Center for advanced training of healthcare workers. Emergency care and nurse action algorithm for anaphylactic shock

Anaphylactic shock is a dangerous condition that threatens the patient's life. Usually develops after contact with certain foreign substances (antigens).

This is a generalized, rapid allergic reaction. Accompanied by hemodynamic disturbances, which leads to circulatory failure and hypoxia.

Without emergency medical care it can result in death.

We will learn what to do in case of anaphylactic shock at home, how to provide first aid.

Anaphylactic shock occurs under the influence of various factors.

Main reasons:

In children, the cause of the reaction is usually the administration of gamma globulin, vaccines, or serums. More often, the condition develops with repeated use of a medicine or allergen.

If mothers took this drug during pregnancy and lactation, anaphylactic shock may occur at the first contact with the drug. The dose of the allergen does not matter for the sensitized person.

The time of development of shock depends on the ability to introduce the allergen. With injections it progresses more quickly. If the drug was administered intravenously, shock occurs instantly.

Usually appears within an hour. The maximum time for the development of anaphylactic shock is up to 3-5 hours. The frequency and severity of symptoms increase with age.

Risk factors

There is an increased risk of developing anaphylactic shock in people with asthma, eczema, and allergic rhinitis.

The condition is usually caused by food, latex, or contrast agents, but not by drugs or insect bites.

Anaphylactic shock. How not to die from allergies

The condition is characterized by rapid development, symptoms appear immediately after contact with the allergen. There are three periods of symptom development:

Flow options:

Malignant (fulminant). Acute cardiovascular and respiratory failure develops. In 90% it is characterized by death.
Lingering. Possibly due to the administration of long-acting drugs. Intensive therapy and monitoring of the patient is extended to several days.
Abortive. Does not threaten the patient's condition. Anaphylactic shock is easily relieved.
Recurrent. This is an episodic phenomenon. The allergen enters the body without the patient’s knowledge.

Moderate severity is characterized by pain in the heart, suffocation, Quincke's edema, urticaria, cold sweat, cyanosis of the lips, and convulsions. Sometimes uterine, nose, and gastrointestinal bleeding occurs.

The patient does not have time to complain about his condition; he loses consciousness after a few seconds. A person experiencing anaphylactic shock must immediately receive emergency assistance, otherwise sudden death will occur.

The patient turns pale, foam comes out of the mouth, and there are large drops of sweat on the forehead.. The pupils are dilated, breathing is wheezing, with prolonged exhalation, blood pressure is not determined, heart sounds are not audible, the pulse is thready.

Let's consider an algorithm of actions for providing pre-medical and medical care for anaphylactic shock.

First aid

If a reaction occurs due to the administration of various medications, a tourniquet is used to tighten the part of the body that is located above the injection site. The tourniquet is not removed for half an hour.

This is all you can do yourself. Next, you need to wait for professional medical assistance. The administration of antishock drugs requires certain qualifications.

As soon as the doctor arrives, he needs to tell him everything that you know about the patient’s condition and the situation that led to this condition.

Describe in as much detail as possible your actions to help the patient.. Tell us how much time has passed since the onset of the reaction, what medications you gave the patient.

Basic drugs that can save lives:

adrenalin;
hormones;
antihistamines.

Forbidden:

start therapy with an antihistamine;
taking a medicine that provokes anaphylaxis;
take a product containing components that may cause a cross-reaction;
take pollen-based medications to a patient with an allergy to it.

Diseases do not go away without a trace. After relief of cardiovascular and respiratory failure, symptoms of the pathological condition may remain: lethargy, weakness, fever, shortness of breath, vomiting, nausea.

Long-term low blood pressure is relieved by adrenaline. For pain in the heart, nitrates (nitroglycerin) are administered. For headaches and decreased intellectual functions, nootropics and vasoactive substances are used.

Infiltrates at the site of the bite, injections will be relieved by hormonal ointments (Hydrocortisone, Prednisolone), absorbable gels, ointments (Heparin, Troxevasin).

Late complications may occur:

hepatitis;
allergic myocarditis;
neuritis;
glomerulonephritis;
diffuse damage to the nervous system (can cause the patient’s death);
10-14 days after suffering anaphylactic shock, Quincke's edema, urticaria, bronchial asthma, and systemic lupus erythematosus may appear.

It is difficult to predict the development of shock. It is necessary to carefully prescribe and take drugs with strong antigenic properties.

Let's consider the general principles of prevention:

Treatment rooms should have anti-shock first aid kits and hang signs with a list of drugs that cause cross-allergic reactions.

If the patient has suffered anaphylactic shock, upon discharge from the hospital a note is made in red on the title page of the medical history. Such patients should be registered at the dispensary.

Also, if you have family members, especially children who are prone to allergies, you need to have disposable syringes and anti-shock medications in your home and travel first aid kit. You also need to know how to provide first aid for anaphylactic shock and how to administer such drugs.

Anaphylactic shock is a serious condition that threatens the patient’s life. Usually it develops rapidly, so it is necessary to immediately call an ambulance.

The life of a patient who has suffered anaphylactic shock depends on the speed of providing quality care.. The reaction can be so rapid that if medical care is incorrectly provided or absent, death can occur within an hour or less.

Anaphylactic shock is a very serious condition that can be fatal without proper treatment.

A nurse can suspect this type of shock based on the following signs that develop immediately after contact with an allergen (administration of medication, bee sting, etc.):

The appearance of weakness, general malaise;
Dizziness, darkening of the eyes;
Difficulty breathing, feeling of lack of air, increasing shortness of breath;
The patient may begin to feel restless;
The skin is pale and cold, sticky to the touch;
Complaints of nausea or vomiting;
The feeling that the body is “burning” (feeling of heat).

