Treatment of anaphylactic shock

According to statistics, the number of allergic diseases among the population increases every year. An increase in the number of patients with acute allergic reactions and conditions that are life-threatening and require urgent medical care has also been noted. The most difficult treatment is anaphylactic shock - the most complex acute systemic response of the body to repeated introduction of an allergen. In this condition, all vital organs and systems suffer, and if you do not start providing assistance in time, you can lose the patient.

The first thing to do in case of anaphylactic shock is to stop taking the medications that caused the development of this process. If the needle is in the vein, the syringe should be disconnected and the therapy should be continued through it. When the problem was caused by an insect bite, simply remove the sting.

Next, it is necessary to note the time when the allergen entered the body. It is important to pay attention to complaints, consider the first clinical manifestations. After that, the victim must be laid down, while raising his limbs. The head should be turned to the side, the lower jaw pushed forward. This will prevent the tongue from sinking and possible aspiration of vomit. If a person has dentures, they are also removed. It is necessary to assess the patient's condition, listen to complaints. It is necessary to measure the pulse, blood pressure and temperature. The nature of shortness of breath is assessed. After that, the skin is examined. If the blood pressure has dropped by about 20%, there is a possibility of shock.

The person needs to be provided with full access to oxygen. Then a tourniquet is applied for 20 minutes. The drug will be injected in that place. Ice should be placed on the injection site. Injections should be made exclusively with syringes or systems. This will prevent the problem from developing again.

If the injection is carried out through the nose or eyes, they must be thoroughly washed. Then a couple of drops of adrenaline must be instilled. If the injection is subcutaneous, the patient should be injected with 0.1% adrenaline solutions. Naturally, it must be diluted in a saline solution. Until the doctor arrives, the system must be prepared. The person must be given 400 ml of saline solution intravenously. On the doctor's command, a 0.1% adrenaline solution is slowly injected. If the puncture is difficult, the drug is injected into the soft tissues located in the sublingual region.

Glucocorticosteroids are administered by jet and then by drip. Usually 90-120 mg of Prednisolone is used. Then they resort to the help of a 1% solution of Dimedrol or a solution of Tavegil. All this is administered intramuscularly. If bronchospasm occurs, Euphyllin 2.4% is prescribed intravenously, about 10 ml. If weakening of breathing has developed, then Cordiamine 25%, about 2 ml. In case of bradycardia, Atropine Sulfate, 0.1% - 0.5 ml is administered.

The goal of treatment for anaphylactic shock

Anaphylaxis is an acute borderline condition, and it does not go away on its own. If the patient is not given immediate help, a fatal outcome is inevitable.

Shock occurs more often during the second contact of the patient with a substance to which the body is hypersensitive (allergic). This condition can be provoked by a wide variety of allergens of protein or polysaccharide origin, as well as special compounds that become allergens after their contact with human proteins.

Allergenic components that can cause an acute reaction can enter the body through the digestive system, through breathing, skin, etc. The most common allergens are:

• antibiotics (penicillins, sulfonamides, tetracycline);
• serums and vaccines;
• enzyme agents;
• hormonal agents;
• plasma substitutes and other similar solutions;
• nonsteroidal anti-inflammatory drugs;
• anesthetic drugs;
• contrast solutions and liquids;
• iodine preparations;
• vitamin complexes;
• food products, preservatives, biological additives;
• parasite and insect bites;
• items of clothing, plants, household chemicals, etc.

An important and first stage of treatment is to identify the allergen that provoked the reaction and stop contact with it.

Medicines for the treatment of anaphylactic shock

A list of medications that may be needed to help a patient in anaphylactic shock may look like this:

• anti-shock hormonal drug Prednisolone - begins to act from the first second of administration, reducing the manifestations of shock;
• an antihistamine – for example, Suprastin or Tavegil – eliminates the sensitivity of receptors to histamine, which is the main substance released into the blood in response to an allergic reaction;
• hormonal substance Adrenaline – necessary for stabilizing cardiac activity in extreme conditions;
• Euphyllin is a medication that ensures respiratory function during a state of shock;
• antihistamine Diphenhydramine, which has a dual effect: it blocks the development of an allergic reaction and suppresses excessive excitation of the central nervous system.

In addition to the medications, you should have syringes of various sizes, medical alcohol for wiping the skin when injecting medications, cotton balls, gauze, a rubber tourniquet, and bottles of sterile saline for intravenous infusions on hand.

Drug treatment should be lightning fast. It is necessary to administer drugs intravenously, this will speed up their effect on the human body. The list of administered drugs should be limited. But, despite this, it should include certain drugs.

