Anaphylactic shock

Anaphylactic shock is an acutely developing process. It carries a great threat to human life and can lead to death. Much depends on the degree of allergic attack and disorders, which he provoked. More details about all the symptoms, causes and treatment will be described below.

ICD-10 code

Anaphylactic shock refers to group T78-T80. This includes both primary identification codes and those that were caused by an unidentified reason. With multiple coding, this heading can be used as an additional code to identify the effects of states classified elsewhere.

• T78.0 Anaphylactic shock caused by a pathological reaction to food.
• T78.1 Other manifestations of a pathological reaction to food.
• T78.2 Anaphylactic shock, unspecified.
• T78.3 Angioedema

Giant urticaria Edema Quincke. Excludes: urticaria (D50.-). Serum (T80.6).

• T78.4 Allergy, unspecified

Allergic reaction of the BDU Increased sensitivity of the BDU Idiosyncrasy of the BDU Excluded: allergic reaction of the BDU to an adequately prescribed and correctly administered drug (T88.7). T78.8 Other adverse reactions not elsewhere classified.

• T78.9 Adverse reaction, unspecified.

Excluded: adverse reaction caused by surgical and therapeutic intervention of the NOS (T88.9).

Statistics

Fortunately, situations where anaphylactic shock develops are not so common. According to statistics, the reaction against the background of taking certain medications is developing only in one person out of 2,700 hospitalized. This is a very small indicator. Lethal outcomes are not so common. Usually, the mortality rate is 1-2 cases out of a million. These statistics are relevant for insect bites.

The statistical data on this pathology differ significantly from country to country. As for Russia, the problem is no more than one person out of 70 thousand a year. In general, the reaction occurs when an insect bites, this is the most common reason for its appearance. In Canada, this indicator is lower, 4 cases per 10 million, in Germany 79 cases per 100 thousand (high index). In the US, the problem is very common. So, in 2003, pathology struck 1500 thousand people per year.

Causes of anaphylactic shock

The main reason is the penetration of poison into the body, it can happen because of a snake bite or an insect. In recent years, the problem began to appear against the background of taking medications. Lead to this is capable of Penicillin, Vitamin B1, Streptomycin. A similar action is caused by Analgin, Novocain, immune sera.

• Poisons. To lead to pathology bites of bugs, wasps and bees are capable. This causes an anaphylactic shock in people who are particularly prone to it.
• Medicines. The above medicines may lead to shock. To relieve the condition of a person it is worth entering his prednisolon and adrenaline. They can remove allergic reaction and swelling.
• Food. Most products can lead to the development of the problem. It is enough just to use the allergen in food. Basically, it's milk, eggs, peanuts, nuts, seeds are kuzhnuta.
• Risk factors. People suffering from asthma, eczema, allergic rhinitis are more susceptible to the development of shock. An allergic reaction can develop into latex, contrast agents.

[1], [2], [3], [4], [5]

Pathophysiology

The key moment of anaphylactic shock is a sharp drop in blood pressure. Like any allergic reaction, this pathology begins with the reaction of the allergen-antibody. A precise definition of why the disease occurs is not. This is an ordinary allergic reaction that can occur on anything.

True, it is proved that when an allergen enters the body, its active reaction with antibodies begins. This triggers a number of cascading actions. As a result, capillaries and areterio-venous shunts expand.

Because of this negative effect, most of the blood begins to pass from the main vessels in the pereferynyke. As a result, a critical drop in blood pressure occurs. This action occurs so quickly that the circulatory center simply does not have time to respond quickly to this process. As a result, the brain does not receive enough blood and the person loses consciousness. True, this measure is extreme, as a rule, it leads to a fatal outcome. Not in all cases, but half of them just ends badly.

Symptoms of anaphylactic shock

The clinical picture of the disease is "famous" for its speed. So, the symptomatology develops within a few seconds, after contact with the allergen occurs. The first thing happens is the depression of consciousness, after which the blood pressure drops sharply. The person is seized with convulsions, and involuntary urination occurs.

Many patients before the main symptoms begin to feel a sharp rush of fever, skin hyperemia. In addition, the fear of death oppresses, there is a headache and painful sensations behind the sternum. Then the pressure drops, and the pulse becomes threadlike.

