Symptoms and first aid for anaphylactic shock: the algorithm of rendering, the actions of a nurse

August 18, 2017 23:00 | Allergies

First aid for anaphylactic shock at home, on the street, on the ground and in the air should be immediate and kachevtennoy.It takes a few minutes to save a person, and the slightest delay is death.Therefore, today our article will tell you about the symptoms and the algorithm for providing emergency care for anaphylactic shock.

First symptoms of

Time of appearance of

The time of appearance of initial signs of anaphylactic reaction is connected with such factors:

  • which substance was an allergen-provoker;
  • method of penetrating an allergen-provoker into the bloodstream;
  • the sensitivity of a person to this allergen;
  • physiological, anatomical features, existing diseases, predisposition to allergies of all kinds;
  • age and weight;
  • existing internal pathologies;
  • is a hereditary predisposition to acute allergic manifestations.

So:

  • For example, an insect venom, a drug injected intramuscularly or intravenously, causes an instantaneous reaction, the symptoms of which develop between 1 and 2 to 3
    0 minutes.
  • An allergic shock to food usually reveals itself later - from 10 minutes to several hours, although in many cases( freshly squeezed orange juice, peanuts) the body is able to react lightning-fast - for 15 to 40 seconds.

And the sooner the pathological symptoms appear after contact with the allergen, the faster their severity grows, the more difficult the condition goes, the more difficult it is to remove the patient from it and the higher the risk of death if the help has not been rendered without delay.

The first symptoms of anaphylactic shock are discussed in this video:

General characteristics of

When describing the basic signs of anaphylactic shock, regardless of the form of the pathology, they are first generalized to close relatives, friends, colleaguesAnd the patient himself were able to quickly navigate in a critical situation.These signs can be expressed separately, not necessarily in a complex or sequential manner, sometimes isolated symptoms appear, but all of them indicate the defeat of various organs:

  • swelling of the nasal mucosa, pharynx, eyelids, lips, tongue, larynx, genitalia, which often accompaniesSevere burning, tingling, itching, raspiranie tissues( in 90% of cases);
  • skin changes with bright rashes, blisters( as hives), red or white spots, with severe itching( with rapid development of anaphylaxis, skin manifestations may occur later or absent altogether);
  • sudden pain behind the breastbone - sharp and frightening patient;
  • numbness of the lips, facial muscles;
  • lacrimation, pain in the eyes, irritation and itching;
  • shortness of breath, cough, wheezing, whistling( stridor), superficial panting;
  • sensation of a coma in the throat, making it difficult to swallow, squeezing the neck;
  • nausea, spasmodic pains in the stomach, stomach, vomiting( more often - when the allergen gets into the stomach)
  • pulsating or squeezing headache, dizziness;
  • perverted gustatory sensations: metallic, bitter taste in the mouth;
  • frequent cardiac muscle contraction( tachycardia) or bradycardia( abnormal heart rate slowing), rhythm disturbance( arrhythmia);
  • drop in blood pressure, blurred vision, blurred vision, double vision;
  • panic reactions with pronounced fear of death, suffocation;
  • with a high adrenaline in the blood on a background of panic attack - a feeling of severe burning in the fingers, tremor( trembling), convulsive movements;
  • Involuntary urination, defecation, spotting from the internal genitalia( in women);
  • clouding and loss of consciousness.

Symptoms of anaphylactic shock

Help-for-anaphylactic-shock-symptoms

symptomatology depending on the type of anaphylaxis

typical( about 53%)

Symptoms:

  • hypotension( blood pressure drop below normal);
  • redness or pallor, blue lips;
  • rash, swelling of any areas( especially dangerous - swelling of the larynx and tongue);
  • severe weakness, tinnitus, dizziness;
  • itching, tingling, burning of the skin on the face, hands;
  • feeling of heat, pressure, raspiraniya in the head, on the face, in the tongue, fingers of hands;
  • anxiety, sense of danger, fear of death;Abnormal sweating.
  • pressure and chest pain, chest tightness;
  • dyspnea, frequent difficult breathing with whistling, wheezing, coughing-bouts;
  • sometimes - foam from the mouth on the background of dyspnea;
  • nausea, stomach pain, bowel, vomiting,
  • pain in the near-cardiac region;
  • dizziness, squeezing pain in the head of varying severity.
  • confusion and loss of consciousness.
  • seizures of individual muscles, arms and legs, there may be seizures by the type of epilepsy;
  • uncontrolled urinary excretion, feces.

Features:

The leading symptom is hypotension( pressure drop) due to the acute state of vascular collapse and respiratory failure due to edema of the larynx or bronchospasm.

When listening: rales large-bubbly( wet, dry).

As a result of severe mucosal edema and extensive spasm of bronchial tubes, noises in the lungs during breathing may not be audible( "mute lung").

