Emergency first aid for anaphylactic shock

Anaphylactic shock requires provide immediate assistance to the victim, and the speed plays a leading role here.

The drug of choice is a 0.1% solution of epinephrine hydrochloride. Other drugs may be used only as adjuvant therapy. And the sooner you will enter the adrenaline from the moment the patient started to develop severe hypotension, respiratory and heart failure, the more favorable the prognosis. If this period is stretched, then death happens in 90% of cases.

The content of the article:

• First aid in anaphylactic shock
• Qualified first aid for anaphylactic shock
• The treatment of the patient in the intensive care unit
• What not to do?
• The kits anaphylactic shock

First aid in anaphylactic shock

An allergic reaction is a complex process, which activates the immune complexes and a number of specific cells (mast cells and basophils). Which in turn triggers a General inflammatory response – itching, sneezing and watery eyes to a condition called anaphylactic shock.

Anaphylactic shock – a serious condition that the symptoms of develops quickly, without medical care may end in death.

Action algorithm consists of three steps:

First, immediately call "fast". As much detail as possible describe the condition of the patient, tell the Manager that preceded anaphylaxis, for example, an insect bite, medication, etc.

Secondly, provide all possible assistance to the victim. It is important not to mistake a state of shock can be caused by not anaphylaxis. The main thing is not to panic and focus, anaphylactic shock is always preceded by contact with an allergen. So, your task is to travel "soon":

• If possible, ask the patient and determine what caused the allergic reaction. It can be dogs, cats, wool, feathers, or dust, household chemicals etc., you must immediately stop contact of the victim with the allergen. If it's a bite or an injection (a shot), then lubricate the wound by any antiseptic, you can use a tourniquet above the wound (only if you know how to do it, remember – do no harm!), the bite can be cooled.

• Give the victim an antihistamine is the one that takes allergies, or any existingin handy first aid kit. If the patient is prone to allergies, and he has in the first aid kit adrenaline, then take a "shot" of adrenaline intramuscularly.

• To put the patient in a convenient horizontal position on the pillow, and loose smooth surface, the legs elevate slightly above the head. To turn your head sideways.

Thirdly, monitor the patient's condition – measure the pulse, to follow the breath and wait for the arrival of doctors "first aid". Upon arrival, the doctor must accurately convey the information that you are aware of: when a reaction has begun, how much time passed from the beginning, what actions were taken and what medications were given to the victim. In any case, do not hide anything, that depends on a person's life!

So, your friend have allergies ate peanuts, or bee sting, or "from the throat" were treated with a tablet of penicillin, what to do?

Anaphylactic shock is the reaction of the immediate type, so begins to develop immediately after contact with the agent provocateur. The qualitative composition of the allergen does not affect the reaction, although a large number of worsen over. If anaphylaxis has begun, without emergency it is likely not over. The speed of onset of symptoms from a few minutes to several hours, can take minutes, so you:

• Call an ambulance, describe in detail the situation – qualitative information will help the dispatcher "fast"to let the doctor and when he will not have to spend time on the analysis of the situation. If the Manager gave you a recommendation, be sure to follow them. Don't panic, don't shout"die"if the situation is not so critical – that you do not accelerate the arrival of the doctors, and only escalate the situation. Keep a clear head, describe to the dispatcher"first aid" things as they are.
• Starts anaphylactic reaction to deterioration under the action of histamine will result in a collapse of blood vessels, blood circulation. The person feels as clouded consciousness, shortness of breath increases, his skin becomes wet and cold, are experiencing acute anxiety, can wet oneself, an acute urge to defecate is followed by an "unconscious"state. Urgently give an antihistamine, lay patient and watch. If you have no experience in first aid, remember the inept"help" more harm than good. Wait for the ambulance.

Qualified first aid in anaphylacticshock

The doctor is obliged to record in writing all actions which he performs for the relief of anaphylactic shock. The basic points of managing patients:

1. Definitely need to eliminate the allergen that provoked the development of pathological reactions. For example, to remove the sting of an insect, to stop the administration of the drug and St. If the allergen was injected into the limb, it is necessary to impose venous tourniquet, which should be placed above the site of injection or sting and apply ice to this area. This will reduce the rate of arrival of drug or poison in the blood system.

2. Then, you should assess the patient's condition. It is important how the person is breathing, the color of his skin, and he is conscious or not. Estimated weight of the victim and its blood circulation. All this must be done as quickly as possible, to be able to instantly move on to the following paragraphs.

3. If you have the time and place of the accident, shall immediately be caused by the resuscitation team. If anaphylactic shock develops outside of the hospital, then you need to call the ambulance.

4. The patient is administered intramuscular Epinephrine (0,1%) – 0,3-0,5 ml. injection – the front of the thigh. The calculation of the dose depends on the age and weight of the patient. So, adults are recommended to count adrenaline hydrochloride 0.01 ml per kg of body weight, and children 1 MLG per kg of body weight. The maximum single dose for an adult is 0.5 MLG, and for children 0.3 ml. If necessary, the drug is administered again after 5-15 minutes. Typically, the response occurs in the first or second injection.

