Whether anaphylactic shock. Anaphylactic shock: photos, symptoms, consequences. What it is

Like other manifestations of allergies, anaphylactic shock occurs after repeated contact of the patient with a substance that previously sensitized the body. Only, unlike other forms, this one can occur so quickly that death can occur long before specialists arrive at the house.

Another distinctive symptom of the disease is its systemic effect: if in case seasonal allergies, only individual organs are affected, then anaphylactic shock affects the entire body at once. The course of the disease is rapid and, as a rule, consists of several phases (depending on the distribution of allergens and histamine in the bloodstream), which allows, in some way, to predict further complications and coordinate life-saving measures.

Causes of anaphylactic shock

The cause of anaphylactic shock can be any substance to which the body has previously been sensitized, but most often it occurs when:

The use of medications (penicillin antibiotics, painkillers, NSAIDs, some vitamins, etc.);
Blood transfusion (foreign group, in large quantities or does not match the Rh factor);
Contact with plant pollen;
Consumption of certain foods (dairy products, eggs, nuts, seafood);
Insect, snake or arthropod bites (despite the presence of obvious hypersensitivity, symptoms of anaphylactic shock with fatal outcome were observed in only half of the cases).

Risk groups include:

Persons with high socio-economic status (there is a risk of sensitization to cosmetic or hygiene products);
Persons with a history of bronchial asthma or other allergic disease;
Persons undergoing frequent medical procedures (long-term hospitalization, frequent use of contrast agents, use of high-dose antibiotics, etc.);
Persons with congenital or acquired immune system deficiency.

Main symptoms of anaphylactic shock

The main symptom complex of the disease, although it has common features, still varies depending on the method of penetration of the allergen into the body.

With direct contact (in ascending order):

Unusually severe sharp pain;
Rapidly developing edema, spreading to nearby tissues;
Redness of the contact site and tumor development;
Severe local itching, quickly spreading throughout the body.

If the allergen enters through the digestive tract (in ascending order):

Severe abdominal pain, making it impossible to perform usual movements;
Nausea and subsequent vomiting;
Profuse diarrhea not responding to appropriate therapy;
Swelling of the mouth and larynx.

With an intramuscular injection of the allergen, the main symptoms of anaphylactic shock do not develop so rapidly (the first warning symptoms may appear several hours later) and at first only manifests itself as “squeezing” chest pain, which is often considered not as the main symptom, but as a side effect.

Subsequently, the disease develops according to the following pattern:

Edema of the larynx becomes more pronounced, and in addition to the patient’s complaints of difficulty swallowing, it is noted during a visual examination;
Difficulty in breathing also becomes more pronounced due to severe laryngo- and bronchospasm. On examination, “asthmatic breathing” is noted (rapid inhalation and prolonged painful exhalation, accompanied by a characteristic whistle);
Arterial pressure is rapidly declining;
The body begins to experience hypoxia, brain activity is disrupted, loss of consciousness is possible;
The skin and mucous membranes turn pale, the patient is covered with cold sweat;
Fingertips, lips and oral cavity acquire a bluish tint;
Collapse occurs and the patient falls into a coma.

First aid for symptoms of anaphylactic shock

If the main initial symptom complex of anaphylactic shock occurs, it is necessary:

Immediately completely eliminate contact with the allergen;
Apply a tourniquet above the site of an insect bite or direct skin contact with the allergen (to prevent further spread and intensify the reaction);
The patient is placed in a supine position, and Bottom part the body should be elevated (this will ensure redistribution of blood flow and preserve blood circulation in the brain);
Call an ambulance or take the patient to the intensive care unit as quickly as possible;
If necessary, carry out resuscitation measures (indirect cardiac massage, artificial respiration or coracotomy).

Of particular difficulty is the increasing asphyxia that occurs as a result of spasm of the trachea and bronchi, which does not make it possible to perform a tracheotomy and significantly complicates intubation.

Treatment of anaphylactic shock

Treatment is carried out by experienced specialists in a hospital setting and includes:

Fractional administration of adrenaline in small portions with monitoring of the patient’s condition;
Intravenous administration of bronchodilators and antihistamines;
Intravenous administration of glucocorticosteroids in very high doses;
Intubation or tracheotomy (if impossible, puncture the trachea with several needles with a wide lumen);
Oxygen inhalation;
Intravenous administration of saline (blood substitutes and other compounds are not used due to their hyperallergenicity).

Prevention

Preventive measures to prevent anaphylactic shock are practically no different from the prevention of other allergic diseases: it is still the same minimal contact with potential allergens, timely treatment of other manifestations of hypersensitivity and periodic allergy tests to identify potentials and changes in the reactivity of the immune system.

Prognosis for anaphylactic shock

The prognosis of the disease, given the possibility of its rapid development and rapid transition to spasm of the respiratory tract, always remains difficult, even if proper assistance is provided. The decisive factor in predicting the outcome of anaphylactic shock is the time from the onset of the first symptoms to the start of therapy, because even a slight delay can cause complications or death.

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Anaphylactic shock is a condition that develops suddenly as a result of exposure to an allergen, poses a threat to life, causes circulatory disorders, leading to the development of vascular insufficiency and hypoxia of all vital organs.

Epidemiology

Among all allergic diseases, the frequency of this pathology is about 5%. People with a predisposition to allergies are much more likely to experience shock than others. The mortality rate from this disease is about 4%.

Causes

Anaphylactic shock is manifestation of the mechanism of anaphylaxis, which is caused by sensitization and increased sensitivity of the body to the action of various allergens. The factors that most often cause the development of AS include: various drugs (about 20% of all cases of shock, most often antibiotics and non-steroidal anti-inflammatory drugs), poisons of hymenoptera insects (about 3%, mainly bees and wasps), latex (0 .5% of cases in the population), food allergens (protein chicken egg, milk, peanuts, soy), pollen, bacterial allergens, serums and vaccines. True shock occurs when an allergen enters the human body a second time; the first contact with it, as a rule, occurs unnoticed.

What is anaphylactic shock? pathogenesis point of view?

AS is an extreme degree of severity of an anaphylactic reaction or excessive sensitivity of the body to substances foreign to it. Its mechanism belongs to the category of allergic reactions of immediate development or IgE-mediated.

The basis for the development of shock will be a sudden drop in vascular tone, as a result of the influence of histamine and other mediators, and dilation of the veins. This leads to a relative decrease in the volume of blood circulating through these vessels and the emergence of a discrepancy between it and the volume of the vascular bed. There is a drop in the filling of the veins, which causes a decrease in the amount of blood that flows to the heart, a decrease in the filling of the heart chambers, a decrease in cardiac output and a drop in blood pressure. Violation of the pumping function of the heart also contributes to a direct violation of the ability of the heart muscle to contract.

All of the above factors lead to a deterioration in blood circulation in small capillary vessels, resulting in a problem with the delivery of oxygen and nutrients, and the removal of products formed during the metabolic process. This causes the development of hypoxia and disruption of microcirculation of organs and tissues. In addition, as a result of exposure to active biological substances, there is a rapid increase in the permeability of surface membranes in the cell, which leads to the occurrence of tissue edema (primarily in the brain and lung tissue) due to the transition of the liquid component of the blood into the interstitial space. It also causes blood to thicken and further reduce the volume of circulating blood. Against this background, in parallel, spasm of the larynx, as well as large and small bronchi, develops very quickly, which is manifested by the appearance of clinical signs of acute respiratory failure. In addition to the above, spasms of intestinal smooth muscles are also characteristic, Bladder and uterus.