Among the objective symptoms at this moment the following symptoms can be noted:

Shallow, rapid breathing;
Low blood pressure (systolic up to 90 mm Hg);
Loss of consciousness, as well as respiratory depression;

Nurse's tactics for anaphylactic shock

First of all, you need to call a doctor. Then follow the following scheme until the doctor arrives:

Stop or reduce the effect of the allergen. For example, stop administering the drug if anaphylactic shock develops due to its administration. In other words, at this stage it is necessary to take all measures to reduce the dose of the allergen.
Prevention of asphyxia: remove removable dentures, place them in a stable position on their side.
Further actions of the nurse in case of anaphylactic shock include measures to improve blood supply to the brain and prevent hypoxia. For this purpose, the foot end of the bed is raised and 100% oxygen is given.
Further, if necessary, all measures for cardiopulmonary resuscitation will be organized.

In general, the nursing process for anaphylactic shock should ensure that all urgent measures to manage the patient are completed before the doctor arrives and subsequent treatment tactics are determined.

Prevention

It is extremely important to be able to anticipate the likelihood of anaphylactic shock. To do this, it is necessary to carefully collect an allergic history and find out the predisposition to a particular type of allergy.

Persons who have previously had allergic reactions to antibiotics should not receive them again. Of course, in some cases, even the smell of an antibacterial agent led a person into a state of anaphylaxis, but in many other situations, a carefully collected history and attentive attitude towards the patient helped to avoid many unpleasant moments.

When prescribing an antibacterial agent for the purpose of preventing anaphylactic shock, a sensitivity test must be carried out not only to this agent, but also to the solvent. This test is carried out even in cases where the antibiotic is re-prescribed. To provide timely assistance in case of anaphylactic shock, each treatment room must be equipped with a first aid kit and the necessary equipment for providing first aid.

allergoportal.ru

Reaction characteristics

The most common causes of anaphylaxis are medications, insect venom, and food.

There are 3 stages this state:

At the first stage(precursor period) there is discomfort, anxiety, general malaise, cerebral symptoms, tinnitus, blurred vision, itching, urticaria.
At the second stage(the height of the period) possible loss of consciousness, decreased blood pressure, increased heart rate, paleness, shortness of breath.
Third stage(period of recovery from shock) lasts several weeks and is characterized by general weakness, memory impairment, and headache.

At this time, complications may develop (myocarditis, encephalitis, glomerulonephritis, thrombocytopenia, acute cerebrovascular accident, acute myocardial infarction).

Read also what anaphylactic shock is, how it develops and why it is dangerous for humans.

Priority measures

To save a person’s life, it is imperative to provide first aid for anaphylactic shock (AMS) until the ambulance arrives. The most important thing is not to panic and follow the plan described below.

Algorithm of action for urgent first aid

Nurse tactics for anaphylactic shock

The nurse carries out all pre-hospital emergency aid items, if none have been carried out.

The nurse should provide the doctor with all known anamnestic data. The nurse’s competence includes the preparation of medications and medical instruments for the further work of the doctor.

The tool kit includes:

Injection syringes;
Tourniquet;
Droppers;
Ambu bag;
Apparatus for artificial lung ventilation;
Kit for insertion of ETT (endotracheal tube).

Medicines:

Paramedic tactics

The paramedic's tactics also include all points of emergency care for anaphylactic shock.

The paramedic's responsibilities include:

Injection administration of 0.1% adrenaline solution, 1% mezaton solution IV, IM.
Injection intravenous administration of prednisolone in a 5% glucose solution.
Injection IV or IM administration of antihistamines after stabilization of blood pressure.
Carrying out a complex of symptomatic therapy with the use of aminophylline to eliminate bronchospasm, diuretics, detoxification and hyposensitizing therapy.

Standard of care for anaphylactic shock

There is a special standard of care for anaphylaxis according to Order No. 291 of the Ministry of Health of the Russian Federation.

He has following criteria: emergency medical care is provided to patients of any age, gender, in acute condition, at any stage of the process, regardless of complications, through emergency medical care, outside the medical organization.

The duration of treatment and the above measures is one day.

Medical arrangements include examination by a physician and/or emergency medical technician.

Additional instrumental research methods include performing and interpreting ECG and pulse oximetry.

To urgent methods preventing anaphylaxis include:

Administration of medications intramuscularly and intravenously;
Insertion of ETT (endotracheal tube);
Administration of medications and oxygen by inhalation using an Ambu bag;
Performing venous catheterization;
IVL (artificial pulmonary ventilation).

Anti-shock first aid kit: composition

When carrying out any operations using anesthesia and other allergenic medications, you need to have a special set of medications to provide urgent assistance to the unpredictable reaction of the body.

Anti-shock kit includes:

Nursing process for anaphylaxis

The nursing process involves a nursing examination. The nurse needs collect anamnesis:

find out what the patient is complaining about;
obtain data on medical history and life history;
assess the condition of the skin;
measure pulse rate, body temperature, blood pressure, respiratory rate, heart rate.

Nurse, Firstly, must:

find out the patient's needs;
prioritize;
formulate an algorithm for patient care.

The health worker is always motivated and interested in the patient’s recovery as quickly as possible, preventing relapses and combating allergens that cause the reaction.

All points of the care plan are carried out as follows:

actions aimed at improving the patient’s condition are coordinated;
creating conditions of peace;
control of blood pressure, respiratory rate, defecation and urination, weight, skin and mucous membranes;
collecting material for research;
preparing the patient for additional research methods;
compliance with timeliness in the supply of medicines;
combating the development of complications;
quick response to doctor's instructions.

Diagnosis of reaction

Establishing diagnosis anaphylaxis is based on clinical data. Information about a persistent decrease in blood pressure, medical history (contract with an allergen), loss of consciousness is sufficient for diagnosis.

Additional diagnostic measures must be taken in relation to exclude the development of complications.

According to the results of a general blood test, patients have leukocytosis and eosinophilia. In some cases, thrombocytopenia and anemia.