5. The victim should be laid on his back raised up the lower limbs. The head should turn sideways, and the lower jaw forward. This would prevent the ceasing of the language and will not allow the patient to choke on her own vomit. When a person is wearing dentures, they should be removed. Patient is seated and not put on the feet, it is very dangerous and can for a few seconds to provoke his death. If the tongue interferes with normal breathing on the background of impaired consciousness, we performed a triple reception Safar (the patient lying on his back, his head perekrashivat in the cervical-occipital Department, and the lower jaw push forward and upward). If possible, the patient is administered a duct or endotracheal tube. In the earlyintubation need victims who develop laryngeal edema. If this is not possible, the system conicotomy. This extra dissection membrane located between the cricoid and thyroid cartilage. When the Airways are free, a person need to ensure pure oxygen.

6. Man should breathe clean air, and if necessary, giving him oxygen inhalation. It is fed through the nose by means of a catheter, through the mouth with a mask or through the air duct tube when spontaneous breathing is preserved, but the consciousness remains confused. Connect patient to ventilator is necessary when disturbance of consciousness, on the background of edema of the trachea and larynx, and also when there is no possibility to resolve the escalating hypotension. In other indications in ICU are: bronchospasm with the transition to respiratory failure, pulmonary edema, which is not removed by medication, coagulopathies bleeding.

7. Intravenous administration of 0.9% sodium Chloride solution in the amount of 1-2 lwith the adult dosage is 5-10 ml/kg for a child 10 ml/kg.

8. The doctor must be in a constant state of readiness to the need for resuscitation procedures, aimed at restoring the functioning of the heart and respiratory system. Adult patients perform chest compressions with a frequency of 100 to 120 shocks per minute at a depth 6 cm. Children perform 100 compression per minute to a depth of 5 cmand babies to 4 cm. The proportion of "breath push" must be equal to 2 to 30.

9. It is important to monitor the patient's pulse, respiratory rate, blood pressure, level of blood oxygenation. If you do so using monitors is not possible, then the pulse is calculated manually every 2-5 minutes.

The treatment of the patient in the intensive care unit

Matter as soon as possible deliver the person to the intensive care unit. Further treatment is carried out as follows:

1. If intramuscular Epinephrine has no effect, it is administered intravenously, in batches, for 5-10 minutes. Or perhaps the intravenous drip of the drug.

   • When a portionthe introduction will need to dilute 1 ml of adrenaline (0.1%) for 10 ml of sodium Chloride (0,9%).

   • With a drip of 1 ml Epinephrine (0,1%), diluted in 100 ml sodium Chloride. The initial flow speed of the medicine is 30-100 ml/h, that is 5 to 15 mcg per minute. The dose should be corrected depending on the condition of the patient and severity of side effects development of intravenous adrenaline.

2. If the human condition is severe then shown intravenous drip Pressor amines.

   • Norepinephrine is administered intravenously, by drip method. You will need 1-2 ml of Norepinephrine at a concentration of 0.2%. It is diluted in glucose solution (500 ml, 5%) or sodium Chloride solution (500 ml of 0.9%). The feed rate of 4-8 micrograms per minute. The drug is administered to until blood pressure returns to normal.
   • It is also possible intravenous Dopamine. It in the amount of 400 mg was dissolved in glucose solution (500 ml, 5%) or sodium Chloride solution (500 ml of 0.9%). The initial infusion rate is 2-10 mcg/kg/min Dose should be corrected in such a manner that the upper pressure does not exceed 90 mm. RT. article If the patient's condition remains severe, increase the dosage to 50 mcg/kg/min. Max per day you can enter no more than 1,500 mg When the patient's condition gradually returns to normal, the dosage of the drug should gradually reduce.

The duration of the introduction of Pressor amines depends on the basic hemodynamic variables. What kind of medication will be administered and what will be the speed of its introduction depends on the specific situation. All the agonists be removed only after it is possible to achieve the stabilization of arterial pressure of the patient. Moreover, this stabilization must be sustainable.

3. If the patient shows resistance to drugs of adrenaline, then foreign authors propose to use Glucagon. Most often resistance is observed in those patients who had previously received beta-blockers (the word "informed" means the situation before the development of anaphylactic shock). The dosage of Glucagon is 1 to 5 ml. Introduce children maximum dose should not be more than 1 ml, the drug is calculated from 20-30 micrograms per kilogram of body weight. Glucagon is administered intravenously for 5 minutes, after which the dose is gradually adjusted. You need to ensure that the patient is lying on his side, as the Glucagon can provoke a gag reflex.