Classification

Depending on the nature of clinical symptoms, there are five main forms of anaphylactic shock:

Hemodynamic, the clinical picture of which is dominated by signs of dysfunction of the cardiovascular system;
Asphyxial - the main clinical manifestation will be the development of acute respiratory failure;
Abdominal - characterized by abdominal pain;
Cerebral, in which signs of impaired cerebral blood flow dominate;
With damage to mucous membranes and skin.

Based on the nature of the shock, there are:

Acute malignant shock;
Benign;
Protracted;
Recurrent;
With an erased flow.

Clinical

This pathology is characterized by a sharp and sudden onset, the time for the development of a pronounced clinical picture is usually several seconds. Although in some cases it can take a couple of hours. The main signs of shock are caused by the development of blood flow disturbances and a drop in blood pressure, which can be wave-like. In addition, symptoms of dysfunction in other organs and systems are also characteristic:

After relief of the shock state, over the next three to four weeks the patient may retain signs of changes in function in various organs and their systems.

Delayed reactions of the allergic type, various pathological processes in the central nervous system, myocarditis of allergic etiology, glomerulonephritis, inflammation of blood vessels (vasculitis), nerve damage (neuritis), etc. may occur. That is why these patients require longer and enhanced medical supervision.

There are four degrees of severity of anaphylactic shock, which depend on the nature and severity of blood flow disturbance:

Grade 1 AS is characterized by a decrease in blood pressure by no more than forty mm. rt. Art. from its normal value. Precursors of the development of shock may appear: skin itching, rashes, cough, sore throat, etc. The patient’s consciousness is preserved, while he may be excited or lethargic, characterized by depression, anxiety, and fear of death. The skin turns red, urticaria and Quincke's edema may appear on it. A cough is also common. At this stage, all symptoms are easily relieved with the help of drugs from the groups of sympathomimetics and glucocorticoids;

Stage 2 severity of anaphylactic shock: blood pressure drops below one hundred mm. rt. Art., but above 60 mm. rt. Art. Consciousness at this stage is still preserved or is lost, but not immediately. A prodromal period may develop with the appearance of anxiety, fear of death, weakness, itching, urticaria, Quincke's edema, hoarseness (up to its complete disappearance), difficulty swallowing, dizziness, headache, tinnitus, paresthesia. Pain syndrome may also occur with pain localized in the abdomen, lower back and around the heart. Upon examination, you can see pale skin, often with a bluish tint, shortness of breath, difficulty breathing, pulmonary wheezing, and an increase in heart rate. Vomiting and involuntary passage of urine and feces as a result of relaxation of the sphincters of the rectum and bladder are also likely;
Stage 3 shock is characterized by loss of consciousness, which occurs very quickly, blood pressure drops below 60 mm. rt. Art. Very often, tonic and clonic convulsions occur, the patient becomes covered in sticky and cold sweat, the lips turn blue, and the pupils dilate. Heart sounds become muffled, the heart rhythm becomes irregular, the pulse becomes threadlike. At this stage, therapy rarely gives a positive result;
Stage 4 anaphylactic shock is characterized by rapid development with immediate loss of consciousness, blood pressure cannot be measured, heart sounds cannot be heard, and there is no breathing. At this stage, there is practically no response to therapy with sympathomimetics and glucocorticoids.

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The first signs of anaphylactic shock

Compared to the body’s usual negative reaction to an allergen, anaphylaxis is characterized by a tenfold increase in the rate of pathological changes in the victim’s body, as well as their severity. Almost all vital systems are affected:

respiratory;
circulatory;
heart;
skin;
brain;
mucous membranes.

Anaphylactic shock is especially dangerous for children who have not yet sufficiently developed all body systems, and also because of the narrowness of the respiratory lumen.

The table below discusses the characteristics of symptoms of anaphylaxis depending on exposure to the allergen.

Symptoms of anaphylactic shock
Classification	Form	Symptoms
Localization	Typical	Skin swelling, difficulty breathing, disruption of the circulatory system.
	Asphyxial	Spasm of the respiratory tract, swelling of the larynx and other respiratory organs, asphyxia.
	Cerebral	Damage to the central nervous system, up to cerebral edema (behavioral disturbances, excitability, fatigue).
	Abdominal	From the gastrointestinal tract there are all signs of poisoning (pain, vomiting, stool disturbances, nausea, flatulence, heartburn, belching, weakness, irritability).
	Hemodynamic	Disruption of the cardiovascular system (chest pain of varying nature and severity, interruptions in heart function, shortness of breath, swelling, changes in skin color, headaches and dizziness).
Heaviness	1 type	Blood pressure is below normal (systolic 110/120 and diastolic 70/90) by 30-40 units. The victim is conscious, but in a state of panic, there is a fear of death. Drug antishock treatment was successful on the first attempt.
	Type 2	Blood pressure is below normal (systolic 110/120 and diastolic 70/90) by 40-60 units. There is a possibility of loss of consciousness, which is confused. Numbness. The response to antishock therapy is good.
	Type 3	The pressure is below normal and cannot be determined by the meter (systolic 110/120 and diastolic 70/90) by 60-80 units. The victim is on the verge of losing consciousness. Very weak response to antishock therapy.
	4 type	Pressure cannot be determined. The victim is unconscious. There is no response to drug antishock therapy.
Speed	Malignant-acute	A sudden and significant drop in pressure, bronchospasm, respiratory failure, confusion, pulmonary edema, skin rashes, possible coma and death.
	Benign-acute	Manifestations from various body systems reach their peak (respiratory failure, skin manifestations, gastrointestinal disorder, central nervous system dysfunction) and gradually subside in response to timely anti-shock treatment.
	Abortive	Very mild manifestations, mainly from the respiratory system. Symptoms often go away without the use of medications.
	Protracted	All the symptoms of typical anaphylactic shock appear, but the response to treatment is weak. A relapse occurs with a sharp drop in pressure and other signs of anaphylaxis.
	Lightning fast	Symptoms appear within seconds (up to half a minute) and the condition worsens too quickly for therapy to be successful. There is a chance to survive only if adrenaline and other medications are administered almost simultaneously with the allergen.

Anaphylactic shock: emergency care

Anaphylactic shock is an allergic reaction in which providing assistance in the first minutes of the onset of negative symptoms can help the patient survive.

Emergency care for anaphylaxis is divided into pre-medical and medical (a table with the main algorithm of actions is presented below).

Type of "emergency"

Algorithm of actions

First aid

1. Ensuring normal blood flow (especially to the heart). To do this, the victim is placed on a flat surface, and his legs are raised above body level, using a roller made of clothing or other objects.

2. Ensuring the flow of oxygen and stopping the action of the allergen. To do this, open all the windows in the room where the patient is, and unbutton his clothes.