In a biochemical blood test, in the event of complications from the kidneys and liver, there may be an increase in creatinine, bilirubin levels, and transaminases.

An X-ray examination of the chest cavity may show visible symptoms of pulmonary edema. The ECG reveals arrhythmias and changes in the T wave. 25% of patients have a risk of developing acute myocardial infarction.

To accurately determine the causative factor that caused the state of shock, immunological tests are performed and allergen-specific immunoglobulins of class E are identified.

Learn more about the symptoms and causes of the reaction.

Treatment of anaphylactic shock

The necessary anti-shock measures are carried out at the time of an attack of anaphylaxis.

After emergency first aid it is necessary to make an intramuscular injection of a 0.1% solution of adrenaline with a volume of 0.5 ml. The substance enters the bloodstream as quickly as possible when it is injected into the thigh.

After 5 minutes, the medication is reintroduced. Duplicate injections give a greater effect than a single injection of the maximum permissible dose (2 ml).

If the pressure does not return to normal, adrenaline is injected in a stream drip.

To consolidate the state and relapse prevention, further treatment includes:

In case of anaphylactic shock, glucorticoids (prednisolone, methylprednisolone) are injected into a vein or into a muscle. The administration is repeated 6 hours later.
Antihistamines (for example, suprastin) are injected into a vein or into a muscle.
If the cause of anaphylaxis was the administration of penicillin, it is necessary to inject penicillinase.
With the development of bronchospasm it is indicated using salbutamol through a nebulizer. If the patient is unconscious, he is injected with aminophylline into a vein.
Oxygen therapy is advisable for patients in a severe stage.
When, if treatment does not give the expected effect and laryngeal edema develops, a tracheostomy is performed.
After emergency anti-shock treatment, the patient is transferred to the intensive care unit for 1-2 days.

After recovering from anaphylaxis The patient is advised to take glucocorticoids in the form of tablets (prednisolone 15 mg with a slow reduction in dosage over 10 days).

New generation antihistamines (erolin, fexofenadine) will also help, and if indicated (history of pulmonary edema), antibacterial therapy is prescribed (excluding penicillin drugs).

During the rehabilitation period, the functioning of the kidneys and liver should be monitored. It is necessary to evaluate the ECG over time to exclude myocarditis.

Conclusion

Anaphylactic shock is a dangerous condition in which Possible death, it is necessary to immediately begin antishock treatment.

Main causes of death are asphyxia, the development of acute vascular insufficiency, bronchospasm, thrombosis and pulmonary embolism, as well as hemorrhages in the brain and adrenal glands.

Fearing the development of these complications, one should monitor the condition of the internal organs.

101allergy.net

Predisposing factors

In most cases, anaphylactic shock develops against the background of a genetic predisposition to an allergic reaction. Sometimes a shock reaction occurs with the secondary administration of sulfonamides, antibiotics, or immune serums.

Provoking factors include:

— Blood transfusion (substitutes).
— Vaccination.
— Skin tests involving allergens.

Providing first aid

The nurse's tactics when providing assistance to the victim are as follows:

— first aid is provided immediately;
— the room is ventilated, exposure to the allergen is eliminated;
- help with anaphylactic shock consists of stopping the administration of the drug;
— a tourniquet is applied to the site of the insect bite or injection;
- the wound is carefully treated.

Nurse's actions

Laying the victim involves placing him in a horizontal position. First aid consists of raising the patient’s legs against the background of low blood pressure, turning his head to the side, and removing (if any) dentures.

First aid also involves constantly monitoring the victim’s breathing and blood pressure.

Independent nursing intervention is to force the patient to take fenkarol, suprastin, tavegil or any other antihistamine. Once the doctor is on site, the process of providing assistance becomes theoretical. The nurse should report on the symptoms of the pathological process, medical history, and when the reaction began.

Preparation of drugs and instruments

Nursing intervention for anaphylactic shock involves careful preparation of the equipment necessary for the doctor. The process includes preparation:

— syringes and needles (s/c and i/m) necessary for injections;
- tourniquet;
— systems for infusion (intravenous);
- Ambu bag;
— set for tracheal intubation;
- ventilator.

The process of helping a doctor consists of preparing medications such as:

— Prenisolone (2%);
— Adrenaline, solution (0.1%);
— Suprastin, solution (2%);
— Mezaton, solution (1%);
— Strophanthin, solution (0.05%);
— Eufillin, saline solution (2.4%).

The nurse is required to evaluate such indicators as:

— Stabilization of heart rate and blood pressure.
- Return of consciousness.

Nurse's first aid kit

The nurse's first aid kit includes the following medications and materials:

— Suprastin, Tavegil, or any other antihistamine drug designed to stop the reaction to histamine.
— It also contains Prednisolone, which helps reduce the shock reaction.
— The main actions of the sister are to administer Adrenaline.
— Also, emergency care involves the administration of Eufillin, a drug that improves blood supply to small vessels.
— The process of providing assistance consists of disinfecting the “problem” area.
— Emergency care involves the use of a tourniquet, which is necessary to limit the area of action of the pathogen.
— Venous catheter, necessary to ensure contact with the vein.

This is a standard first aid kit that can be found in any treatment room. It is important to remember that timely first aid can save the patient’s life. In order to avoid the risk of a shock reaction, you should inform your sister in time about the presence of certain allergens.

emclinic.com.ua

Causes

Anaphylactic shock (ICD 10 code - T78.2) can develop under the influence of a wide variety of factors. The most common causes of anaphylactic shock are:

In order to provide timely emergency assistance for anaphylactic shock (the algorithm of actions will be described below), it is important to know how this condition manifests itself.