4. When the patient is unresponsive neither Glucagon nordrugs of adrenaline, perhaps the use of Isoproterenol. It is administered intravenously in a volume of 1 mg (0.1 mcg/kg/min). However, the use of this drug carries a risk of arrhythmia and myocardial ischemia.

5. In order to prevent the reduction of circulating blood volume is necessary to introduce such drugs as:

   • Dextran with a molecular weight of 35-45 thousand daltons.
   • Sodium chloride at 0.9% concentration.
   • Other isotonic solutions.

6. Drugs of the second row after the adrenaline are:

7. Corticosteroids, the initial dose which is equal to: 90-120 mg inkjet, for intravenous Prednisolone, 8-32 mg drip, for intravenous Dexamethasone, 50-120 mg inkjet, for intravenous Methylprednisolone, 8-32 mg IV drip for Betamethasone. It is also possible the use of other systemic glucocorticoids. For therapy in children the dosage is slightly different, for example, 2-5 mg/kg for Prednisolone, 20-125 mg/kg Betamethasone. According to the technique of pulse therapy corticosteroids not administered. The duration of treatment and dose adjustment depends on the patient.
8. If there is evidence, then perhaps the introduction of blockers of H1-histamine receptors. However, they are allowed to apply against the complete stabilization of hemodynamics. It can be drugs such as: Clemastine, Diphenhydramine, Tavegil, etc. Hloropiramin or Clemastin administered intravenously or intramuscularly at a dose of 2 mg (0.1% -2 ml) adult patients. Children shows intramuscular dose of 25 µg/kg/day, and the dose should be divided into 2 times. You can also use Diphenhydramine (20-50 mg for adults, 1 mg/kg for children weighing less than 30 kg) or Suprastin. Dosage for Suprastin is 20 mg (0.2% -1 ml) for adults and 5 mg (0.25 ml) for children. The drug is also administered intravenously or intramuscularly.

9. If the patient has bronchospasm is not relieved even after the introduction of adrenaline, it shows the inhalation of the beta2-antagonists. For this, the patient must breathe through the nebulizer solution Salbutamol 2.5 mg/2.5 ml. in Parallel to the patient intravenously administered Aminophylline 5-6 mg/kg.

10. If edema of the larynx, the patient perform a tracheostomy.

The more severe anaphylactic shock, the longer it will be sickunder the careful supervision of doctors. Even if the state was able to quickly stabilize the patient for at least 2 days needs to stay in the hospital. The fact that there is a high risk of relapse of anaphylaxis.

Moreover, retains the option of development are delayed in time complications like hepatitis, neuritis, myocarditis allergic nature, and so Also for 21-28 days may work different systems and organs.

What not to do?

• Not to start treatment with the introduction of antihistamine!
• It is forbidden to use the medication that triggered the anaphylaxis. Nor are those drugs which contain components which are able to give a cross-reaction.
• Of the diet excludes product which has led to the development of anaphylactic shock.
• If the patient has a confirmed Allergy to pollen, he does not prescribe drugs based on it.

The kits anaphylactic shock

Adrenaline (Epinephrine) in the solution of 0.1%, 1 mg/ml. the Drug is contained in ampoules №10.

Noradrenaline in the solution of 0.2%. The drug in ampoules №10.

MetaSAN in 1% solution. The drug in ampoules No. 5.

Dopamine in solution of 5 ml (200 mcg). The drug in ampoules No. 5.

Suprastin solution 2%. The drug in ampoules №10.

Tavegil in a solution of 0.1%. The drug in ampoules №10.

Prednisolone in a solution of 30 mg. of the Drug in ampoules №10.

Dexamethasone solution 4 mg. of the Drug in ampoules №10.

Hydrocortisone hemisuccinate or solucortef 100 mg - №10. The drug is for.

Aminophylline in the solution is 2.4%. The drug in ampoules №10.

Salbutamol in aerosol form to accomplish inhalation. Dosage of 100mcg/kg No. 2.

Strophanthin-K in a solution of 0.05%. The drug in ampoules No. 5.

Kordiamin in a solution of 25%. The drug in ampoules No. 5.

Diazepam in 0.5% solution. The drug in ampoules No. 5. An alternative – or Seduksen Relanium.

Glucose solution 5%, 250 ml of number 2.

Atropine solution of 0.1%. The drug in ampoules No. 5.

Sodium chloride solution 0,9%. The drug in capsules No. 20.

Sodium chloride solution 0,9%, 400 ml, №2.

Ethyl alcohol 70% concentration 100 ml.

The tongue depressor No. 1.

Waterskiier No. 1.

Pillow oxygen No. 2.

A tourniquet and scalpel No. 1.

Disposable syringes 1 ml, 2 ml, 5 ml and 10 ml and 5 needles to them.

Catheter intravenous needle to him No. 5.

Ice No. 1.

System for drip infusion No. 2.

Two pairs of disposable medical gloves.

Duct.

Manual breathing apparatus of the type Ambu.