There are other options for the development of anaphylactic shock. So, it is possible to damage the skin. A person feels the increasing itching, which is characteristic for the Quincke's edema. Then develops a severe headache, nausea. Then convulsions occur, accompanied by involuntary urination, defecation. Then the person loses consciousness.

There is a defeat of the respiratory system, a person listens to the choking caused by swelling of the mucous membrane. From the heart there is acute myocarditis or myocardial infarction. Diagnosis is based on clinical manifestations.

Anaphylactic shock precursors

After the interaction with the allergen has occurred, the stage of precursors develops. It is characterized by the appearance of a feeling of impending death. The person begins to pester discomfort, fear and anxiety. He can not describe his condition. It's really strange.

Then begins to appear noise in the ears. Perhaps a sharp drop in vision, which brings a lot of discomfort. The person is in a pre-unconscious state. Then the back pain develops, fingers and toes begin to grow dumb. All these symptoms indicate that anaphylactic shock develops in a person. It is also characterized by the development of urticaria, Quincke's edema and severe itching.

It is important to understand that things are bad, and it is necessary to give urgent help to a person. If you have any symptoms, you should contact a medical institution. Without special preparation and use of the necessary drugs, it is impossible to help a person.

[6], [7]

Anaphylactic shock

Medicinal anaphylactic shock, is an acute allergic reaction, which occurs immediately. There is everything against the background of taking medications. They squeeze mediators and lead to disruption of the activity of important organs and systems. That can lead to a lethal outcome.

There is a problem due to a history of drug allergy. Possible development against the background of long-term use of medicinal substances, especially if they are characterized by repeated use. Depot preparations, polypharmacy, as well as increased sensitizing activity of the drug may lead to shock. The risk is professional contact with drugs, the presence of an allergic disease in history, the presence of dermatomycosis.

This pathology is not so common. Basically, this is due to self-treatment, without consulting a doctor or using a medication that can cause allergies.

[8], [9]

Anaphylactic shock in pregnant women

This phenomenon eventually begins to gain momentum. Pregnancy in itself makes a woman vulnerable to many factors, including allergic reactions. Often, this condition is caused by the use of certain medications.

The clinical picture of the manifestations does not differ from the symptomatology of anaphylactic shock in other people. However, this phenomenon in pregnant women can lead to spontaneous abortion or the onset of premature birth. This process can lead to premature detachment of the placenta, which entails the death of the fetus. It is not excluded the development of disseminated intravascular coagulation syndrome. It is he who causes fatal uterine bleeding.

A particular burden is borne by the reaction that occurs with the loss of consciousness. A woman can simply die, within 30 minutes. Sometimes this "process" is prolonged for 2 days or 12 days. It entails failures in the work of vital organs and systems.

Treatment in this case is extremely difficult. After all, the role of the allergen itself is the fruit. If a woman's condition is severe, it is recommended to terminate the pregnancy. In general, a pregnant girl should take care with caution, so as not to provoke such a reaction of the body.

[10], [11], [12], [13], [14], [15], [16], [17]

Anaphylactic shock in newborns

Anaphylactic shock is an allergic reaction that has an immediate type. I mean, the condition worsens immediately after contact with the allergen. It can happen because of taking medications, as well as using X-ray contrast substances. Very rarely the process occurs against the background of an insect bite. There were cases when the "problem" provoked the cold. The most common problem arises from the negative effects of antibiotics. Usually the reaction occurs on Penicillin. If the mother took such a drug, and then nursed her baby, the reaction will be immediate.

The baby begins to be troubled by a sense of fear and anxiety. The child is naughty, crying. There is blue, pale face. Often, shortness of breath starts, accompanied by vomiting and a rash. The child's blood pressure increases, but it is impossible to understand this without measuring it. After that, there is a loss of consciousness, there are cramps. Naturally, the lethal outcome is not ruled out.

If the condition is accompanied by acute respiratory insufficiency, then the baby has a sharp weakness, he lacks air, pierces a painful cough. Skin sharply turn pale, sometimes foam appears at the mouth, and also wheezing. The babies show up very quickly. Weakness, tinnitus and pouring sweat are the first sudden signs. The skin becomes pale, the pressure drops. Within a few minutes, loss of consciousness, convulsions and death may develop. Therefore, it is important to determine the problem in time and to begin emergency care.