The course of the pathological process can be:

Symptoms of anaphylactic shock develop gradually. In its development, the pathological condition goes through 3 stages:

period of precursors - this condition is accompanied by headache, nausea, dizziness, severe weakness, and a skin rash may appear. The patient experiences deterioration in hearing and vision, his hands and facial area become numb, he experiences a feeling of anxiety, discomfort and lack of air.
height - the victim loses consciousness, blood pressure decreases, the skin turns pale, breathing becomes noisy, cold sweat appears, itching of the skin, cessation of urine output or, conversely, incontinence is observed, blue lips and limbs are noted.
recovery from a state of shock - the duration of this period can be several days, patients feel dizzy, weak, and have a complete loss of appetite.

Degree of severity of violation:

1. light. The warning period lasts up to 15 minutes. In such a situation, the victim has the opportunity to inform others about his condition.

Signs of anaphylactic shock in such a situation are as follows:

chest pain, headache, weakness, blurred vision, lack of air, ringing in the ears, pain in the abdomen, numbness of the mouth, hands;
pale skin;
bronchospasm;
vomiting, diarrhea, involuntary urination or bowel movements;
momentary fainting;
pressure reduction to 90/60 mm Hg. st, pulse is weakly palpable, tachycardia.

Medical care for anaphylactic shock in such a situation gives good results.

2. average. The duration of the precursor period is no more than 5 minutes. Symptoms of mild severity are supplemented by clonic or tonic convulsions. The victim may be unconscious for about 20 minutes.

The pressure drops to 60/40 mmHg. Art., tachycardia or bradycardia develops. Rarely, internal bleeding may occur. In this case, the effect of therapy for anaphylactic shock (photos of signs of such a disorder are available in the article) is slow, long-term observation is necessary.

3. heavy. The state of shock develops extremely quickly, in a matter of seconds the person loses consciousness. Signs such as pallor, bluish skin, intense sweating, dilated pupils, foam from the mouth, convulsions, wheezing, pressure is difficult to determine, and the pulse is practically not audible are observed. Actions for anaphylactic shock in such a situation must be quick and accurate.

In the absence of adequate assistance, the likelihood of death is high.

Therapeutic measures

First aid for anaphylactic shock should be provided by people who are near the patient during the development of a dangerous condition. First of all, you need to call an ambulance; in case of anaphylactic shock, you should act quickly and, most importantly, try not to panic.

First aid for anaphylactic shock (algorithm of actions):

help the victim take a horizontal position, his legs must be raised, for this you need to place a rolled-up blanket under them;
to prevent vomit from entering the respiratory tract, the patient’s head should be turned on its side and dentures, if any, should be removed from the mouth;
provide fresh air access by opening a window or door;
exclude exposure to an allergic substance - treat the area of the bee sting or injection with any antiseptic, apply ice to cool the wound, apply a tourniquet above the wound;
Feel the pulse on the wrist; if there is none, on the carotid artery. In the event that the pulse is completely absent, begin performing indirect cardiac massage - place clasped hands on the chest area and perform rhythmic pushes;
if the victim is not breathing, perform artificial respiration using a clean scarf or piece of cloth.

The cardiopulmonary resuscitation procedure is an extremely important stage in providing first aid for anaphylactic shock. Videos of the correct execution of such actions can be viewed on medical websites.

Medical manipulations and the frequency of their implementation are clearly regulated by the Order of the Ministry of Health and Social Development of the Russian Federation “On approval of the standard of medical care for patients with unspecified anaphylactic shock” (Order No. 626). In case of anaphylactic shock, first aid and further actions of medical personnel are equally important.

The nurse's tactics for anaphylactic shock depend on the severity of the pathological condition. First of all, you need to stop the development of the allergic process.

The algorithm of actions for anaphylactic shock involves the use of medications, as well as a clear sequence of their administration. In critical situations, due to untimely or inadequate use of medications, the patient’s condition can only worsen.

When symptoms of anaphylactic shock appear, emergency care includes the use of drugs that help restore the most important functions of the body - heart function, respiratory function, blood pressure.

With the help of intravenous administration of the drug, you can get the fastest possible positive result.

When providing first aid for anaphylactic shock, the nurse uses medications such as:

Anaphylactic shock often occurs in children. Children with allergies are more predisposed to developing such a reaction. The hereditary factor also plays an important role. First aid for anaphylactic shock in children involves the same medical measures as for adults.

To prevent death, action must be taken quickly and consistently. You should absolutely not leave your child alone; you should behave calmly and not make him panic.

Therapeutic manipulations in a medical institution

After performing emergency measures, the victim must be immediately taken to the hospital and treatment continued.

Emergency care for anaphylactic shock in the clinic includes:

carrying out intensive therapy using crystalloid and colloid solutions;
the use of special drugs to stabilize cardiac function and respiration;
carrying out detoxification measures and replenishing the required blood volume in the body, for this purpose an isotonic solution is administered;
a course of treatment with tableted antiallergic drugs (fexofenadine, desloratadine).

After suffering anaphylactic shock, it is necessary to stay in the clinic for at least 14-20 days, because dangerous complications cannot be ruled out.

Blood, urine and ECG tests are required.

Possible consequences

As with any other pathological process, complications are possible after anaphylactic shock. After the functioning of the heart and breathing returns to normal, the victim may continue to experience some characteristic symptoms.

The consequences of anaphylactic shock are manifested:

lethargy, weakness, muscle and joint pain, increased temperature, shortness of breath, pain in the abdominal area, nausea, vomiting;
prolonged hypotension (low blood pressure) - vasopressors are used for relief;
pain in the heart due to ischemia - nitrates, antihypoxants, cardiotrophics are used for therapy;
headache, decreased mental abilities due to prolonged hypoxia - the use of nootropic drugs and vasoactive drugs is required;
when infiltrates occur at the injection site, hormonal ointments are used, as well as gels or ointments that have a resolving effect.

In some cases, late consequences may develop:

neuritis, hepatitis, central nervous system damage, glomerulonephritis - such pathologies lead to death;
urticaria, Quincke's edema, bronchial asthma - such disorders can develop 10-12 days after the shock;
systemic lupus erythematosus and periarteritis nodosa can result from repeated interaction with an allergic substance.

