Treatment of anaphylactic shock

According to statistics, the number of allergic diseases in the population increases every year. There was also an increase in the number of patients with acute allergic reactions and conditions that threaten life and require urgent medical care. The most difficult is the treatment of anaphylactic shock - the most complex acute emerging systemic response of the body to the repeated administration of an allergen. In this condition, all vital organs and systems suffer, and if you do not begin to provide assistance on time, the patient can be lost.

The first thing to do with anaphylactic shock is to stop taking drugs that triggered the development of this process. If the needle is in the vein, you need to disconnect the syringe and continue therapy with him. When the problem was caused by an insect bite - just remove the sting.

Further it is necessary to note the time when the organism received an allergen. It is important to pay attention to complaints, to consider the first clinical manifestations. After that, the victim must be laid, while lifting his limbs. The head should be turned to the side, the lower jaw is pushed forward. This will prevent the sinking of the tongue and possible aspirations of the vomit. If a person has dentures, then they too are removed. It is necessary to assess the patient's condition, to listen to complaints. The pulse, pressure and temperature should be measured. The character of dyspnea is assessed. After that, the skin is examined. If blood pressure has decreased by about 20%, there is a possibility of shock.

A person needs to fully provide access to oxygen. Next, a tourniquet is applied for 20 minutes. At that point, the drug will be injected. At the injection site, ice should be put. Injections should be performed solely by syringes or systems. This will avoid the re-development of the problem.

If the administration is through the nose or eyes, they must be rinsed thoroughly. Then drip a couple of drops of adrenaline. If the administration is subcutaneous, it is necessary to cut off the patient 0.1% of adrenaline solutions. Naturally, it must be diluted in physiological saline. Until the doctor comes, you need to prepare the system. A person needs to inject 400 ml of saline intravenously. At the command of a doctor, a 0.1% solution of epinephrine is slowly introduced. If the puncture is difficult, the agent is injected into soft tissues that are located in the hyoid area.

Struino, and then droplets of glucocorticosteroids are injected. Typically, 90-120 mg of prednisolone is used. Then resort to a 1% solution of Diphenhydramine or Tavegil's solution. All this is administered intramuscularly. If there was a bronchospasm appointed intravenously, Eufillin 2,4%, about 10 ml. If there was a weakening of breathing, then Cordiamin 25%, about 2 ml. At a bradycardia it is entered Atropine Sulfat, 0,1% - 0,5 ml.

The purpose of treatment of anaphylactic shock

Anaphylaxis is an acute borderline condition, and it does not pass by itself. If you do not immediately help the patient, then a fatal ending is inevitable.

Shock occurs more often during the second contact of the patient with a substance to which the organism experiences hypersensitivity (allergy). Such a state can provoke a 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 appear in the body through the digestive system, through breathing, skin, etc. The most common allergens are:

• antibiotics (penicillins, sulfonamides, tetracycline);
• serum and vaccine;
• enzymatic means;
• hormonal means;
• plasma substitutes, etc. Similar solutions;
• non-steroidal anti-inflammatory drugs;
• preparations for anesthesia;
• contrast solutions and fluids;
• preparations of iodine;
• vitamin complexes;
• food products, preservatives, biological supplements;
• bites of parasites and insects;
• elements of clothing, plants, household chemicals, etc.

An important and first stage of treatment is the determination of the allergen, which provoked the reaction, and the interruption of contact with it.

Medications for the treatment of anaphylactic shock

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

• antishock hormonal drug Prednisolone - from the first second of the introduction begins to act, reducing the manifestations of shock;
• 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 to stabilize the work of cardiac activity in extreme conditions;
• Euphyllin - a medication that provides the function of breathing during a shock state;
• antihistamine means Dimedrol, which has a double action: it blocks the development of an allergic reaction and suppresses unnecessary excitation of the central nervous system.

In addition to drugs, at hand should be syringes of various sizes, medical alcohol for rubbing the skin with injectable preparations, cotton balls, gauze, rubber tourniquet, bottles with sterile saline solution for intravenous infusions.

Medication should be lightning fast. Be sure to inject drugs intravenously, this will speed up their effect on the human body. The list of inputs should be limited. But, despite this, certain drugs must be included in it.