For severe:

  • dilates pupils that do not respond to light;
  • pulse weak threadlike;
  • heart rate is fast or slower than normal;
  • failure in the rhythm( arrhythmia);
  • heart sounds are deaf.

More often than all other forms gets an acute malignant course with a high probability of death of the patient.

Hemodynamic( 30 - 35% of cases)

Symptoms:

  • sharp pains in the heart;
  • significant drop in blood pressure indicators;
  • deaf heart tones, weak pulse - until disappearance;
  • heart rhythm disorder( arrhythmia) - up to asystole;
  • strong pallor due to spasm of blood vessels or so-called "flaming hyperemia"( reddening of the whole skin with a feeling of extreme heat);
  • Or the "marbling" of the skin due to a violation of blood circulation in the capillaries, cyanosis( blue lips, nails, tongue).

Signs of the defeat of respiration and the nervous system are less pronounced.

The leading pathosymptom is a violation of cardiovascular activity followed by acute heart failure.

With early diagnosis and active treatment, the prognosis is favorable.

Asphyxic( 17%)

Help-for-anaphylactic-shock-nurse Symptoms of respiratory failure:

  • cough paroxysmal dry;
  • hoarse voice, wheezing;
  • obstructed superficial breathing with stridor( whistle) and convulsive ingestion of air;
  • sensation of swelling of the throat, neck, foreign object in the respiratory tract;
  • feeling of chest compressions;
  • spasm of the respiratory tract - larynx, bronchi;
  • blue skin around the nose and lips, blue nails;
  • pulmonary edema;
  • nasal congestion and swelling of the nasal mucosa, pharynx, larynx;
  • cold sweat, panic, loss of consciousness.

In this case, acute respiratory failure predominates due to edema of the laryngeal mucosa with overlapping of its lumen( partially or completely) bronchospasm before complete obstruction of bronchioles, pulmonary edema.

Asphyxic form predisposes the existing chronic bronchitis, asthma, pneumonia, pneumosclerosis, bronchiectatic disease, emphysema.

The prognosis is determined by the degree of respiratory failure.At a delay in acceptance of measures the patient perishes from an asphyxia.

Cerebral( medullary)

Symptoms:

  • overexcitation, anxiety, fears, panic;
  • rhythm disturbance of breathing( respiratory arrhythmia);
  • sopor( numbness, a condition close to coma, oppression of consciousness with loss of control over actions);
  • convulsions( muscle twitching, leg cramps);
  • loss of consciousness in acute circulatory disturbances in the vessels of the brain;
  • stiffness( stiffness) of the occipital muscles;
  • probable arrest of respiration and heart rhythm with edema of the brain.

Central nervous system disorders predominate.

The prognosis depends on the time of the beginning of medical care.

Abdominal( 25%)

Symptoms:

  • cutting pains in the epigastric zone( under the spoon), signs of irritation of the peritoneum resembling the symptoms of perforation of the ulcer, intestinal obstruction, pancreatitis;
  • nausea, diarrhea, vomiting;
  • acute pain in the heart( in which the false diagnosis of "myocardial infarction" is often diagnosed);
  • is a shallow and brief disorder of consciousness;
  • slight decrease in blood pressure( not lower than 70/45 mm Hg).

Other typical symptoms are less pronounced.

Leading symptoms are symptoms of an "acute abdomen", which often leads to an error in the diagnosis of

Harbinger - itching in the mouth, swelling of the tongue and lips.

More often than other forms it is completed safely.

Caused by physical exertion( 2-5%)

Symptoms:

  • skin itching;
  • hot flushes to the head, fever, erythema( redness), rash or blistering rash( hives);
  • swelling of the face, neck;
  • abdominal pain and diarrhea;
  • dyspnea, laryngeal edema;
  • sharp drop in blood pressure.

Physical stress, either as a single factor, or in combination with eating food or drugs, often leads to the development of an anaphylactic reaction that increases until shock.

If the reaction is stopped before a shortness of breath, a rapid excretion of the patient out of shock is predicted.Swelling and low blood pressure are life-threatening symptoms.

Next, we will consider the algorithm of the nurse's actions and the first aid for anaphylactic shock in children and adults.

First aid for children and adults with anaphylactic shock

At the first sign of an anaphylactic reaction, an ambulance is called immediately. For any direction of events - even if the person's condition seems stable, you should know that for every fifth patient an anaphylactic reaction manifests itself in two phases: after the first stage of anaphylaxis, which seems to have safely ended within the range of 1 hour to 3 days, there is a second -Often - more serious.

Help-at-anaphylactic-shock

Help-at-anaphylactic-shock

Sequential.