Composition of a first aid kit

According to the Sanitary Rules and Norms (Sanpin), a first aid kit for anaphylactic shock should include the following medications:

adrenaline hydrochloride 0.1% in ampoules (10 pcs.);
prednisolone in ampoules (10 pcs.);
Diphenhydramine 1% in ampoules (10 pcs.);
aminophylline 2.4% in ampoules (10 pcs.);
sodium chloride 0.9% (2 containers of 400 ml);
reopolyglucin (2 containers of 400 ml);
medical alcohol 70%.

Also, the kit for assistance with anaphylactic shock should contain consumables:

2 systems for internal infusions;
sterile syringes of 5, 10, 20 ml - 5 pieces each;
2 pairs of gloves;
medical tourniquet;
alcohol wipes;
1 package of sterile cotton wool;
venous catheter.

The composition of the styling for anaphylactic shock does not include the presence (and further use) of the medication Diazepam (a medication that has a depressant effect on the nervous system) and an oxygen mask.

A first aid kit stocked with the necessary medications should be available in all institutions, as well as at home if there is a family history of anaphylaxis or a predisposition to allergic reactions.

proallergen.ru

Video: Anaphylactic shock. First aid.

Emergency measures for anaphylactic shock

First, you must immediately stop administering the drug. If shock occurs during an intravenous injection, the needle must remain in the vein to ensure adequate access. The syringe or system should be replaced. A new system with saline solution should be in every manipulation room. If shock progresses, the nurse should perform cardiopulmonary resuscitation according to current protocol. It is important not to forget about your own safety - use personal protective equipment, for example, a disposable artificial respiration device.

Prevention of allergen penetration

If shock develops in response to an insect bite, measures must be taken to prevent the poison from spreading throughout the victim’s body:

Video: Elena Malysheva. First aid for anaphylactic shock

– remove the sting without squeezing it or using tweezers;
– apply an ice pack or a cold compress to the bite site;
– apply a tourniquet above the bite site, but for no more than 25 minutes.

Patient position in shock

The patient should lie on his back with his head turned to the side. To make breathing easier, free the chest from constricting clothing and open a window for fresh air. If necessary, oxygen therapy should be given if possible.

The nurse's actions to stabilize the victim's condition

It is necessary to continue removing the allergen from the body, depending on the method of its penetration: inject the injection or bite site with a 0.01% solution of adrenaline, rinse the stomach, give a cleansing enema if the allergen is in the gastrointestinal tract.

To assess the risk to the patient's health, it is necessary to conduct research:

– check the status of ABC indicators;
– assess the level of consciousness (excitability, anxiety, inhibition, loss of consciousness);
– examine the skin, pay attention to its color, the presence and nature of the rash;
– establish the type of shortness of breath;
– count the number of breathing movements;
– determine the nature of the pulse;
– measure blood pressure;
– if possible, do an ECG.

Actions of a nurse under the supervision of a doctor

The nurse establishes permanent venous access and begins administering medications as prescribed by the doctor:

– intravenous drip of 0.1% solution of adrenaline 0.5 ml in 100 ml of physiological solution;
– introduce 4-8 mg of dexamethasone (120 mg of prednisolone) into the system;
– after hemodynamic stabilization, use antihistamines: suprastin 2% 2-4 ml, diphenhydramine 1% 5 ml;
– infusion therapy: rheopolyglucin 400 ml, sodium bicarbonate 4% -200 ml.

In case of respiratory failure, you need to prepare an intubation kit and assist the doctor during the procedure. Disinfect instruments, fill out medical documentation.

After stabilizing the patient's condition, he needs to be transported to the allergology department. Monitor vital signs until complete recovery. Teach the rules for preventing threatening conditions.

There is an opinion that allergies, although they cause numerous inconveniences for the patient, are not a life-threatening condition. This is not true. An allergy can manifest itself in the form of anaphylactic shock, which, if emergency treatment is not provided, can be fatal. Any person, even those without medical skills, needs to know what to do if anaphylaxis develops. In difficult situations, this will help preserve health and, possibly, life.

Anaphylactic shock concept

Shock is an acute reaction to a variety of allergens. When a compound that is identified by the immune system as foreign appears in the body, the production of special proteins, immunoglobulins E, begins. These antibodies remain in the blood, even if the allergen has already been removed from the body.

If the provocateur re-enters the bloodstream, these proteins combine with its molecules. Immune complexes begin to form. Biologically active compounds - mediators of an allergic reaction (histamine, serotonin) are released into the blood. The network of small blood vessels becomes more permeable. Blood begins to flow into the mucous membranes and subcutaneous tissue. This leads to the appearance of swelling, thickening of the blood, the blood supply to all organs and tissues is sharply disrupted, and eventually shock develops. Since there is an outflow of blood, its other name is redistribution.

What allergens can cause shock?

Types of likely irritants:

A state of shock occurs most quickly when the provocateur enters the body intramuscularly or intravenously. Slower - if the path was through the respiratory tract or skin. After eating, signs of anaphylactic shock are observed after 1-2 hours.

Signs of shock

Among the initial signs, patients name fear of death, skin rashes, and painful itching.

On the part of the skin and mucous membranes (in 90% of patients) – swelling of the larynx, lips, eyelids, extremities, the appearance of urticaria.
Damage to the respiratory system (in 50% of patients) – difficulty breathing, swelling of the throat, wheezing, cough, hoarse voice, stuffy nose, profuse mucus coming out of it.
Blood vessels and heart (in 30-35% of cases) – decreased blood pressure, rapid pulse, weakness, dizziness, and possible fainting.
If the central nervous system is damaged, seizures, headaches, and hallucinations may occur.
Gastrointestinal tract (in 20-25% of patients) – spasmodic painful sensations in the abdomen, a person feels nauseous, has the urge to vomit, diarrhea, and swallowing is impaired.