3. Call an ambulance.

4. Checking the victim’s mouth for displaced dentures that are interfering with breathing. If he has a recessed tongue, then you need to place a hard object between the teeth and turn your head to the left or right.

5. If the allergen entered the patient’s bloodstream through an injection or insect bite, then the area above the area of exposure should be tied with a tourniquet. Apply ice to the manipulation area.

6. Tell the emergency doctors about all the actions taken and the symptoms observed.

Health care

1. Administration of adrenaline solution in various ways, depending on the severity of the patient’s condition. Injection of the injection or bite site with a solution of adrenaline (0.1% at 4-6 points in a circle).

2. Intravenous or infusion administration of one of the following drugs: prednisolone, hydrocortisone or dexamethasone.

3. Introduction of a large volume of sodium chloride into the patient’s body (depending on the patient’s weight).

4. Inhalation of oxygen to the patient through a special mask. If necessary, a tracheotomy is performed.

5. Administration of antihistamines (with caution).

6. Observe the patient in the hospital for a week to avoid relapse.

What are the consequences of anaphylactic shock?

In addition to a possible relapse within 2-3 days, anaphylactic shock entails the following ailments:

kidney disease (glomerulonephritis);
bronchial asthma (chronic form);
disturbances in the functioning of the central nervous system;
toxic nerve pathology (polyneuropathy);
inflammation of the heart muscle (myocarditis);
bleeding in the gastrointestinal tract;
bronchospasms;
pulmonary edema;
cerebral edema;
cerebral hemorrhage;
to whom.

A victim of anaphylaxis can only be helped if immediate medical attention is provided. Healthy people Those who have relatives with allergies of any type need to be prepared for this severe reaction and take preventive measures (attentiveness to food and medications, caution during the seasonal flowering of certain plants, etc.).

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State of shock

Symptoms of anaphylactic shock

As you know, at the moment almost every second person on earth suffers from allergies. This can be a chronic form, in which the patient constantly experiences allergy symptoms, and sometimes an acute reaction appears only once and never overtakes the person again. But there are conditions that are not similar to a typical allergic reaction, and yet they can be fatal.
Shock is a state of the body in which it is under severe stress and cannot function normally. Metabolic processes in the brain are disrupted, which lead to irreversible consequences. Every fifth person who experiences this condition dies from anaphylactic shock, since symptoms develop very quickly, and first aid is often not provided at the right time. That is why it is worth knowing in detail what this condition is, how to recognize the first signs of anaphylaxis and help a person.

Causes of anaphylaxis

Chocolate is a strong allergen

Most often, anaphylactic shock is caused by poison entering the body. This could be a snake bite, an insect bite, or penetration chemical substances. Currently, cases of anaphylaxis after the administration of medications, as well as due to doctors’ errors during blood transfusions, immunotherapy, provocative tests and other manipulations, have become more frequent.
The main causes of anaphylactic shock:

Very often, foods cause severe reactions. Most often, such allergens are: chocolate, nuts, milk, citrus fruits. A person may have a very strong individual intolerance to a particular product. There are many cases of anaphylactic shock when eating peanut butter or chocolate. Moreover, this reaction most often develops in children. According to statistics, by the age of 16, those children who had allergies in childhood, but did not come into contact with a dangerous substance for many years, tolerate it normally in their youth.
In addition, there are a number of factors that influence susceptibility to anaphylaxis. These include bronchial asthma, Quincke's edema, eczema, and allergic rhinitis. If a person experiences frequent acute allergic reactions, there is a risk that anaphylactic shock may develop. If a person is constantly in contact with an allergen, this contributes to a state of shock. The longer the contact is, the lower the risk becomes. Therefore, prevention of anaphylactic shock includes complete avoidance of contact with allergens and constant monitoring by a doctor.

Pathogenesis of the disease

Anaphylaxis is based on hypersensitivity, and it has a lightning-fast character. Symptoms can develop in just a few minutes. In rare cases, anaphylactic shock develops up to 5 hours, and the longer the symptoms take to develop, the easier it is to save the person.
The main and significant symptom of anaphylactic shock is poor circulation due to the active production of histamine and other substances. As a result, blood pressure drops to critical levels, brain starvation occurs, the person often loses consciousness, and convulsions may begin.
The reaction mainly develops from a large dose of the allergen (from bites or injections), as well as upon repeated contact, when antibodies combine with newly received allergens and spread internally through the bloodstream. The longer a person is in contact with a substance, the greater the likelihood of shock. Treatment of anaphylactic shock is a long and difficult process, with assistance in the first minutes of the onset of anaphylaxis playing a key role.

Types of anaphylaxis

There are several varieties of this condition:

Let us dwell in more detail on anaphylactic shock itself and its types.

Lightning Shock

This condition develops very quickly, literally in a few minutes, and the person feels a sharp deterioration in health. If you do not get your bearings in time and do not start emergency care, a rapid onset of death is possible.

Every fifth person dies from this condition because those around them do not have time to provide help.
Characterized by the following symptoms:

Lightning shock may not even be accompanied by the usual allergy symptoms, so it is very difficult to distinguish it from other types of shock conditions. It is necessary to devote all efforts to maintaining the patient’s stable condition, immediately call an ambulance and not panic.

Acute anaphylactic shock

Headache anaphylactic shock is more common in older people

With anaphylactic shock, the condition begins to develop like a typical allergy. Within a few minutes the following symptoms appear:

After all these symptoms, shock becomes lightning fast if the necessary assistance is not provided at the first stage. With an acute anaphylactic reaction, the chances of saving the patient's life are much higher, since anaphylaxis is easier to recognize and symptoms develop more slowly. However, this does not reduce the danger, so ambulance must be called immediately.

Subacute anaphylactic shock

If we compare the prognosis for the course of the disease, then this type of shock is the most favorable, since in this case the symptoms develop even more slowly than in the acute form. The person manages to take antihistamines or limit contact with the allergen. If this does not happen, the reaction develops further, moving along the chain into acute and then lightning fast. This is why preventing anaphylactic shock is so important. If you notice allergy symptoms, take immediate action to prevent the condition from getting worse, otherwise it can lead to dire consequences.

First aid

In case of anaphylactic shock, first aid plays a key role, which must be provided to the person who is next to the victim. This will help save a person’s life and maintain his condition until the ambulance arrives.

The algorithm of actions is as follows:

First aid

This stage is carried out by an ambulance team that arrives on call. First of all, doctors administer a dose of adrenaline and prednisole to the victim in order to stop the development of anaphylactic shock. Further measures are carried out on the way to the hospital. It is necessary to provide the patient with access to oxygen if the airways become swollen. For this, doctors use aminophylline, which is administered intravenously by stream or drip. If measures do not help, opening the trachea and artificial ventilation of the lungs is possible. The patient is given a large dose of hormonal drugs to stabilize the condition. Further measures are carried out in a hospital setting.