  • Many doctors recommend the immediate administration of epinephrine( epinephrine) even with the initial signs of anaphylactic shock.Most often this option is justified, because the patient's condition may worsen in seconds.
  • Others are advised to delay using adrenaline at home if there are no obvious abnormalities in the work of the heart and respiration, explaining this by the fact that Adrenaline is a means of increased danger that can cause heart failure.Even experts of the "first aid" often avoid using adrenaline, shifting responsibility for the consequences to resuscitation doctors in the hospital.

Therefore, a lot depends on the severity of the manifestations, which should be closely monitored prior to the arrival of the ambulance.

More details on pre-medical care for anaphylactic shock will be told by this video:

Immediate Action

However, you must act as quickly as possible and perform the following:

  1. Eliminate allergen source: remove stinger, stop intramuscular injection of medication.
    • to tighten the vein( without squeezing large arteries) in place above the injection site or bite( loosen for 1 minute every 10 minutes);
    • put on a hot water bottle with cold water, ice, in order to inhibit the spread of the allergen with the blood flow, if possible;
    • if necessary - release mouth and nose from mucus, vomit, remove dentures;
    • if the patient is unconscious, pull the tongue outward so that it does not block the larynx;
    • to turn the patient on its side so that the tongue and food masses, with possible vomiting, do not block the way for air;
    • remove all belts, unfasten buttons, loosen neckties, if necessary, tear off clothes, so as not to restrict breathing, baby to unfasten.
  2. If the patient is breathing, he is laid on his back, lifting his legs to redirect blood to the heart and brain.But in the case of the beginning of the laryngeal edema - on the contrary, - it is necessary to take an upright position, and take the child in his arms, holding the back.

If the breathing and pulse are present, the person is conscious, his condition is more or less stable, and he is able to respond to requests, immediately use the following medicines:

  • Hormones - for coping of the edema of the respiratory tract and death of the patient from suffocation:
    • Prednisolone( ampoule - 30 mg).Adults receive up to 300 mg( up to 5-10 ampoules), children from one year to 14 years of age, the dose is calculated at a rate of 1-2 mg per kilogram of body weight, the norm for newborns is 2-3 mg per kilogram.
    • Dexamethasone( 1 ml - 4 mg), adults from 4 to 40 mg, for children of any age the dose is calculated by body weight: 0.02776 - 0.1666 mg per kilogram.Intramuscularly, slowly, deeply into the buttock.If no improvement is observed, medication is given again after 15 to 30 minutes.
  • Antihistamine to suppress the body's response to histamine release:
    • Suprastin.Adults median doses are 40 to 60 mg.Initial dosages for children: from birth to the year 5 mg;From the age of one year to 6 years - 10 mg;From 6 to 14 years: 10 to 20 mg.Given that the rate per kilogram of weight can not be more than 2 mg.
    • In addition to Suprastin, Tavegil, Dimedrol, and Pipolphen are used.
  • Intramuscular injection of I as most effective in critical situations.

If it is not possible to make an intramuscular injection, the ampoule is gently broken, the syringe is filled with medicine and, after removing the needle from the syringe, poured out under the tongue - into the corner of the mouth, ensuring that the patient does not choke.The therapeutic effect with this method comes very quickly, because through the sublingual vessels the medicine is immediately absorbed into the blood.

If the drug drips into the eyes, into the nose, and it causes acute anaphylaxis, the eyes and nasal passages are washed and instilled in them adrenaline( 0.1%) or hydrocortisone( 1%), or dexamethasone.

The critical situation before the arrival of the ambulance

In case of a catastrophic situation - the patient suffocates or does not breathe, turns blue, loses consciousness, the symptoms indicate severe respiratory, heart failure - IMMEDIATE introduction of ADRENALINE.

The drug and its action Where and how much to enter
Adrenaline.In 1 ampoule, 1 ml of solution 0.1%
  1. Increases blood pressure, narrowing peripheral vessels.

  2. Strengthens cardiac output by increasing contractile activity of the heart.

  3. Relieves spasm of bronchi and bronchioles.

  4. Suppresses the release into the blood of substances that regulate allergic manifestations( histamine, acetylcholine), as well as bradykinin, contributing to a critical drop in pressure in shock.

  • Enter intramuscularly at any site( and through clothing - too).The optimal insertion site is the outer middle part of the thigh.Can be administered under the skin.

  • Adult single dose: 0.3 - 0.8 ml.

  • Children are calculated strictly, based on the norm of 0.01 mg per kilogram of the weight of a small patient or 0.01 ml / kg.With a shortage of time for calculations - in milliliters: 0.1 - 0.3( according to the body weight).

  • In acute respiratory failure and unconsciousness, the solution is poured under the tongue in the same dosages - it will be absorbed into the bloodstream as quickly as in the injection.

  • If no positive effect is observed, adrenaline administration can be repeated every 5 to 10 or 15 minutes, which is related to the severity of the patient's condition.