Forms of anaphylaxis

Depending on the manifestation of the reaction, the forms are differentiated:

Typical (develops more often than others). After a sharp release of histamine into the bloodstream, the patient becomes dizzy, blood pressure drops, swelling develops, and itching begins. The skin is pale, the lips are bluish. Weakness, nausea, heart pain, nervous excitement and panic occur.
Asphyxial. Breathing is impaired. There is swelling of the throat, shortness of breath, and a stuffy nose. If the patient is not helped, death from suffocation is possible.
Brain. There are malfunctions in the functioning of the central nervous system - loss of consciousness, the person has convulsions.
Gastrointestinal. The pressure may drop to 80-70/40-30 mmHg, lips and tongue swell, abdominal pain, diarrhea, and vomiting begin.
Anaphylaxis provoked by heavy physical exertion. The reaction can be triggered either by excessive loads themselves or by their combination with the consumption of allergenic foods or taking medications. Characterized by the combination of all the above manifestations. The initial sign is a strong decrease in blood pressure.

Severity

There is the following classification:

1st degree characterized by pressure below normal by 30-40 mmHg (normal pressure fluctuates in the range 120-110/90-70 mmHg). The person is excited and may develop a panic attack. The reaction appears within 30 minutes or longer. Therefore, there is a high chance that first aid for anaphylactic shock will be effective when a person is just anticipating the onset of an attack;
2nd degree– symptoms develop from 10-15 minutes to 30 minutes. The pressure drops to 90-60/40 mm Hg, loss of consciousness is possible. Also, since there is a reserve of time, there is a good chance of emergency assistance;
3rd degree. Anaphylaxis develops within a few minutes, the patient may faint, systolic pressure is in the range of 60-30 mmHg, diastolic pressure is usually not determined. The chances of successful treatment are low.
4th degree. It is also called fulminant (fulminant) shock. Develops in a few seconds. The person immediately faints; the pressure cannot be determined. The chances of resuscitation are almost zero. Fortunately, grade 4 is extremely rare.

What to do in case of anaphylactic shock?

At the slightest suspicion that a person is developing anaphylaxis, it is necessary to call an ambulance. Before her arrival, first aid should be provided at home or where the patient’s attack began. Therefore, you should know the algorithm for providing emergency care for anaphylactic shock. It is also necessary to take into account the fact that two phases of allergic manifestations are likely. A repeat attack is possible after a period of time from 1 hour to 3 days.

Algorithm of actions before doctors arrive:

The patient should lie on his back, his legs should be elevated, placing a pillow, cushion, etc. under them to activate blood flow to the heart. Raise your head if your tongue sinks in, or turn it to the side if vomiting begins.
Open windows and vents to allow access to fresh air.
Unbutton the person’s clothes, loosen fasteners and belts.
If possible, remove the allergen (remove the insect sting from the bite site, do gastric lavage if you are allergic to food). It is recommended to apply a piece of ice to the wound or tighten the tourniquet above the affected area to reduce the rate of penetration of the irritant into the bloodstream.
First aid involves the need for adrenaline injections. They should be done immediately, as soon as the first signs of shock appear. A 0.1% solution is administered intramuscularly, intravenously (drip, stream) or subcutaneously. Intravenous administration at home is difficult to provide, so intramuscular injection from the outside into the middle part of the thigh, possibly through clothing, is more often practiced. Dose for adults – 0.3-0.5 ml, for children – 0.1 ml. If there is no immediate effect, repeat injections after 5-10 minutes. The maximum total dosage is 2 ml for adults, 0.5 ml for children. If the pressure drops rapidly and the person is suffocating, it is possible to inject a single volume of 0.5 ml into the area under the tongue. It is very convenient to have a special syringe pen (EpiPen), the contents of which are also injected into the thigh. An insect bite can be injected in a circle with 1 ml of 0.1% adrenaline, making 5-6 injections.

Actions of doctors upon arrival:

Adrenaline injections are given if for some reason this has not been done before.
Glucocorticoid hormones - dexamethasone, hydrocortisone or prednisolone - are administered intravenously.
Provide intravenous infusion of a significant volume of fluid (0.9% sodium chloride solution) to eliminate its deficiency in the bloodstream. For children, the amount is administered at the rate of 20 ml per 1 kg of body, for adults the total volume is up to 1 liter.
The patient is provided with oxygen inhalation using a mask. In case of swelling of the larynx and inability to breathe, an emergency tracheotomy is performed.

All these measures continue while the person is being transported to the hospital in the intensive care unit. There they continue to pour in liquid and the necessary solutions. The doctor decides to prescribe antihistamines (Tavegil, Suprastin, Loratadine, Diphenhydramine, Cetirizine, etc.).

To maintain heart function, Dopamine is used, for bronchospasms - Albuterol, Eufillin, for convulsive syndrome - anti-convulsants, etc. The patient usually stays in the hospital for at least 5-7 days, so that there is no risk of missing a possible recurrent attack.

Prevention

Allergy sufferers must take measures on their own to avoid negative consequences:

be sure to have adrenaline (single dose) in ampoules and a disposable syringe or disposable syringe pen with you;
as soon as a person feels an attack approaching, immediately notify everyone around him, ask them to call an ambulance and help him give an injection;
try to avoid situations where the allergen can enter the body (study the composition of purchased products, do not approach pets with intolerance, etc.);
When prescribing medications, warn doctors that you are allergic.

Statistics show that in approximately 2% of cases, anaphylaxis is fatal. Therefore, the patient needs to be extremely attentive to his condition. Other people should have an idea of how to properly help a person so that the attack passes without serious consequences.