• Catecholamines. The most important of this group of drugs is Adrenaline. Due to a certain stimulation of adrenoreceptors, it will allow to narrow the vessels, as well as reduce the activity of the myocardium. In addition, adrenaline significantly increases cardiac output, and also has a bronchodilator effect. To enter it it is necessary at a rate of 0,3-0,5 ml 0,1%. It can be administered as a mixture. Usually it consists of 1 ml of a 0.1% solution of adrenaline and a solution of sodium chloride, in a volume of 10 ml. Probably, repeated introduction within 5-10 minutes.
• Glucocorticosteroids. In general, Prednisolone, Dexamethasone, Metiprednisolone, Hydrocortisone are used. They are administered from the calculation of 20-30 mg of the drug per kilogram of weight. This will help to establish a positive dynamics of the patient. Drugs of this category can significantly inhibit the effect of allergens on capillaries, thereby reducing their permeability.
• Bronchodilators. Among them, Euphyllin is actively used. It helps to reduce the release of histamine metabolites, thereby reducing 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 proceeding to a maintenance dose of 0.9 mg / kg / h.
• Infusion therapy. It is in the introduction of 0.9 sodium chloride solution, acesol, 5% glucose solution. Due to their significantly increased blood circulation volume, there is a vasoconstrictive effect.
• Antigiapamine preparations. Drugs of this group can effectively affect the condition of a person. Prevent or completely eliminate Quincke's edema and hives. They can reduce the action of Histamine on the body. This leads to relief of attacks of anaphylactic shock. It is simple to introduce 1-2 ml of Tavegil or Suprastin solution.

Protocol for the treatment of anaphylactic shock

In addition to the standard treatment protocol, there is also an auxiliary treatment regimen, which is used for the case of a complicated course of anaphylaxis. To stop the laryngeal edema, for example, the above drugs and funds will be small. Here you need surgical intervention - tracheostomy. This operation is the setting of a tracheostomy (a special tube for breathing) through an opening in the trachea. Simultaneously with the operation, additional local anesthetics are used.

If the shock condition occurs with a prolonged loss of consciousness, and there is a threat of development of a coma, the doctor can use a standard set of antishock therapy.

Normalization of the patient's condition and elimination of danger are recorded with the help of special analyzes and studies characterizing the restoration of the functionality of vital organs, in particular, the liver and urinary system.

If the shock was triggered by the introduction of a drug, then this is necessarily recorded in the medical history and medical records of the patient. In this case, all preparations of the group that caused an allergic reaction should be indicated. The recording should be visible at a glance, so it is applied with a red marker on the title page of the card. This is done first of all in order to have an idea of what help the patient should be provided if he is unconscious.

Algorithm for the treatment of anaphylactic shock

Algorithm of assistance in the development of anaphylactic shock consists in blocking the effect of an allergenic substance on the body and in combating the main symptoms of a 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, the most important drugs for anaphylaxis are hormonal drugs:

• The use of adrenaline allows you to narrow the lumen of peripheral vessels, thus inhibiting the movement of the body of histamine secreted by the immune system;
• The use of prednisolone calms immune activity, which can lead to cardiac arrest.

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

In extraordinary severe situations, the list of drugs that are used for anaphylactic shock is known to expand, including the required resuscitation measures.

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

Treatment of anaphylactic shock in the prehospital stage

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

What does the pre-hospital treatment stage include?

1. Intramuscular urgent administration of Epinephrine (Epinephrine hydrochloride) to all without exception, victims with signs of anaphylaxis. The agent is injected into the upper half of the trunk (for example, in the superficial muscle of the shoulder). Dosage of the drug for an adult patient is 0.5 ml 0.1% solution. If necessary, repeat the injection after 5 minutes. Intravenous infusion of epinephrine is used only in extreme cases, with a deep shock state or clinical death, or in cases where the shock developed against a background of general anesthesia. Patients whose condition did not improve with adrenaline administration are given Glucagon, 1-2 mg intravenously or intramuscularly every 5 minutes, to a visible positive effect.
2. Intensive introduction of fluids. At "top" pressure less than 90 mm Hg. Art. Use a jet injection (up to 500 ml for 20-30 min), then switching to a drop, isotonic sodium chloride solution (800-1200 ml) with further connection of Polyglucin (400 ml). Simultaneously with the administration, blood pressure and diuresis are monitored.
3. Relief breathing. To improve the patency of the trachea and bronchi, aspiration of accumulated mucus is carried out, inhalation of pure oxygen is used. If necessary, tracheostomy is carried out with the further use of the ventilator.

Non-pharmacological treatment of anaphylactic shock is carried out before the arrival of the "first aid" and consists of the following measures:

• blocking the ingress of the allergen into the body;
• providing the patient with a horizontal position with the head turned to the side and down;
• the application of a tourniquet over the site of the introduction of an allergen or an insect bite;
• if necessary, artificial heart massage and artificial ventilation.