Inpatient treatment of anaphylactic shock

Dropper for purifying blood from antibodies

At this stage, doctors direct all efforts to stabilize metabolic processes, since the consequences of anaphylactic shock can lead to irreversible changes in the brain. The patient is prescribed droppers that cleanse the blood of antibodies, as well as therapy, which includes taking antihistamines as prescribed by a doctor, anti-inflammatory drugs, and other medications. It is necessary to completely restore all functions of the internal organs and establish the reason why such a reaction occurred.
When the patient returns to normal, it is necessary to conduct a diagnosis to identify which substances caused anaphylactic shock. If these were medications, this data should be entered into the medical record so that there is no relapse. You will have to stay away from provoking foods. During recovery, a hypoallergenic diet is prescribed so that nothing provokes the production of histamine in the body.

It should be remembered: the most common cause leading to anaphylactic shock is self-administration. medicines without the consent of the doctor. You should not self-medicate, it can be very dangerous!

Sometimes such a reaction is caused by provocative tests, which are carried out under the close supervision of doctors, only in a hospital setting. Such studies are not prescribed to young children, and adults are warned in advance what the consequences may be. However, if anaphylaxis develops, doctors are ready to immediately provide the necessary assistance to stabilize the patient’s condition.
Allergies are a very dangerous disease if not taken seriously. Even the slightest ailments can develop into dangerous conditions, such as anaphylactic shock, so you need to monitor your body, do not neglect the advice of doctors and do not prescribe any medications yourself.

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Features of the disease

Anaphylactic shock (anaphylaxis, allergic shock) is an acute, rapidly developing pathological reaction of the body in response to an attack (shock) of allergens, in which all systems and organs experience extremely pronounced painful changes, often incompatible with life (every 5 - 10 patient). The speed of all processes characteristic of a banal allergy, in the case of shock, accelerates, and their severity increases tens of times.

Affected:

all organs and respiratory tracts, vessels and capillaries;
brain, heart;
organs of the gastrointestinal system;
skin and mucous membranes.

The video below will tell you what anaphylactic shock is:

Children

Anaphylaxis poses a particular danger to the child’s body due to the insufficient development of many systems and organs, protective function, anatomical and physiological characteristics. For example, swelling of the larynx in a child is a critical condition, since the respiratory lumen is extremely small and swelling of the mucous membrane to a thickness of only 1 mm will easily block the access of air to a newborn and infant.

At this age, vaccinations and medications often provoke an acute allergic reaction. But if in adults shock usually occurs during the secondary penetration of allergens into the blood, then in children anaphylaxis can develop upon first contact with the provocateur of allergic shock, if the mother used a certain medication during pregnancy and breastfeeding, and it passed through the placenta or milk into the blood. baby's blood. Moreover, neither the dose nor the method of administration of the pharmacological agent matters if the child is already sensitized (has increased sensitivity to a specific substance).

In addition, children are more likely to develop anaphylaxis to foods.

Pregnancy

Pregnancy also creates special vulnerabilities for the expectant mother and fetus. With the overload experienced by the heart and vascular system during anaphylaxis, the likelihood of miscarriages, early placental abruption, premature birth and intrauterine death is very high. The pregnant woman herself is also at risk for catastrophic bleeding, stroke, respiratory failure, and heart failure.

Read about the types and forms of anaphylactic shock below.

Classification

According to flow forms

Classification according to the forms of anaphylactic shock (AS) is tied to the key signs of the disorder specific systems and target organs to which the main aggression of allergens is directed.

According to the course, anaphylaxis is divided into forms:

Typical. It occurs most often, accompanied by dysfunction of blood vessels, organs and respiratory tracts, skin and subcutaneous edema.
Hemodynamic. Accompanied by impaired blood circulation, insufficient functioning of the myocardium and heart vessels.
Asphyxial, with the dominance of manifestations of acute respiratory failure, swelling and spasms of the respiratory tract, reaching the degree of asphyxia (suffocation).
Abdominal or gastrointestinal form with symptoms of acute poisoning, “acute abdomen,” diseases of the stomach and intestines.
Cerebral, with characteristic lesions of the central trunks nervous system, cerebral vessels developing before cerebral edema.
Form of AS, provoked physical overload.

According to severity

The severity of the pathology according to the criteria:

Basic criterion	Severity
I	II	III	IV
Blood pressure in mm Hg. Art.	below the normal value 110 – 120 / 70 – 90 by 30 – 40 units	Systolic (upper) 90 – 60 and below, diastolic (lower) 40 and below	Upper 60 – 40, lower - up to 0 (not determined during measurement)	Not defined
Consciousness	Saved. Severe panic, fear of death	Confused consciousness, state of stupor (numbness), possibility of loss of consciousness	High risk of loss of consciousness	Sudden loss of consciousness
Patient's response to antishock treatment	Active	Good or satisfactory	Weak	Weak or absent

The severity of the shock determines the time of onset of the first signs. The sooner symptoms begin to appear from the moment the allergen enters the body, the more severe the manifestations of anaphylaxis.

By type of flow

Classification of AS according to the type of flow:

Leakage / type	Peculiarities
Acute malignant. More common in the typical form.	sudden progressive onset; a sharp drop in blood pressure (lower - systolic drops to 0); confusion, progression of signs of respiratory distress, bronchospasm. the severity of the manifestations increases, the reaction to active treatment weak or absent. severe pulmonary edema develops, a persistent decrease in pressure, and a coma occur. The patient's risk of death is high.
Acute benign	The main pathological manifestations are quite pronounced. But during therapy they are not characterized by an increase, they can be reversed and subside. A favorable prognosis is highly likely with emergency treatment.
Abortive	Pathological symptoms are mild and quickly suppressed, often without the use of drugs. Occurs in asthma patients taking hormones (Prednisolone, Dexamethasone).
Lingering	Both types are characterized by: A fast start. Typical clinical manifestations of anaphylaxis. Treatment for a protracted type of course gives a temporary, partial effect. The relapsing course is characterized by a secondary sharp drop in blood pressure after it has stabilized and the patient has recovered from the acute condition. The remaining symptoms are not as pronounced as in acute types of pathology, but are difficult to respond to therapy. More often observed with long-term use patients with long-acting medications (for example, Bicillin).
Recurrent
Lightning fast	Lightning-fast development of an anaphylactic reaction - within 10 – 30 seconds. More often this happens when the medicine is injected into a vein. The prognosis is disappointing. A favorable outcome is possible only with the equally immediate administration of adrenaline and other antishock agents.

Read more about the causes of anaphylactic shock.

Causes

Development mechanism

Stage I

Sensitization (abnormal increase in sensitivity to a specific allergen substance).

The initial ingress of an allergen is perceived by the immune system as the penetration of a foreign agent, to which special protein compounds are produced - immunoglobulins E, G, after which the body is considered sensitized, that is, ready to attack allergic reaction when the allergen is reintroduced. Immunoglobulins bind to immune (mast) cells.

Stage II

Directly - an anaphylactic reaction.

When the allergen enters the blood again, immunoglobulins immediately come into contact with it, after which specific substances are released from mast cells that regulate allergic and inflammatory reactions, the main of which is histamine. It causes swelling, itching, vasodilation - and, as a result, a drop in pressure and breathing problems. During anaphylactic shock, histamine is released simultaneously and in a huge volume, which leads to catastrophic disruption of the functioning of all organs.