Every person should know how to provide assistance during anaphylactic shock, the algorithm of which in most cases is repeated. is one of the most severe manifestations of an allergic reaction. Occurring rapidly, it leads to acute circulatory disorders. Blood pressure drops sharply. The heart function is inhibited and respiratory function is impaired. There is a lack of oxygen supply to vital organs. Primarily the brain and heart. This condition of the victim is called urgent, i.e. life-threatening.

Therefore, assistance for anaphylactic shock, the algorithm for which everyone should know, must be carried out immediately!

Cause of anaphylactic shock

Anaphylaxis occurs almost instantly after contact with a substance to which the victim is already intolerant. In other words, there has already been contact with this or a substance similar in structure. And that person's immune system can recognize it.

Typically, eyewitnesses see the moment of direct contact between a person and an allergen. They can clearly indicate to the doctors who arrived on the call what preceded the reaction. Thereby making assistance with anaphylactic shock as effective as possible. This will help save the life and health of the victim.

Medical workers of any rank study the algorithm for providing emergency care for anaphylactic shock without fail. They should know it, regardless of their specialization (therapist, surgeon, dentist, etc.) and the category of the medical educational institution from which they graduated (university, college, school, etc.).

But absolutely anyone can find themselves in a position where the victim needs help. Even a teenager or a schoolboy. In order not to get confused in a critical situation, you need to know the cause that can cause anaphylaxis, signs of shock and a clear sequence of actions. Keep in mind that anaphylactic shock is eliminated by emergency care, the algorithm of which must be strictly followed.

Allergenic substances that can cause anaphylaxis

Substances that, if ingested into the body, may cause anaphylactic shock, are conventionally divided into four large groups. These include medicines, food products, poisons of stinging insects, household chemicals and hygiene products.

Medicines, regardless of the method of administration (tablets, injections, inhalations, etc.), can cause a severe allergic reaction, including anaphylaxis. These primarily include antibacterial drugs, non-steroidal anti-inflammatory drugs, vitamins and a number of others. This also includes dietary supplements.

The foods that most often cause anaphylactic shock are fish and other seafood (including vegetable ones), nuts, mushrooms, and fruits. In principle, an allergic reaction can occur to any food containing animal or plant protein.
When insects bite, substances of a protein nature - poisons - also enter the body. Some of them have very high toxicity, which, along with an immediate allergic reaction, can have a negative effect on other systems (nervous, respiratory, muscular). This can further aggravate the victim's condition. Then medical care for anaphylactic shock should also be accompanied by the introduction of antidotes to toxins.
The household chemicals and hygiene products around us pose no less danger. Many detergents, cleaning and other helping compositions contain biological or surfactants (BAS and surfactants). They are the ones who can cause shock. Hygiene products (household or medical gloves), as well as contraceptives (condoms, vaginal diaphragms) contain latex, which can also cause anaphylaxis. Moreover, the latter even indirectly, from a partner.

If you report that the victim was in contact with one of these drugs before the attack began, help with anaphylactic shock and its algorithm will be much more effective.

Rate of development of anaphylactic shock

Anaphylactic shock is a very insidious condition. Its signs can appear within a few seconds or minutes, or several hours after contact with the allergen. This directly depends on the nature of the substance that causes anaphylaxis, the way it enters the body and the level of sensitization of the immune system of the person sensitive to this substance.

Of no small importance is the amount of allergen entering the body and the reactivity of the immune system. As the reaction develops, these two factors determine the severity of anaphylactic shock.

Light form

It can manifest itself in dizziness, a feeling of heat, and weakness. The victim may be heard to be conscious but may be disoriented. He may be bothered by a feeling of fear. When measuring blood pressure, the numbers obtained are slightly lower than the usual “working” values for a given person.

Average degree

Characterized by more severe symptoms. In this case, confusion is determined. The victim is inhibited and disoriented. But upon contact, he retains the ability to give quite intelligible answers. Blood pressure level is reduced by a third or more from the “working” level.

Severe course

With this form of anaphylactic shock, the victim loses consciousness. The skin is pale, covered with sweat, and there is cyanosis (blueness) above the upper lip. The tonometer readings are either minimal or absent altogether. Heartbeat is quiet, slow. Breathing is difficult to determine.

If those near the victim know these signs, then treatment for anaphylactic shock can be provided in full. And this will save a person’s life and preserve his health.

Atypical course of anaphylaxis

About a third of all cases of anaphylaxis go through the stage of “imaginary well-being.” This is manifested by a significant improvement in the general condition after a mild or moderate reaction. In the absence of proper therapy, after a few hours and up to a day, a sharp deterioration is possible. This can lead to very sad consequences. Therefore, only after clearly following the entire algorithm for providing emergency care for anaphylactic shock, you can not be afraid of missing this option.

Sequencing

If the victim is conscious and has eaten or drunk something, you can try to induce vomiting. If an attack occurs in response to the action of household chemicals, the victim should be taken out of the room, ensuring an influx of fresh air. When an insect bites, if the sting remains in the skin, you should not try to pull it out - there is a risk of crushing the capsule with the poison in it.

If you are bitten on a limb, it is better to apply a tourniquet above the injury site and apply cold to the area. Cold can also be used when biting other parts of the body.

Anaphylactic shock. Clinic. Urgent Care

So, what do you need to know? If a person is suspected of having anaphylactic shock based on the listed signs, first aid, the algorithm of which is presented in a clear sequence of actions, begins with the immediate elimination of the allergen.

Next, you should dial the ambulance number. For stationary devices, the ambulance service number is still relevant - 03. When calling from a mobile phone, the number may differ depending on the telecom operator. It is advisable to check with the network help desk for emergency numbers and enter them into the phone’s memory as “hot keys”.

The unified rescue service center has been operating successfully in Russia for quite some time now. The call number 112 is available to subscribers of any operator even if the account balance is negative.

The next action, carried out simultaneously with the call, is to assess the severity of the victim’s condition and determine whether this condition may be anaphylactic shock or not. If the answer is yes, then actions continue, as prescribed by the algorithm for providing emergency care for anaphylactic shock.