[18], [19], [20], [21],

Stages of

There are four stages in the development of shock. The first of these is a cardiogenic variant. This stage is the most common. It is symptomatic of cardiovascular insufficiency. So, there is a tachycardia, a person feels a sharp decrease in pressure, a thread-like pulse. Disorders of external respiration are observed. This option does not lead to death.

• Asthmoid (asphyxiation) variant. It is characterized by the manifestation of bronchiolospasm, all this leads to the development of acute respiratory failure. There is suffocation, it is associated with swelling of the larynx.
• Cerebral variant. It is characterized by the defeat of the central nervous system. This is due to acute edema of the brain. Hemorrhages, as well as impaired brain function, are not excluded. This condition is characterized by a psychomotor disorder. Often there is a loss of consciousness, as well as tonic-clonic convulsions.
• Abdominal variant. It is characterized by the development of symptoms as a result of taking antibiotics. It can be Bicillin and Streptomycin. Lethal outcome may occur due to the development of cardiovascular insufficiency, as well as cerebral edema.

Forms

There are several forms of pathology development. Lightning fastest form is the fastest, it becomes clear from the name itself. It develops within 2 minutes, after the allergen enters the body. It is characterized by rapid development of symptoms, as well as cardiac arrest. Signs are very scarce, there is a sharp pallor, symptoms of clinical death appear. Sometimes patients simply do not have time to characterize their condition.

• Heavy form. It develops within 5-10 minutes, after contact with the allergen. The patient starts complaining about acute shortage of air. It is suppressed by a sharp feeling of heat, a headache, and a painful syndrome develops in the region of the heart. Heart failure develops very quickly. If qualified assistance is not provided on time, a fatal outcome will occur.
• Medium-heavy form. Development occurs within 30 minutes, after the allergen has penetrated the body. Many patients complain of fever, redness of the skin. They are pestered by headache, fear of death and intense excitement.
• Lightning-fast form is characterized by a sharp onset and rapid progression. Arterial pressure drops very quickly, a person loses consciousness and suffers from an increased respiratory insufficiency. A distinctive feature of the form is resistance to intensive anti-shock therapy. In addition, the development of pathology is greatly progressing, perhaps a coma. Death can occur for the first time minutes or hours, as a result of the defeat of important organs for life.

There are options for lightning current. They are completely dependent on the clinical syndrome. It can be acute respiratory or vascular insufficiency.

When shock accompanied by acute respiratory failure develops a feeling of chest tightness, a person does not have enough air, begins a painful cough, shortness of breath, headache. An angioedema can occur in the face and other parts of the body. With the progression of the syndrome, a fatal outcome is possible.

Allergic reaction with acute vascular insufficiency is characterized by its sudden onset. The person feels weakness, noise in the ears, pouring sweat. The skin becomes pale, the pressure falls, the heart is weakened. Lethal outcome can occur because of the increase in symptoms.

[22], [23], [24], [25]

Consequences and complications

With regard to the consequences, they are affected by the severity of anaphylactic shock, as well as its duration. The whole danger lies in the fact that the process can negatively affect the entire organism as a whole. I mean lead to the rejection of many vital organs and systems.

The less time there was between contact with the allergen and the development of shock, the harder the consequences. For a while, there is no symptomatology completely. But, repeated contact can become more dangerous than the first.

Often the problem leads to the development of very dangerous diseases. These include non-infectious jaundice, as well as glomerulonephritis. There are strong failures in the functioning of the vestibular apparatus, the central nervous system. The consequences are really burdensome. Therefore, the faster a person is given emergency care, the higher the chance to prevent a lethal outcome and development of problems with many organs and systems.

With regard to complications, they need to be divided into two types. After all, they can occur both after contact with the allergen, and during the recommended treatment. So, complications caused by contact with an allergen include respiratory arrest, DIC syndrome, bradycardia, which entails cardiac arrest. Possible development of cerebral ischemia, renal failure, as well as general hypoxia and hypoxemia.

Complications after incorrect therapy, also aggravating. They can arise in almost 14% of all cases. This can be due to the use of adrenaline. Against this background, there is a tachycardia of various types, it is possible arrhythmia and myocardial ischemia.

During the treatment it is necessary to understand that carrying out cardiopulmonary resuscitation may be necessary at any time. You should know how this is done. After all, the process must be performed using the standard ALS / ACLS algorithms.