Main reasons

Among the many reasons for the development of AS, they include, firstly, the administration of drugs, including:

antibiotics (penicillin, aminoglycosides, Metronidazole, Trimethoprim, Vancomycin);
Aspirin, other non-hormonal anti-inflammatory drugs (NSAIDs);
ACE inhibitors (drugs for hypertension - Enalapril, Fosinopril, Captopril, even if the medicine had been taken for several years before);
sulfonamides, iodinated drugs, B vitamins;
plasma expanders, iron supplements, nicotinic acid, No-spa, immunoglobulins.

Other reasons for the development of AS:

Risk factors:

Existing allergic diseases (urticaria, atopic dermatitis, allergic rhinitis)
Chronic diseases of the respiratory organs, including asthma, chronic pneumonia, bronchitis, bronchial obstruction).
Diseases of the heart and blood vessels
The presence of previous anaphylactic reactions.
Concomitant treatment of the patient with the following drugs:
- beta-blockers (the reaction of the respiratory tract to histamine, bradykinin increases and the effect of adrenaline used to bring the patient out of shock decreases).
- MAO inhibitors (suppress the enzyme that breaks down adrenaline, thus enhancing side effect adrenaline).
- ACE inhibitors (can cause swelling of the larynx, tongue, pharynx with the development of suffocation, “Capoten cough”).

Signs of anaphylactic shock

Symptoms

The initial manifestations of the rapid development of anaphylaxis are observed already in the first seconds after the allergen enters the blood. This usually happens when the medicine is injected into a vein. The typical increase in symptoms ranges from 5 to 40 minutes.

But a two-phase course of anaphylactic shock is often observed, when after all the symptoms subside against the background of intensive treatment, after a day or three, a second wave of anaphylaxis may suddenly begin.

The basic symptoms of anaphylactic shock are often combined or manifested in a complex manner - in accordance with the forms of AS:

Frequency of manifestations	Signs
9 times out of 10	exhaustion, dizziness, fear of death; feeling of heat on the face, hyperemia (redness) of the skin; itchy rash, red spots and blisters like urticaria (with the rapid development of pathology - changes in the skin occur later than other symptoms); swelling of the larynx, lips, tongue, pharynx, eyelids, genitals, fingers, neck decrease in pressure.
In half of the patients	swelling of the sinuses, sneezing, mucus from the nose; bouts of dry cough; feeling of a lump in the throat, shallow heavy breathing, hoarseness; stridor (wheezing in and out), wheezing in the lungs; bronchospasm; sharp pallor, blueness of the lips, skin around the nose and mouth, nail plates; eye irritation, itching; loss of consciousness.
In a third of patients	pressing or throbbing pain in the head; significant and sharp decrease in pressure; pain and a feeling of compression behind the sternum, in the pericardial region; slowing of the pulse, disruption of the rhythm of heart contractions.
Each has 3–4 patients	itching of the oral mucosa; difficulty swallowing; attacks of nausea, vomiting, loose stools, cramping pain, cramps in the stomach and intestines.
In 5 – 10% of anaphylaxis:	numbness of the facial muscles, lips; visual impairment (blurredness, double vision, hazyness); panic attacks, tremor (shaking), convulsions; uncontrolled urination and bowel movements; cerebral edema.

Diagnostics

If episodes of an anaphylactic reaction have never been detected in a patient before, then studies are not able to predict its manifestation in the future, that is, to predict its development. However, the probability of its occurrence can be predicted to one degree or another:

absolutely everyone who suffers from any form of allergy;
in people whose relatives (especially parents) have experienced a similar experience of anaphylaxis.

Since anaphylaxis is a condition in which all manifestations increase very quickly, the diagnosis is most often made already during the development of the pathology, based on the speed of development of symptoms, and even more often - after treatment or death. Since delay in such a situation leads to the death of the patient, a detailed study of each symptom at this moment is impossible and simply extremely dangerous.

The danger of a false diagnosis

On the other hand, due to lack of time and lack of professionalism, false diagnoses are often made.

For example, with the development of gastrointestinal (abdominal form) anaphylaxis, all the signs are very similar to the symptoms of acute poisoning, appendicitis, pancreatitis, biliary colic.
In the hemodynamic form, with its severity of heart pain and manifestations of insufficiency, the person is diagnosed with myocardial infarction.
Bronchial spasms, shortness of breath and even swelling of the larynx are considered signs of an asthmatic attack, and brain and neurological disorders are considered to be strokes, meningitis and other diseases that have nothing to do with anaphylactic shock.

Such false diagnoses are deadly for the patient, since there is simply no time left for proper treatment.

Actions for AS

Identifying the problem

Identification of the aggressor allergen that caused anaphylactic shock is a very important stage that should be included directly in the treatment of the pathology. If the patient has not experienced allergic reactions, special studies are carried out. They are able to confirm the diagnosis of allergization of the body as a whole, as well as the causative allergen in a specific case of anaphylaxis.

Among them are:

skin, skin, patch tests (Patch test);
blood test for the presence of immunoglobulins E (IgE), responsible for allergic reactions;
provocative tests.

To ensure the safety of the patient's health in the event of a sharp response to an allergy provocation, all studies are carried out with a high degree of caution. The safest radioimmunological method is considered to be the allergen sorbent test (RAST), which most accurately determines the anaphylactic allergen without affecting the structure of the body.

Safety is ensured by conducting the analysis outside the patient’s body. The blood taken from the patient is alternately added different kinds allergens. If, after the next interaction of blood with an allergen, an abnormal amount of antibodies is released, this indicates this allergen as the cause of an anaphylactic reaction.

This video will tell you about first aid for anaphylactic shock:

Treatment

In the hospital - in the intensive care unit and department intensive care carry out the main treatment of anaphylactic shock.

Basic principles

Basic principles of treatment of anaphylactic shock:

Elimination of serious dysfunctions in the functioning of the heart muscle, blood vessels, respiratory and nervous systems.
Prevention of a sudden drop in pressure and the development of coma.
Prevention of pulmonary edema, cerebral edema, asphyxia, cardiac arrest.
Removing life-threatening edema of the larynx, trachea, and bronchi.
Suppression of further releases of histamine, bradykinin, kallikrein and removal of allergen substances from the blood.

We will talk further about whether adrenaline is administered for anaphylactic shock and what other medications are needed.