In the network of Russian drugstores, there are often special pen-syringes-handles with the already required dose of adrenaline, which are used once for anaphylaxis: the EpiPen pen, with a single dose of 0.15-0.3 mg.

If medication is not available or they do not help

Indirect cardiac massage and forced breathing - in the working environment or at home begin immediately if there is a cardiac arrest.

If the airway is strongly swollen and does not pass air, ventilation before injecting adrenaline is more often unsuccessful.Therefore, in cases of spasm of respiratory tract, larynx, trachea, only indirect heart massage is performed, without stopping it before the arrival of ambulance doctors.

Massage Technique

Pomoshh-pri-anafilakticheskom-shoke-masazh Heart muscle massage is performed by deeply punching( 4 to 5 cm) with a chest crossed in the heart zone, folded across the palms.The pressure is not carried out with the muscles of the hands, but with the whole body mass through the arms straightened in the elbows - vertically.Do 50 to 60 clicks per minute.If the person doing the massage has no one to change, and he is exhausted, it is allowed to press on his chest even with a heel - just do not stop.

When massage and pulmonary ventilation are performed by two( if air penetrates into the lungs), the actions alternate:

  • is optimal: 4 strokes, inhaled through the mouth with the patient's nose squeezed and the head thrown back, again with 4 pressure;It is possible to blow in the air and into the nose, but this method is less effective, as usually the mucous membrane becomes very swollen, interfering with the intake of air;
  • if resuscitation is performed alone, alternate two breaths with 30 pressure on the patient's chest.

The following is considered emergency care for anaphylactic shock by a nurse on site and in a clinic.

Medical assistance

A patient with symptomatic anaphylaxis is urgently sent to the intensive care unit of the hospital.Complex treatment is aimed at stopping circulatory disorders, normalizing the functioning of the heart and respiratory tract, removing the edema, interrupting the action of the allergen.

The methods of emergency therapy, which are performed with an allergic shock, involve the use of medications.

Adrenaline

Epinephrine: Early administration of the solution prevents the development of severe conditions.Specialists "ambulance" when applying the medicine on the spot( not in the hospital) inject it intramuscularly, without wasting time on manipulating the veins.Dosages are indicated in the section "First aid".

  • If is administered intravenously, : Adult dose with body weight of 70 to 80 kg is 3 to 5 μg per minute.It is advisable to pour the medicine into the vein by means of a dropper, since with intravenous injection adrenaline is kept in the blood for 3-10 minutes.To do this, dissolve 1 ml of adrenaline 0.1% in 0.4 liters of NaCl.The speed of the drip introduction is 30-60 drops per minute.
  • Or is used as a jet infusion into the vein, for which 0.5 ml of adrenaline is diluted in 0.02 ml of the NaCl solution, applying 0.2 to 1.0 ml every 30 to 60 seconds.Sometimes the medicine is injected directly into the trachea.

The area of ​​the body where a drug that provoked anaphylaxis, or the place where the insect's sting was located, is cut off at 5-6 points with an adrenaline solution of 0.1% diluted in a 1:10 ratio.

Other preparations

  1. Glucocorticosteroids are intravenously.Prednisolone, Dexamethasone in the dosages indicated above.
  2. Antihistamine - intramuscular.Suprastin 2 - 4 ml, Diphenhydramine 1% 1 - 2 ml, Tavegil 0.1% 2 - 4 ml.
  3. Euphyllin( 2.4%) 5-10 ml with Dexamethasone( 2-4 ml) is injected into the vein with bronchial spasm.
  4. Oxygen therapy( supply of oxygen under pressure) is performed with signs of cyanosis( blue skin), wheezing.
  5. Cardiac glycosides - in cases of failure of myocardial function.
  6. Atropine( 0.1%) is used for pathologically slow heartbeat( bradycardia) of 0.25;0.5 or 1.0 mg.Children's doses are adjusted by age and body weight of the child from 0.05 to 0.5 mg.If the doses are not effective - an injection of atropine is done every 10 to 15 minutes.
  7. Diuretics are used for swelling, but only if the patient's pressure is normal, so as not to cause a critical drop: Lasix 0.040-0.08 grams, Furosemide solution 1% -1.2 ml, Mannitol 15%( 1-1.5Grams per kilogram of body weight).
  8. Relanium 2 - 4 ml with the appearance of seizures.
  9. Reopoliglyukin - for the removal of toxins, allergens and prevention of circulating blood volume deficiency.
  10. Colloidal, saline solutions - with a dangerous lowering of blood pressure.
  11. After normalization of the pressure( top to 90 mm Hg), Dopamine 0.4 grams per 0.5 liter dextrose 5% is poured.
  12. If the medication that caused an allergic shock has entered the body through the esophagus, the stomach is washed.

We recommend you to look at this video of Elena Malysheva about helping with anaphylactic shock: