How is anaphylactic shock in children treated?

The first and most important principle is not to panic!

• The child is placed on his side to avoid asphyxia due to aspiration of vomit and tongue retraction.
• If there is no vomiting, the patient is placed on his back with the leg end raised.
• The patient is surrounded with heating pads, access to fresh air and airway patency are provided, and oxygen therapy is started.

The following activities are carried out simultaneously and very quickly:

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

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

If arterial blood pressure does not rise and general weakness persists, then the following is administered:

• 0.01% adrenaline solution (1 ml of 0.1% adrenaline ampoule solution 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 with a dose of 0.2 mcg/kg/min, increasing it to 1.5-2.0 mcg/kg/min):
• colloidal (non-protein!) blood substitutes or isotonic sodium chloride solution (15 ml/kg/min) are quickly administered intravenously;
• in case of oliguria and cardiac weakness, it is advisable to administer dopamine (200 mg in 250 ml of isotonic sodium chloride solution, which corresponds to 800 mcg in 1 ml of the resulting solution) at a dose of 5 mcg/kg/min (starting dose) with a gradual increase to 10-14-20 mcg/kg/min against the background of oxygen therapy;
• 3% prednisolone solution (0.1-0.2 ml/kg) or hydrocortisone (4-8 mg/kg) intramuscularly;
• for bronchospasm and other respiratory disorders, intravenously 2.4% solution of euphyllin (5-7 mg/kg in 20 ml of isotonic sodium chloride solution);
• for cardiac weakness, glucagon (0.225 mg/kg) and cardiac glycosides (strophanthin in age-appropriate doses).

The airway should be monitored and an airway should be inserted immediately if necessary. The internal diameter of the endotracheal tube can be calculated using the following formula:

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

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

In case of persistent (for 20 minutes) arterial hypotension, it is necessary to start mechanical ventilation.

In mild cases of anaphylactic shock, H2-histamine blockers, H2-histamine blockers (cimetidine 5 mg/kg or ranitidine 1 mg/kg) are administered orally or intramuscularly (intravenously). The use of pipolfen is contraindicated due to its pronounced hypotensive effect.

In case of anaphylactic shock caused by an insect bite or drug injection, the injection or bite site (except for the neck and head area) is injected at 5-6 points with a 0.1% solution of adrenaline diluted in 10 ml of saline. A tourniquet is applied to the limbs above the injection site or insect bite, which is loosened for 1-2 minutes every 10 minutes. The injection site (bite) is covered with ice to slow absorption.

In case of anaphylactic shock that developed as a result of the administration of penicillin, immediately after the patient has been brought out of collapse and asphyxia, intramuscular administration of penicillinase (1,000,000 U) is indicated.

All patients with anaphylactic shock should be hospitalized, since the course of shock can be undulating. Usually, the condition worsens after 5 and 24 hours from the onset of the disease. Transportation of patients is allowed only after withdrawal from a life-threatening condition. In the hospital, infusion therapy is carried out to replenish fluid losses and bring the BCC into line with the volume of the vascular bed. It is necessary to remember that some patients (in all cases of severe shock) may develop DIC syndrome, which may require anticoagulant (heparin) and antiplatelet (curantil) therapy. Discharge from the hospital is carried out no earlier than the 10th day due to the possibility of developing myocarditis, glomerulonephritis, serum sickness, encephalitis. The listed possible complications of anaphylactic shock determine the plan for examining the patient in the hospital.

The most important condition for rational therapy of a patient with anaphylactic shock is the speed, purposefulness and competence of all measures, the training of the personnel, their skill. All medical institutions (including dental and allergological offices, sanatoriums, schools, etc.), where any injections, preventive vaccinations, allergological examination and specific immunotherapy are carried out, must have all the necessary medications and equipment to bring the patient out of anaphylactic shock, instructions on the sequence of measures in providing emergency care must be posted. Medical personnel must pass the appropriate exam (test) annually.

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

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

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