• Catecholamines. The main drug in this group is Adrenaline. Due to a certain stimulation of adrenoreceptors, it will allow to narrow the vessels, and also reduce the activity of the myocardium. In addition, Adrenaline significantly increases cardiac output, and also has a bronchodilator effect. It should be administered in the amount of 0.3-0.5 ml of 0.1%. It can be administered as a mixture. Usually it consists of 1 ml of 0.1% adrenaline solution and sodium chloride solution, in a volume of 10 ml. Repeated administration within 5-10 minutes is possible.
• Glucocorticosteroids. Prednisolone, Dexamethasone, Metiprednisolone, Hydrocortisone are mainly used. They are administered at a rate of 20-30 mg of the drug per kilogram of weight. This will allow the patient to establish positive dynamics. Drugs in this category are able to significantly inhibit the action of allergens on capillaries, thereby reducing their permeability.
• Bronchodilators. Among them, Euphyllin is actively used. It allows to reduce the release of histamine metabolites, thereby stopping bronchospasm. It should be administered intravenously at a dosage of 5-6 mg/kg for 20 minutes. If there is an urgent need, the administration is repeated, thereby switching to a maintenance dose of 0.9 mg/kg/h.
• Infusion therapy. Consists of the introduction of 0.9 sodium chloride solution, acesol, 5% glucose solution. Due to them, the volume of blood circulation increases significantly, and a vasoconstrictive effect occurs.
• Antihypoglycemic drugs. Drugs of this group can effectively affect a person's condition. Prevent or completely eliminate Quincke's edema and urticaria. They can reduce the effect of histamine on the body. This leads to the relief of anaphylactic shock attacks. It is enough to simply inject 1-2 ml of Tavegil or Suprastin solution.

Anaphylactic shock treatment protocol

In addition to the standard treatment protocol, there is also an additional treatment regimen that is used in case of complicated anaphylaxis. For example, the above-mentioned drugs and agents will not be enough to relieve laryngeal edema. Here, surgical intervention is required - tracheostomy. This operation involves the installation of a tracheostomy (a special breathing tube) through an opening in the trachea. Additional local anesthetics are used simultaneously with the operation.

If the shock condition is accompanied by prolonged loss of consciousness, and there is also a risk of developing a comatose state, the doctor can use a standard set of anti-shock therapy.

Normalization of the patient's condition and elimination of danger are recorded using special tests and studies that characterize the restoration of the functionality of vital organs, in particular, the liver and urinary system.

If the shock was caused by the administration of a drug, this must be recorded in the patient's medical history and medical card. All drugs of the group that caused the allergic reaction must be indicated. The entry must be visible at first glance, so it is written in red marker on the title page of the card. This is done primarily to have an idea of what kind of assistance should be given to the patient if he is unconscious.

Algorithm for the treatment of anaphylactic shock

The algorithm for helping with the development of anaphylactic shock consists of blocking the effect of the allergen on the body and combating the main symptoms of the shock state.

At the first stage, measures are taken to help restore the function of all organs and systems of the patient. For this reason, hormonal agents are considered to be the most important drugs for anaphylaxis:

• the use of Adrenaline allows to narrow the lumen of peripheral vessels, thereby inhibiting the movement of histamine secreted by the immune system throughout the body;
• The use of Prednisolone calms the immune activity that can lead to cardiac arrest.

After emergency measures, the second stage of treatment is prescribed - elimination of the consequences of the shock state. As a rule, almost all patients after receiving emergency care require further drug treatment.

In extraordinary severe situations, the list of drugs used for anaphylactic shock is deliberately expanded to include the required resuscitation measures.

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Treatment of anaphylactic shock at the prehospital stage

Since anaphylactic shock is considered an immediate threat to the patient's life, emergency measures should be taken immediately and as quickly as possible. Treatment can be divided into initial (pre-hospital) and inpatient.

What does the pre-hospital treatment stage include?

1. Intramuscular urgent administration of Epinephrine (Adrenaline hydrochloride) to all victims without exception with signs of anaphylaxis. The drug is administered into the upper half of the body (for example, into the superficial muscle of the shoulder). The dosage of the drug for an adult patient is 0.5 ml of a 0.1% solution. If necessary, the injection is repeated after 5 minutes. Intravenous infusion of adrenaline is used only in extreme cases, in deep shock or clinical death, or in cases where shock has developed against the background of general anesthesia. Patients whose condition has not improved with the administration of adrenaline are given Glucagon, 1-2 mg intravenously or intramuscularly every 5 minutes, until a visible positive effect is achieved.
2. Intensive administration of fluids. At the "upper" pressure of less than 90 mm Hg, jet administration is used (up to 500 ml in 20-30 min), then switching to drip administration of isotonic sodium chloride solution (800-1200 ml) with subsequent addition of Polyglucin (400 ml). Simultaneously with the administration, blood pressure and diuresis are monitored.
3. Relief of breathing. To improve the patency of the trachea and bronchi, aspiration of accumulated mucus is performed, and inhalation of pure oxygen is used. If necessary, a tracheostomy is performed with subsequent use of an artificial lung ventilation apparatus.

