of cardiogenic shock or acute myocardial infarction

Symptoms of anaphylactic shock

According to the severity of symptoms, anaphylactic shock can be from mild to extremely severe and fatal, it depends on how quickly the pressure decreases and brain function is disturbed due to hypoxia (lack of oxygen).

In mild symptoms, symptoms of anaphylactic shock can last from a few minutes to two hours and appear

  • reddening of the skin
  • strong itching and sneezing
  • nasal mucous discharge,
  • sore throat with dizziness,
  • headache
  • decreased pressure and tachycardia.

There may be a feeling of heat through the body, discomfort in the abdomen and chest, severe weakness and misting of consciousness.

With an average degree of shock may occur

skin blistering or angioedema (angioedema)

conjunctivitis or stomatitis

heartache with sharp heartbeats, arrhythmias, and a sharp decrease in pressure.

patients feel severe weakness and dizziness

vision is disturbed, there may be agitation or lethargy, fear of death and trembling

sticky sweat, body cold, noise in the ears and head, fainting

there may be a spasm of the bronchi with respiratory disorders, bloating with nausea or vomiting, severe abdominal pain, and urinary disorders.

In severe anaphylactic shock almost instantly develops.

vascular collapse with a sharp decrease in pressure, blue or deadly pallor, threadlike pulse character, almost zero pressure

there is a loss of consciousness with dilated pupils, involuntary discharge of urine and feces, lack of response to external stimuli

pulse gradually disappears, pressure stops registering

breathing and cardiac activity stops, clinical death occurs

Diagnostics

The diagnosis is made on the basis of data on the administration of the drug (contact with the allergen) and the immediate start of the reaction.

The state of anaphylactic shock is critical – the diagnosis is established by an emergency doctor or resuscitator. Anaphylactic shock may be similar to other anaphylactic reactions (angioedema or acute urticaria), but the basis of the process is the same as the relief measures.

Treatment of anaphylactic shock

The beginning of the treatment is necessary on the spot by any person – medical or non-medical; professional help is provided by emergency doctors and resuscitation doctors.

First aid for anaphylactic shock

emergency call

if there is no breathing and heartbeat – indirect heart massage and artificial respiration

if a person is conscious, it is necessary to lay him on his side, undoing all the fasteners of clothes and straps, put a pillow or anything under his feet so that they are raised

stop the admission of the allergen (with an insect bite or administration of the drug – a tourniquet on the limb, removal of food from the mouth)

Medical care – on-site assistance, until hospitalized,

an injection site or a bite must be crushed with an adrenaline solution intramuscularly or subcutaneously (adults 0.5 ml of 0.1% solution, children over 6 years old – 0.3 ml of 0.1% solution) and cover with ice,

subcutaneously inject caffeine and cordiamine solutions

injections of prednisone or hydrocortisone are also needed.

As treatment is done in the hospital, injections of adrenaline and hormones are repeated, antagonists of medical drugs are administered for drug allergies, administration of antihistamines, calcium chloride or gluconate solutions are used. In case of bronchospasm, aminophylline is administered, in case of laryngeal edema, intubation or tracheotomy is indicated.

Further therapy is carried out taking into account cardiac abnormalities, respiratory disorders or metabolic disorders.

Complications and prognosis

The main complication is death in delay with assistance. With timely measures possible complete recovery from the shock, but the timing of the withdrawal from the state of shock range from several hours to several days.

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