Activities and medications

Intramuscular injections of Adrenaline (epinephrine) 0.1% after 10 - 15 minutes, 0.2 - 0.8 ml. When calculating children's doses, take into account the norm of 0.01 mg (0.01 ml) per kilogram of the baby's weight. If a positive reaction does not occur, administer intravenous injection of 1 ml of adrenaline in 10 ml of NaCl solution - slowly - 5 minutes to prevent myocardial ischemia. Or 1 ml of medicine in 400 ml of NaCl through a dropper, which is more rational.
Infusion of fluids to prevent coma: 1 liter of NaCL solution, then 0.4 liters of Polyglucin. Initially, a jet injection of up to 500 ml is provided in 30 - 40 minutes, later - through a dropper. It is believed that colloidal solutions fill the vascular bed more actively, but crystalloid liquids are safe, since dextrans themselves can cause anaphylaxis.
Glucocorticoids.
- Hydrocortisone into a muscle or vein: adults from 0.1 to 1 gram. For children, intravenous injections from 0.01 to 0.1 grams.
- Dexamethasone: 4 – 32 mg intramuscularly, daily dose for intravenous injections 3 mg per kilogram. After the patient has recovered from the acute condition, Dexamethasone tablets are prescribed in a daily dose of up to 15 mg. Children's doses are calculated based on the weight of the children: from 0.02776 to 0.16665 mg per kilogram.
- Prednisolone: 150–300 mg once intramuscularly, infants up to one year old per kilogram of weight 2–3 mg, from 1 year to 14 years 1–2 mg.
Means for restoring respiratory patency and relieving bronchospasm, suppressing histamine releases.
- Eufillin 2.4% 5 – 10 ml intravenously. Drip administration provides a dose of 5.6 mg per kilogram (20 ml of the drug is diluted in 20 ml of 0.9% NaCl and 400 ml of saline). The highest doses per day per kilogram of weight: 10 - 13 mg, children from 6 years old - 13 mg (0.5 ml), from 3 to 6, 20 - 22 mg (0.8 - 0.9 ml). Eufillin is used with caution in the last trimester of pregnancy, since tachycardia is possible in the mother and fetus.
- In addition to Euphyllin, Aminophylline, Albuterol, and Metaproterol are used.
Medicines to activate the heart. Atropine 0.1% subcutaneously 0.25 – 1 mg. Children's single doses are prescribed according to weight and age in the range of 0.05 - 0.5 mg.

Medicines that prevent low blood pressure and increase cardiac output.
- Dopamine. Use intravenously after dilution in a solution of 5% glucose or sodium chloride. Adults (per kilogram of body weight per minute) from minimum dosages of 1.5 - 3.5 mcg (infusion rate 100 - 250 mcg / min) to 10.5 - 21 mcg (750 - 1500 mcg per minute). For children over 12 years of age, the highest dose per kilogram is 4 - 8 mcg (per minute).
- In pregnant patients, Dopamine is used only when there is a threat to the life of the mother; no teratogenic (disfiguring) effect of Dopamine has been identified. Breast-feeding stop.

Antihistamines, which stop the release of allergy-provoking substances into the blood, eliminate itching, swelling, and hyperemia. It is rational to prescribe after restoration of the circulating blood volume, since they can lower blood pressure.
- Intramuscular: Suprastin (20 mg) 2 – 4 ml; initial pediatric doses: 6 – 14 years up to 1 ml, 1 – 6 years 0.5 ml, from a month to a year 0.25 ml. The highest single dose per kilogram of weight cannot exceed 2 mg.
- Pipolfen, Tavegil, Diphenhydramine are also used.

After the acute period has passed, the patient is prescribed glucocorticosteroids in tablets with a gradual reduction in dosage over 7 to 10 days, and antihistamines.

Therapeutic treatment

Oxygen therapy. Helps with buildup oxygen starvation tissues and bronchospasm.
Hemosorption– a special extrarenal technique for removing allergens from the blood by passing it through sorbents.

All patients who have experienced anaphylaxis should be observed in the hospital for up to 2–3 weeks, due to the likelihood of developing repeated anaphylaxis and late complications from the heart, blood vessels, respiratory and urinary systems.

Therefore, in the hospital they do the following several times:

blood and urine tests;
study of urea and creatinine levels in the blood;
electrocardiogram or ultrasound of the heart;
stool examination for Gregersen's reaction.

Disease prevention

To reduce the risk of developing AS in people with high probability exposure to an allergen is necessary:

be sure to have a set of medications emergency care(we wrote separately about the standard of its provision for anaphylactic shock):
- adrenaline solution;
- Prednisolone in ampoules;
- Ventolin, Salbunanol;
- Suprastin or Tavegil or Diphenhydramine (ampoules)
- tourniquet
be able to use an automatic syringe for injecting adrenaline (Epi-pen, Allerjet);
avoid insect bites (cover open areas, do not eat sweets and ripe fruits outside the home), use special repellents;
correctly evaluate the components in the products you eat to avoid the penetration of allergens through the stomach;
at work, avoid contact with industrial chemicals, inhalation and skin allergens;
do not use β-blockers if there is a risk of developing severe anaphylaxis, replacing them with medications of another group;
when conducting studies using radiopaque agents, inject Prednisolone in advance
do allergy tests from medications and other substances;
choose medications in tablets rather than injections;
always have with you a “passport” (card, bracelet, pendant) with information about allergic diseases and medications that help with AS.

About possible complications after an allergic reaction such as anaphylactic shock, read on.

Complications

Severe complications can be diagnosed:
Glomerulonephritis
Intestinal and stomach bleeding
Cardiac pathologies, including myocarditis
Bronchospasm and pulmonary edema;
Swelling and bleeding in the brain

If help is delayed, the pulse becomes weak, the person loses consciousness, and there is a high risk of death.

Forecast

The prognosis is favorable only in case of immediate medical assistance with an accurate diagnosis and emergency hospitalization of the patient.

However, even relief of an acute state of anaphylaxis with medications does not mean that everything ended well, since there is a high probability of a secondary drop in pressure and the development of anaphylaxis (usually within 3 days, but a longer period also occurs).

This video will tell you what to do when anaphylactic shock occurs:

Laying anaphylactic shock in the treatment room

Anaphylactic shock is a dangerous, rapidly developing pathological reaction of the body to an allergen. This condition can be very Negative consequences. And this article will therefore tell you about the pathogenesis of anaphylactic shock in children and adults, give clinical recommendations and tell you what first aid kit you need to have if you are overtaken by anaphylactic shock.

Features of the disease

Affected:

all organs and respiratory tracts, vessels and capillaries;
brain, heart;
organs of the gastrointestinal system;
skin and mucous membranes.

The highest frequency of this immediate allergic reaction occurs in women, boys and young men.

The video below will tell you what anaphylactic shock is:

Children

In addition, children are more likely to develop anaphylaxis to foods.

Pregnancy

Read about the types and forms of anaphylactic shock below.

Classification

According to flow forms

Classification according to the forms of anaphylactic shock (AS) is based on key signs of disorder of specific systems and target organs, which are the main targets of allergen aggression.

According to the course, anaphylaxis is divided into forms:

Typical. It occurs most often, accompanied by dysfunction of blood vessels, organs and respiratory tracts.
Hemodynamic. Accompanied by impaired blood circulation, insufficient functioning of the myocardium and heart vessels.
Asphyxial, with the dominance of manifestations of acute respiratory failure, swelling and spasms of the respiratory tract, reaching the degree of asphyxia (suffocation).
Abdominal or gastrointestinal form with symptoms of acute poisoning, “acute abdomen,” diseases of the stomach and intestines.
Cerebral, with characteristic lesions of the central trunks of the nervous system, cerebral vessels, developing to cerebral edema.
Form of AS, provoked physical overload.

