How is anaphylactic shock treated in children?

The first and most important principle is not to panic!

• The child is laid on his side in order to avoid asphyxia as a result of aspiration of vomit, the tongue lingering.
• In the absence of vomiting, the patient is placed on his back with an elevated foot end.
• Patient obkladyvayut warmers, provide access to fresh air, patency of the airways, begin oxygen therapy.

Simultaneously and very quickly carry out the following activities:

• 0.1% solution of epinephrine or 1% solution of mezatone, or norepinephrine at a dose of 0.01 ml / kg subcutaneously (intramuscularly adrenaline should not be introduced, because it dilates the vessels of skeletal muscles, which enhances the decentralization of blood circulation);
• caffeine solution from 0.1 to 1.0 ml or cordiamine from 0.1 to 1.0 ml.

The introduction of these drugs is repeated after 15-20 minutes.

If the arterial blood pressure does not rise, the general weakness remains, then they enter:

• 0.01% solution of adrenaline (1 ml of an ampoule 0.1% solution of epinephrine is diluted in 9 ml of isotonic sodium chloride solution); 0.1 ml / kg of the resulting solution is administered intravenously slowly in 10-20 ml of 5% glucose solution (start at a dose of 0.2 μg / kg / min, increasing it to 1.5-2.0 μg / kg / min):
• intravenously quickly injected with colloidal (not protein!) blood substitutes or isotonic sodium chloride solution (15 ml / kg / min);
• with oliguria, cardiac weakness, it is advisable, against the background of oxygen therapy, the infusion of dopamine (200 mg in 250 ml of isotonic sodium chloride solution, which corresponds to 800 μg in 1 ml of the solution obtained) at a dose of 5 μg / kg / min (starting dose) with a gradual increase to 10 -14- 20 μg / kg / min;
• 3% solution of prednisolone (0.1-0.2 ml / kg) or hydrocortisone (4-8 mg / kg) intramuscularly;
• with bronhospazme and other respiratory disorders intravenously 2.4% solution of euphyllin (5-7 mg / kg in 20 ml isotonic sodium chloride solution);
• with cardiac weakness, glucagon (0.225 mg / kg) and cardiac glycosides (strophanthin in age doses).

It is necessary to monitor the patency of the respiratory tract and, if necessary, immediately enter the duct. The internal diameter of the endotracheal tube can be calculated by the following formula:

diameter of the tube (in mm) = (16 + patient's age (in years)): 4.

For example, for a two-year-old child, an intubation tube with an internal diameter of 4.5 mm should be used.

With a stable (within 20 min) arterial hypotension, it is necessary to begin mechanical ventilation.

In case of mild cases of anaphylactic shock inside or intramuscularly (intravenously), H2-histamin blockers, H2-histamin blockers (cimetidine 5 mg / kg or ranitidine 1 mg / kg) are administered. The use of pifolen is contraindicated in connection with its pronounced hypotensive effect.

In case of anaphylactic shock, developed on an insect bite or injection of a medicine, the place of injection or bite (excluding the neck and head region) is cut at 5-6 points with a 0.1% solution of adrenaline diluted in 10 ml of saline. At the extremities above the site of administration of the drug or an insect bite, a tourniquet is applied, which is attenuated for 1-2 minutes every 10 minutes. The injection site (bite) is covered with ice to slow the absorption.

In anaphylactic shock, which has developed on the introduction of penicillin, immediately after removal of the patient from collapse and asphyxia, intramuscular injection of penicillinase (1 000 000 units) is shown.

All patients with anaphylactic shock should be hospitalized, since the course of the shock can be undulating. Usually, deterioration occurs after 5 and 24 hours from the onset of the disease. Transportation of patients is allowed only after removal from a life-threatening condition. In the hospital, infusion therapy is performed in order to replenish the fluid loss and bring it in line with the volume of the vascular bed. It should be remembered that in some patients (with severe shock in all), the development of DIC syndrome is possible, which may require anticoagulation (heparin) and antiaggregant (curantil) therapy. An extract from the hospital is conducted no earlier than the 10th day because of the possibility of developing myocarditis, glomerulonephritis, serum sickness, encephalitis. The listed possible complications of anaphylactic shock and determine the plan for examination of a patient in a hospital.

The most important condition for rational therapy of a patient with an anaphylactic shock is the speed, focus and literacy of all activities, staff training, and his skill. In all medical institutions (including dental and allergological rooms, sanatoriums, schools, etc.), where any injections, preventive vaccinations, allergological examination and specific immunotherapy are carried out, there must be all the necessary medicines and equipment for removing the patient from anaphylactic shock, hanging instructions on the sequence of activities in providing emergency care. Medical personnel must pass an appropriate exam each year (set-off).

Prevention of anaphylactic shock. Before parenteral administration of drugs, the implementation of preventive vaccinations, it is necessary to find out how the child reacted to previous drug administration. Alien biological preparations (lysozyme, prodigiozan, gelatin, countercracker, etc.) should be prescribed to children only if absolutely necessary. After vaccination, the introduction of the drug, allergen, the child should be under the supervision of a doctor for at least 30 minutes.

Forecast. With anaphylactic shock, the prognosis is always serious and depends on the rationality and timeliness of the therapy.

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