[26], [27], [28], [29], [30], [31],

Diagnosis of anaphylactic shock

Diagnosis should begin with interviewing the victim. Naturally, this is done in cases when the manifestation of shock does not carry a lightning form. It is worth to clarify the patient whether he had previously had allergic reactions, what caused them and how they manifested themselves. It is necessary to find out information regarding the medicines used. These can be glucocorticoids, antihistamines or adrenaline. They can lead to the development of a negative process.

After the survey, the patient is examined. The first thing you need to assess a person's condition. Then the skin is examined, sometimes they become cyanotic or vice versa, they become pale. Next, the evaluation of the skin, the presence of erythema, edema, rash or conjunctivitis. The oropharynx is examined. Often anaphylactic shock causes swelling of the tongue and soft palate. The victim should be measured. Assesses the patency of the airways, the presence of dyspnea or apnea. It is necessary to measure pressure, if the condition is severe, then it is not determined at all. In addition, it is necessary to clarify the presence of such symptoms as vomiting, vaginal discharge (bloody type), involuntary urination and / or defecation.

[32], [33], [34], [35]

Analyzes for anaphylactic shock

This process is characterized by a very peculiar manifestation, which may differ depending on the affected organs and systems. It is characterized by a sharp decrease in pressure, a disorder of the central nervous system, a spasm of smooth muscles. This is not the whole list of manifestations.

In the diagnosis of anaphylactic shock, laboratory tests are not conducted at all. Because according to them nothing can be learned. However, the coping of an acute reaction does not always mean that everything has ended happily, and the process has receded. In 2-3% of cases, manifestations begin after a time. And this may not be the usual symptomatology, but the real complications. Thus, a person is able to "get" jade, damage to the nervous system, allergic myocarditis. The manifestation of immune disorders have a lot of similarities among themselves.

Thus, the number of T-lymphocytes is significantly reduced, and changes occur in its activity. The level of T-suppressors decreases. As for immunoglobulins, they increase dramatically. The reaction of the blast transformation of lymphocytes increases dramatically. In the body, autoantibodies appear.

[36], [37], [38], [39], [40], [41], [42], [43], [44]

Instrumental diagnostics

It should be noted that the diagnosis of the process is clinical. There are no such instrumental methods that could confirm the existence of this process. After all, everything is seen and so. However, despite this, there are still some research methods that are carried out along with first aid. These include ECG, Pulse Oximetry and Chest X-ray, CT and MRI.

So, ECG, monitoring is performed in 3 leads. A record of 12 leads is shown only to those patients who have had specific heart rhythm disturbances, which are characteristic of ischemia. The implementation of this procedure should not in any way impede the delivery of emergency care. It is necessary to take into account the fact that any changes in the ECG can be caused by hypoxemia or hypoperfusion. To provoke such a course is capable of myocardial diseases caused by the use of andrenaline.

• Pulse oximetry. If the values of SpO2 are low, then a person has hypoxemia. Usually, if there is an anaphylactic shock, this process precedes the cardiac arrest. The process can be observed in two states. So, with bronchial asthma or stenosing laryngitis. Therefore, everything should be evaluated in a complex.
• Chest X-ray. It is performed exclusively after the stabilization of the human condition and in the presence of signs of lung pathology. It is advisable to take pictures immediately. Auxiliary techniques are CT and MRI. They are conducted exclusively in those cases when there is a suspicion of PE.

Differential diagnostics

Laboratory studies during the development of the reaction are not carried out. After all, you need to act quickly, take the time to take tests and wait for the answer - no. A person needs urgent help.

An increase in the levels of certain enzymes in the blood, suggests that a person has developed a critical condition. So, usually histamine starts to rise sharply, it happens literally within 10 minutes. True, this method of determination is not generally available. Tryptase. Peak values are observed already in an hour and a half after the start of the process, they persist for 5 hours. In patients, there may be an increase in both the two indicators and one.

To determine the level of these enzymes, it is necessary to take blood. To do this, take 5-10 ml sample. It is worth noting that the sampling of the analyzes should go in parallel with the urgent emergency! Re-taking takes place 2 hours after the symptoms begin to manifest themselves.

5-hydroxyindoleacetic acid. Serves for laboratory differential diagnosis of carcinoid syndrome measured in daily urine. LgE does not play a special role. It is only possible to confirm the diagnosis.

Skin tests are conducted to determine the trigger that this process could trigger. It can be an allergic reaction to food or medicine.