According to severity

The severity of the pathology according to the criteria:

Basic criterion	Severity
I	II	III	IV
Blood pressure in mm Hg. Art.	below the normal value 110 – 120 / 70 – 90 by 30 – 40 units	Systolic (upper) 90 – 60 and below, diastolic (lower) 40 and below	Upper 60 – 40, lower - up to 0 (not determined during measurement)	Not defined
Consciousness	Saved. Severe panic, fear of death	Confused consciousness, state of stupor (numbness), possibility of loss of consciousness	High risk of loss of consciousness	Sudden loss of consciousness
Patient's response to antishock treatment	Active	Good or satisfactory	Weak	Weak or absent

By type of flow

Classification of AS according to the type of flow:

Leakage / type	Peculiarities
Acute malignant. More common in the typical form.	sudden progressive onset; a sharp drop in blood pressure (lower - systolic drops to 0); confusion, progression of signs of respiratory distress, bronchospasm. the severity of manifestations increases, the response to active treatment is weak or absent. severe pulmonary edema develops, a persistent decrease in pressure, and a coma occur. The patient's risk of death is high.
Acute benign	The main pathological manifestations are quite pronounced. But during therapy they are not characterized by an increase, they can be reversed and subside. A favorable prognosis is highly likely with emergency treatment.
Abortive	Pathological symptoms are mild and quickly suppressed, often without the use of drugs. Occurs in asthma patients taking hormones (Prednisolone, Dexamethasone).
Lingering	Both types are characterized by: A fast start. Typical clinical manifestations of anaphylaxis. Treatment for a protracted type of course gives a temporary, partial effect. The relapsing course is characterized by a secondary sharp drop in blood pressure after it has stabilized and the patient has recovered from the acute condition. The remaining symptoms are not as pronounced as in acute types of pathology, but are difficult to respond to therapy. It is more often observed when patients take long-acting medications (for example, Bicillin) for a long time.
Recurrent
Lightning fast	Lightning-fast development of an anaphylactic reaction - within 10 – 30 seconds. More often this happens when the medicine is injected into a vein. The prognosis is disappointing. A favorable outcome is possible only with the equally immediate administration of adrenaline and other antishock agents.

Read more about the causes of anaphylactic shock.

Causes

Development mechanism

Stage I

Sensitization (abnormal increase in sensitivity to a specific allergen substance).

The initial ingress of an allergen is perceived by the immune system as the penetration of a foreign agent, to which special protein compounds are produced - immunoglobulins E, G, after which the body is considered sensitized, that is, ready for a sharp allergic reaction when the allergen is reintroduced. Immunoglobulins bind to immune (mast) cells.

Stage II

Directly - an anaphylactic reaction.

When the allergen enters the blood again, immunoglobulins immediately come into contact with it, after which specific substances are released from mast cells that regulate allergic and inflammatory reactions, the main of which is histamine. It causes swelling, dilation of blood vessels - and, as a result, a drop in pressure and breathing problems. During anaphylactic shock, histamine is released simultaneously and in a huge volume, which leads to catastrophic disruption of the functioning of all organs.

With anaphylaxis, a similar pathological process, if medical intervention does not occur, develops rapidly, irreversibly leading to death.

Main reasons

Among the many reasons for the development of AS, they include, firstly, the administration of drugs, including:

antibiotics (penicillin, aminoglycosides, Trimethoprim, Vancomycin);
Aspirin, other non-hormonal anti-inflammatory drugs (NSAIDs);
ACE inhibitors (hypertension medications - Fosinopril, even if the medicine has been taken for several years before);
sulfonamides, iodinated drugs, B vitamins;
plasma expanders, iron supplements, nicotinic acid, immunoglobulins.

With intravenous infusion of the medication, the reaction develops after 10–15 seconds, with intramuscular injection - after 1–2 minutes, when taking tablets and capsules - after 20–50 minutes.

Risk factors:

Existing allergic diseases (allergic rhinitis)
Chronic diseases of the respiratory organs, including asthma, chronic pneumonia, bronchitis, bronchial obstruction).
Diseases of the heart and blood vessels
The presence of previous anaphylactic reactions.
Concomitant treatment of the patient with the following drugs:
- beta-blockers (the reaction of the respiratory tract to histamine, bradykinin increases and the effect of adrenaline used to bring the patient out of shock decreases).
- MAO inhibitors (suppress the enzyme that breaks down adrenaline, thus increasing the side effects of adrenaline).
- ACE inhibitors (can cause swelling of the larynx, tongue, pharynx with the development of suffocation, “Capoten cough”).

Signs of anaphylactic shock

Symptoms

The basic symptoms of anaphylactic shock are often combined or manifested in a complex manner - in accordance with the forms of AS:

Frequency of manifestations	Signs
9 times out of 10	exhaustion, fear of death; feeling of heat on the face, hyperemia (redness) of the skin; itchy rash, red spots and blisters like urticaria (with the rapid development of pathology - changes in the skin occur later than other symptoms); swelling of the larynx, lips, tongue, pharynx, eyelids, genitals, fingers, neck decrease in pressure.
In half of the patients	swelling of the sinuses, sneezing, mucus from the nose; bouts of dry cough; feeling of a lump in the throat, shallow heavy breathing, hoarseness; stridor (wheezing in and out), wheezing in the lungs; bronchospasm; sharp, blue discoloration of lips, skin around the nose and mouth, nail plates; eye irritation, itching;
In a third of patients	pressing or throbbing pain in the head; significant and sharp decrease in pressure; pain and a feeling of compression behind the sternum, in the pericardial region; , failure in the rhythm of heart contractions.
Each has 3–4 patients	itching of the oral mucosa; difficulty swallowing; attacks, vomiting, loose stools, cramping pain, spasms in the stomach and intestines.
In 5 – 10% of anaphylaxis:	numbness of the facial muscles, lips; visual impairment (blurredness, double vision, hazyness); panic attacks, tremor (shaking), convulsions; uncontrolled urination and bowel movements; cerebral edema.

Diagnostics

absolutely everyone who suffers from any form of allergy;
in people whose relatives (especially parents) have experienced a similar experience of anaphylaxis.

The danger of a false diagnosis

On the other hand, due to lack of time and lack of professionalism, false diagnoses are often made.

For example, with the development of gastrointestinal (abdominal form) anaphylaxis, all the signs are very similar to the symptoms of acute poisoning, appendicitis, pancreatitis, biliary colic.
In the hemodynamic form, with its severity of heart pain and manifestations of insufficiency, the person is diagnosed with "".
Spasm of the bronchi, and even swelling of the larynx are considered signs of an asthmatic attack, and brain and neurological disorders are considered to be other diseases that have nothing to do with anaphylactic shock.

Such false diagnoses are deadly for the patient, since there is simply no time left for proper treatment.

Therefore, if, after a glass of orange juice, severe chest pain suddenly occurs, this immediately indicates the development of anaphylaxis. And you don't need to wait for any other signs.

Actions for AS

Identifying the problem

Among them are:

skin, skin, patch tests (Patch test);
blood test for the presence of immunoglobulins E (IgE), responsible for allergic reactions;

Safety is ensured by conducting the analysis outside the patient’s body. Different types of allergens are added alternately to the blood taken from the patient. If, after the next interaction of blood with an allergen, an abnormal amount of antibodies is released, this indicates this allergen as the cause of an anaphylactic reaction.

This video will tell you about first aid for anaphylactic shock:

Treatment

In the hospital - in the intensive care unit and intensive care unit, the main treatment of anaphylactic shock is carried out.