Treatment in hospital

A further set of measures does not directly affect the course of the shock state, but with its help it is possible to reduce anaphylactic symptoms, accelerate the recovery of the organism and prevent a possible reoccurrence.

• Corticosteroids are not emergency medications. Their effectiveness appears on average only 5 hours after intravenous injection. However, the benefits of corticosteroids are great: they are able to prevent or shorten the duration of the second phase of the course of anaphylaxis. In this case, inject drugs such as hydrocortisone in the amount of 125-250 mg, or Dexazone in an amount of 8 mg, intravenously. Such injections should be repeated every 4 hours before the acute reaction is removed.
• Antihistamines should be used after the stabilization of blood circulation, because one of the side effects of such drugs is lowering blood pressure. Enter Diphenhydramine intravenously from 20 to 50 mg, or intramuscularly from 2 to 5 ml of 1% solution. The introduction can be repeated after 5 hours. At the same time, the administration of Ranitidine (50 mg) or Cimetidine (200 mg) intravenously is recommended.
• Preparations-bronchodilators are used in the presence of bronchospasm, not eliminated by the introduction of Adrenaline. As a rule, for the restoration of respiratory function, Salbutamol is used in an amount of 2.5-5 mg, with the possibility of repeated administration of the drug. The preparation of the reserve in this case is Eufillin (intravenously in the amount of 6 mg per kilogram of the patient's weight).

Treatment of anaphylactic shock in children

The treatment measures are taken in the most urgent way, even with the suspicion of anaphylaxis, without waiting for the full development of symptoms. Sending a child to a hospital is mandatory.

The first thing to do is to avoid getting the allergen into the body. Further n / k or / m injected 0.1% adrenaline (dose is calculated depending on the age and weight of the baby). A hypothetical area of exposure to an allergenic substance is applied cold.

Immediate introduction of corticosteroids: Dexamethasone, Prednisolone or Hydrocortisone.

If the allergenic substance has got into the body with food, then an emergency rinsing of the stomach cavity should be performed, followed by the giving of sorbent preparations (activated charcoal or Enterosgel).

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

• to stop the ingress of an allergen into the body;
• the child lay a little on his side and down his head - this improves blood circulation in the brain and reduces the risk of inhaling vomit;
• if necessary, fix the tongue;
• ensure access of clean air;
• urgently call an "emergency room" or any health care provider;
• if necessary, carry out 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 complexity of the condition and the presence of complications, the patient's age, the results of the tests, etc. All the nuances should be considered in order to prevent late complications in the work of the organs and body systems.

Patients who have experienced anaphylactic shock should consider in the future that for their lives there is a serious risk of repeated anaphylaxis. They should be extremely careful about the possible re-entry of the allergen into the body.

The attending doctor must indicate in the case history and discharge the substance or medication that caused the anaphylactic reaction in the body. The final consultation of an allergist is mandatory.

The patient is discharged from the hospital only after stabilization of blood, urine, cardiogram, and in digestive disorders - feces analysis.

New in the treatment of anaphylactic shock

Anaphylactic shock is a complex and responsible condition, which often leads to death. For this and other reasons, allergy specialists are interested in finding new means for treating allergies.

• Application of medicinal radiation. The French specialist in immunology has developed a method according to which not medicinal products are used for the treatment of allergies, but their radiation in water. It turned out that medicines can be replaced with their "projections", which are fixed in the liquid. Such a method strikes its seemingly unrealistic. Nevertheless, more than two thousand tests have already been conducted, which confirmed the effectiveness of the method.
• Method of autolymphocytotherapy. The essence of this technique is in the introduction of the patient's own lymphocyte mass, which has been processed beforehand, preserving information about all contacts with allergens. This procedure makes the body unresponsive to a potential encounter with allergens.
• A new generation of antihistamines. Experts from Finland found that histamine substances ("mediators" of allergies) can affect not only the H1-histamine receptors. This conclusion can be used to develop new medications. By the way, some of them already undergo clinical trials. For example, tryptase, chymase, cathepsin G are enzymatic substances that break down certain proteins. In addition, they are able to block H4-histamine receptors. It is likely that after a while in the pharmacy network, we will be able to purchase combined drugs aimed at inhibition of H1 and H4 histamine receptors, which in combination will give a more tangible positive result.

Of course, medicine is moving in its development "seven-mile" steps. Both allergists and immunologists and patients sincerely hope that soon scientists will find the latest successful techniques and tools that can prevent allergy and treat anaphylactic shock quickly and safely.