In addition, tests for markers of IgE-independent reactions, metanephryls, vanillylmandelic acid, serotonin in the blood, as well as a test panel for determination of vaso-intestinal polypeptides are conducted.

All of the above is only ancillary research. Determine the presence of the problem can even be a visual examination of the patient.

[45], [46]

Treatment of anaphylactic shock

This stage completely depends on the etiology. The first step is to stop the parenteral administration of medications, a tourniquet is placed on the injection site (just above it) for 25 minutes. After 10 minutes it can be weakened, but not more than 2 minutes. This is done if the problem was caused by the administration of the drug.

If the problem occurs against the background of an insect bite, you should immediately remove the sting with an injection needle. It is not desirable to remove it manually or with tweezers. This can lead to extrusion of the poison from the sting.

To the place where the injection was made, ice or a hot water bottle with cold water should be applied, for 15 minutes. After that, the injection site splits in 5-6 places, thus infiltration occurs. To do this, use 0.5 ml of a 0.1% solution of epinephrine with 5 ml of isotonic sodium chloride solution

Anti-shock therapy is performed. Man is provided with airway patency. The patient must be laid, but at the same time lowered his head, so that there was no aspiration vomit. The lower jaw should be pulled out, in the presence of removable dentures - to eliminate them. Then 0.3-0.5 ml of 0.1% adrenaline solution is injected intramuscularly into the shoulder or thigh area. Possible introduction through clothing. If necessary, the procedure is repeated for 5-20 minutes, while it is necessary to monitor the level of pressure. Further access is provided for intravenous administration. A 0.9% sodium chloride solution is administered to a person. For an adult at least one liter, and for a baby 20 ml per kilogram of weight.

Antiallergic therapy. It is necessary to use glucocorticoids. Prednisolone is mainly used. It is administered in a dosage of 90-150 mg. For children up to a year, the dosage is 2-3 mg per kilogram of body weight. At the age of 1-14 years - 1-2 mg per kilogram of body weight. Introduction intravenous, jet.

Symptomatic therapy. To increase the pressure, dopamine is administered intravenously at a rate of 4-10 μg / kg / min. If bradycardia begins to develop, then atropine is administered at a dosage of 0.5 mg subcutaneously. If necessary, the procedure is repeated after 10 minutes. When bronhospazme should be made by inhalation Salbamatol, preferably 2, -5-5 mg. If cyanosis starts to develop, then oxygen therapy should be performed. It is also necessary to monitor the functions of breathing, and always have the quick reaction skill. After resuscitation can be needed at any time.

Prevention

Predict the development of this state is almost impossible. After all, a problem can arise at any time and for an unexplained reason. Therefore, it is necessary to carefully use drugs that have pronounced antigenic properties. If a person has a reaction to Penicillin, then you can not assign him funds from this category.

With caution, introduce lactation to babies. Especially if heredity is due to the presence of allergies. One product should be injected within 7 days, not faster. If a person develops a persistent reaction to cold, then he should give up bathing in the reservoirs. Children can not stay outdoors for a long time in winter (naturally, if there is a cold problem). You can not stay in places of large concentrations of insects, near the apiary. This will avoid the bite of an insect and thereby cause a shock state of the body.

If a person has an allergic reaction to an allergen, it is worth taking special medications so as not to provoke its strong development.

Forecast

It should be noted that the frequency of deaths is 10-30% of the total number. In this case, much depends on the severity of the patient's condition. The deaths associated with drug allergies are caused by the assumption of gross errors in the choice of medication. Contraception can also contribute to this process.

Particularly dangerous are people who have a persistent allergic reaction to penicillin. The use of a syringe with its remains can lead to an unexpected reaction of the organism, which carries a real danger. Therefore, use only a sterile syringe. All persons who directly contact drugs, while at the same time have a risk of developing shock, must change their place of work. If you follow specific rules, then the forecast will be favorable.

It is important to understand that no sanatorium conditions will help to get rid of a possible allergy. You just need to limit contact with the main allergen. If there is a strange reaction to stay in cold water or in general to cold, you need to limit contact with it. Only this way it is possible to save the situation. Naturally, the likelihood of the prognosis is affected, and the speed of the reaction, when an acute form of shock develops. It is necessary to give the person urgent help and call an ambulance. Joint actions will help to save the life of the victim.

[47], [48], [49]