Non-drug treatment of anaphylactic shock is carried out before the arrival of the ambulance and consists of the following measures:

• blocking the allergen from entering the body;
• providing the patient with a horizontal position with the head turned to the side and down;
• applying a tourniquet over the site of introduction of an allergen or insect bite;
• if necessary – artificial heart massage and artificial ventilation of the lungs.

Inpatient treatment

The subsequent set of measures does not directly affect the course of the shock state, but with its help it is possible to reduce anaphylactic symptoms, speed up the body's recovery and prevent a possible repeated reaction.

• Corticosteroids are not emergency medical care drugs. Their effectiveness is manifested on average only 5 hours after intravenous injection. However, the benefits of corticosteroids are great: they can prevent or shorten the duration of phase II of anaphylaxis. In this case, drugs such as Hydrocortisone in the amount of 125-250 mg, or Dexazone in the amount of 8 mg, are administered intravenously. Such injections are recommended to be repeated every 4 hours until the acute reaction is relieved.
• Antihistamines should be used after stabilization of blood circulation, because one of the side effects of such drugs is a decrease in blood pressure. Diphenhydramine is administered intravenously from 20 to 50 mg, or intramuscularly from 2 to 5 ml of a 1% solution. The administration can be repeated after 5 hours. Simultaneously, it is recommended to administer Ranitidine (50 mg) or Cimetidine (200 mg) intravenously.
• Bronchodilators are used in the presence of bronchospasm that is not eliminated by the administration of Adrenaline. As a rule, Salbutamol is used to restore respiratory function in an amount of 2.5-5 mg, with the possibility of repeated administration of the drug. The reserve drug in this case is Euphyllin (intravenously in an amount of 6 mg per kilogram of the patient's weight).

Treatment of anaphylactic shock in children

Treatment measures are started as soon as possible, even if anaphylaxis is suspected, without waiting for the symptoms to fully develop. Sending the child to the hospital is mandatory.

The first step is to prevent the allergen from entering the body. Then 0.1% adrenaline is administered subcutaneously or intramuscularly (the dose is calculated depending on the age and weight of the baby). Cold is applied to the suspected area of the allergen.

Urgent administration of corticosteroids is started: Dexamethasone, Prednisolone or Hydrocortisone.

If an allergenic substance has entered the body with food, then an emergency gastric lavage should be performed, followed by administration of sorbent preparations (activated carbon or Enterosgel).

At the pre-hospital stage, people around and parents can provide the following assistance to the child:

• prevent the allergen from entering the body;
• Place the child slightly on his side and head down - this improves blood circulation in the brain and reduces the risk of inhaling vomit;
• if necessary, fix the tongue;
• ensure access to clean air;
• immediately call an ambulance or any medical worker;
• if necessary, perform artificial respiration.

Treatment after anaphylactic shock

After the state of anaphylaxis, patients need treatment with glucocorticoids for one to three weeks. Treatment begins with 50 mg of prednisolone. The dose depends on the severity of the condition and the presence of complications, the patient's age, test results, etc. It is necessary to take into account all the nuances in order to prevent late complications in the functioning of the organs and systems of the body.

Patients who have experienced anaphylactic shock should take into account in the future that there is a serious risk to their life of repeated anaphylaxis. They should be extremely careful about possible repeated exposure to the allergen.

The attending physician must indicate in the medical history and discharge the substance or medication that caused the anaphylactic reaction in the body. A final consultation with an allergist is mandatory.

The patient is discharged from the hospital only after the results of blood, urine, cardiogram tests, and, in case of digestive disorders, stool tests have stabilized.

New in the treatment of anaphylactic shock

Anaphylactic shock is a complex and serious condition that is often fatal. For this and other reasons, allergists are interested in finding new treatments for allergies.

• Use of medicinal radiation. A French immunologist has developed a method that uses not medicinal preparations but their radiation in water to treat allergies. It turns out that medications can be replaced by their “projections” that are fixed in liquid. This method is striking in its seemingly unrealistic nature. However, more than two thousand tests have already been conducted, which have confirmed the effectiveness of the method.
• Autolymphocyte therapy method. The essence of this method is the introduction of the patient's own lymphocyte mass, previously processed with the preservation of information about all contacts with allergens. This procedure makes the body immune to potential encounters with allergens.
• A new generation of antihistamines. Finnish specialists have discovered that histamines (allergy "mediators") can affect not only H1-histamine receptors. This conclusion can be used to develop new medications. By the way, some of them are already undergoing clinical trials. For example, tryptase, chymase, cathepsin G are enzymes that break down certain proteins. In addition, they are able to block H4-histamine receptors. It is likely that in some time we will be able to purchase combined medications in pharmacies aimed at inhibiting H1 and H4 histamine receptors, which in combination will give a more noticeable positive result.

Of course, medicine is moving forward in its developments by leaps and bounds. Both allergists and immunologists and patients sincerely hope that scientists will soon find the latest successful methods and means that will be able to prevent allergies and treat anaphylactic shock quickly and safely.