Basic principles

Basic principles of treatment of anaphylactic shock:

Elimination of serious dysfunctions in the functioning of the heart muscle, blood vessels, respiratory and nervous systems.
Prevention of a sudden drop in pressure and the development of coma.
Prevention, brain, asphyxia, cardiac arrest.
Removing life-threatening edema of the larynx, trachea, and bronchi.
Suppression of further releases of histamine, bradykinin, kallikrein and removal of allergen substances from the blood.

We will talk further about whether adrenaline is administered for anaphylactic shock and what other medications are needed.

Activities and medications

Intramuscular injections of Adrenaline (epinephrine) 0.1% after 10 - 15 minutes, 0.2 - 0.8 ml. When calculating children's doses, take into account the norm of 0.01 mg (0.01 ml) per kilogram of the baby's weight. If a positive reaction does not occur, administer intravenous injection of 1 ml of adrenaline in 10 ml of NaCl solution - slowly - 5 minutes to prevent myocardial ischemia. Or 1 ml of medicine in 400 ml of NaCl through a dropper, which is more rational.
Infusion of fluids to prevent coma: 1 liter of NaCL solution, then 0.4 liters of Polyglucin. Initially, a jet injection of up to 500 ml is provided in 30 - 40 minutes, later - through a dropper. It is believed that colloidal solutions fill the vascular bed more actively, but crystalloid liquids are safe, since dextrans themselves can cause anaphylaxis.
Glucocorticoids.
- Hydrocortisone into a muscle or vein: adults from 0.1 to 1 gram. For children, intravenous injections from 0.01 to 0.1 grams.
- : 4 – 32 mg intramuscularly, daily dose for intravenous injections 3 mg per kilogram. After the patient has recovered from the acute condition, Dexamethasone tablets are prescribed in a daily dose of up to 15 mg. Children's doses are calculated based on the weight of the children: from 0.02776 to 0.16665 mg per kilogram.
- : 150 – 300 mg once intramuscularly, infants up to one year old per kilogram of weight 2 – 3 mg, from 1 year to 14 years 1 – 2 mg.
Means for restoring respiratory patency and relieving bronchospasm, suppressing histamine releases.
- 2.4% 5 – 10 ml intravenously. Drip administration provides a dose of 5.6 mg per kilogram (20 ml of the drug is diluted in 20 ml of 0.9% NaCl and 400 ml of saline). The highest doses per day per kilogram of weight: 10 - 13 mg, children from 6 years old - 13 mg (0.5 ml), from 3 to 6, 20 - 22 mg (0.8 - 0.9 ml). Eufillin is used with caution in the last trimester of pregnancy, since tachycardia is possible in the mother and fetus.
- In addition to Euphyllin, Aminophylline, Albuterol, and Metaproterol are used.
Medicines to activate the heart. Atropine 0.1% subcutaneously 0.25 – 1 mg. Children's single doses are prescribed according to weight and age in the range of 0.05 - 0.5 mg.

Medicines that prevent low blood pressure and increase cardiac output.
- Dopamine. Use intravenously after dilution in a solution of 5% glucose or sodium chloride. Adults (per kilogram of body weight per minute) from minimum dosages of 1.5 - 3.5 mcg (infusion rate 100 - 250 mcg / min) to 10.5 - 21 mcg (750 - 1500 mcg per minute). For children over 12 years of age, the highest dose per kilogram is 4 - 8 mcg (per minute).
- In pregnant patients, Dopamine is used only when there is a threat to the life of the mother; no teratogenic (disfiguring) effect of Dopamine has been identified. Breastfeeding is stopped.

Antihistamines, which stop the release of allergy-provoking substances into the blood, eliminate itching, swelling, and hyperemia. It is rational to prescribe after restoration of the circulating blood volume, since they can lower blood pressure.

Anaphylactic shock is a severe, life-threatening pathological condition that develops when the body comes into contact with certain foreign substances (antigens). Anaphylactic shock refers to allergic reactions immediate type, in which the combination of antigen with antibodies causes the release into the bloodstream of a number of biologically active substances(histamine, bradykinin). These substances cause increased permeability of blood vessels, impaired blood circulation in small blood vessels, spasm of the muscles of internal organs and a number of other disorders. Blood accumulates in the periphery, blood pressure drops, internal organs and the brain do not receive enough oxygen, which is the main reason.

You need to understand that such a reaction of the body to foreign substances is inadequate, hyperergic (i.e. super strong). The severity of a person’s condition is due to a failure of the immunological response of the body itself.

Causes of anaphylactic shock

Most common reasons the development of anaphylactic shock are insect bites and the administration of medications (such as penicillin, sulfonamides, serums, etc.). Such reactions occur less frequently for food products(chocolate, peanuts, oranges, mangoes, various types of fish), inhalation of pollen or dust.

Symptoms of anaphylactic shock

The clinical picture of anaphylactic shock is characterized by rapid development; symptoms appear within a few seconds or minutes after contact with the allergen.

depression of consciousness;
drop in blood pressure;
convulsions;
involuntary urination.

In most patients, the disease begins with the appearance of a feeling of heat, skin flushing, fear of death, and chest pain. Blood pressure drops sharply, the pulse becomes thready.

Possible variants of anaphylactic shock with a predominant lesion:

skin with increasing skin itching, hyperemia, the appearance of widespread urticaria and Quincke's edema;
nervous system (cerebral variant) with the development of severe headache, nausea, increased tactile sensitivity, convulsions with involuntary urination and defecation, loss of consciousness;
respiratory organs ( asthmatic variant) with dominant suffocation due to swelling of the mucous membrane and spasm of the smooth muscles of the upper respiratory tract;
heart (cardiogenic) with the development of a picture of acute myocarditis or myocardial infarction.

The diagnosis is usually made based on the clinical picture.

What can you do (first aid for anaphylactic shock)

At the slightest suspicion of the development of anaphylactic shock, you should immediately call an ambulance. Before the doctor arrives, you should try to stop further entry of the allergen into the body. If anaphylactic shock occurs as a result of an insect bite, a tourniquet should be applied above the bite site. This way, you will stop the allergen from entering the general bloodstream. Try to place the victim in a horizontal position on his back with his head tilted to the side, to prevent asphyxia due to retraction of the tongue or aspiration of vomit, then release the neck, chest, abdomen, and ensure an influx of oxygen.

What can a doctor do?

The doctor’s first actions will also be aimed at preventing further entry of the allergen into the bloodstream: a tourniquet is applied above the injection site or bite site or an epinephrine solution is injected (). Ensure supply fresh air, allow oxygen to be inhaled from an oxygen cushion, and antiallergic drugs are administered. Further treatment of anaphylactic shock is aimed at normalizing cardiovascular and respiratory activity, reducing the permeability of the vascular wall and preventing late complications from internal organs.

Prevention

It is impossible to predict the occurrence of anaphylactic shock in most cases. But you should pay attention to manifestations of allergies to a particular substance ( medicinal product, food product, etc.) and in the future try to avoid reintroducing this substance into the body. Patients who have previously suffered anaphylactic shock must have a card with them indicating their allergen.