Assess the consciousness of the victim - whether he can answer the questions: what is he complaining about and what happened (what is the cause of this condition). With mild to moderate severity, the victim can usually clearly name the cause.

Next, it is assessed how freely breathing is. To ensure better patency of the upper respiratory tract, the victim should unbutton his collar (loose his tie), remove his scarf, etc. In case of loss of consciousness, this mechanical obstruction to air flow can sometimes be eliminated by pulling the lower jaw, grabbing its corners with one hand, forward.

How ambulance and emergency service operators or the Ministry of Emergency Situations can help

By making a call and calling an ambulance, the person providing assistance will no longer feel alone in the face of the problem that has arisen. Both the doctors rushing to the rescue and the dispatcher of the ambulance service or the Ministry of Emergency Situations will already know about this. While waiting for the team, the dispatcher will help the person helping to calm down, concentrate and describe the condition of the victim.

Each dispatcher must have a memo in his working documents: “How to recognize anaphylactic shock? Emergency assistance, algorithm for its provision.” Using it, the dispatcher will monitor the correctness of actions and prompt when the state changes. In extreme cases, in severe cases of anaphylactic shock, he will tell you the technique of cardiopulmonary resuscitation. Will check the correctness of its implementation.

Pediatric features of anaphylaxis

In children, anaphylactic shock, emergency care, and the algorithm for its provision have a number of differences. In a child’s body, the relative fluid content is higher, the fiber is looser, and the self-regulation mechanisms are not yet fully mature. All this leads to more rapid development of edema.

In addition, children are very scared of this condition. This, in turn, increases the concentration of stress hormones in the blood, which narrow the already collapsed airways and blood vessels. Accordingly, helping children with anaphylactic shock differs from helping adults. The child must be reassured before the doctors arrive to partially restore the normal functioning of the respiratory system.

Clinical manifestations in children in shock and first aid

It is usually not difficult to recognize anaphylactic shock in children. First aid for children is also easy. The child's skin turns pale, weak filling and tension are palpable.

This is explained simply. In a state of shock, centralization of blood circulation occurs, in which blood is redistributed to more important organs - the brain, heart, lungs, kidneys. This is a kind of “life support quartet” that is designed to keep a person conscious and prevent the body from dying.

The principles of first aid for children come down to three simple rules: position them correctly, warm them and calm them down. Children do not have a severe course of anaphylaxis, so they are conscious, although slightly inhibited.

It is necessary to place the baby in a position with raised legs so that blood flows more to the chest and brain. This will ensure sufficient blood supply to the vessels of the brain, heart and lungs. This will promote almost optimal blood flow and prevent such serious complications as damage to organ tissue cells due to oxygen deficiency (hypoxia), and the formation of blood clots in the lumens of blood vessels.

It should also be noted that there is often a sharp drop in blood pressure that accompanies anaphylactic shock. The care algorithm in this case prescribes maintaining peripheral access. This means that when anaphylaxis develops from moderate degree and above, the peripheral veins collapse, and then it is quite problematic for doctors to administer infusions into them. A tourniquet applied to the shoulder with light tension will prevent the veins from drooping, and it will be much easier to insert an IV.

The child is covered in cold sweat in shock. This results in a large loss of heat. The baby should be covered, creating a comfortable temperature for him. Maintaining the optimal temperature of the skin will ensure the normal movement of fluid from the bloodstream into the interstitial environment and back. This, in turn, reduces swelling, both general and local.

You can't leave your child alone! A frightened baby is already stressed, and with difficulty breathing and in a situation that is incomprehensible to him, he will further aggravate his condition.

If any of the signs occur, you should immediately call an ambulance. The absolute indication for hospitalization is anaphylactic shock diagnosed by a doctor. Emergency care for children started on call continues in the intensive care unit. This is necessary for dynamic monitoring and adequate therapy. The possibility of an atypical course of anaphylaxis is especially taken into account.

An acute condition in which there is a threat not only to the health, but also to the life of the victim, quite often causes panic in people near the victim. This requires adding one more point to the algorithm for providing emergency care for anaphylactic shock. It is necessary to calm down, restore your breathing and carefully and accurately begin to save the person in trouble.

Anaphylactic shock is an immediate acute allergic reaction that occurs as a result of drug or food allergies, as well as after insect bites or inhalation of allergens.

Nowadays, the reasons why a person can suddenly develop anaphylactic shock are truly endless. It can even be triggered by eating foods such as cheese, sausages, processed foods that have been frozen for a long time, fish, tomatoes, egg whites, berries, chocolate, and when dyeing hair.

In a word, each of us can become a victim of anaphylactic shock at any time, including a person who has never suffered from any allergic diseases in his life. Therefore, it is important to know in advance what anaphylactic shock is and first aid for it.

Meanwhile, in the United States, for example, more than 1,000 deaths are recorded every year due to anaphylactic shock. At the same time, there are cases when anaphylaxis develops rapidly and death occurs within just a few minutes after a person comes into contact with the allergen.

Therefore, often the fate of the victim depends not only on the professionalism of doctors, but also on how correctly and timely pre-medical care will be provided to him.

What should be done in case of anaphylactic shock?

First of all, it is very important to recognize the signs of anaphylaxis in time. The first symptoms when an allergen enters the body with food or tablets are severe abdominal pain, nausea and vomiting.

Sometimes the described symptoms are accompanied by severe swelling of the larynx, which is expressed in a sharp difficulty in breathing, which becomes rapid, noisy, and hoarse. If anaphylaxis is the result of external contact with an allergen, then the first symptom is a pronounced local allergic-type reaction - swelling and redness at the site of the insect bite, which is accompanied by severe pain, severe swelling and itching of the skin.

The patient himself becomes very pale, while his lips become bluish. There are often cases when anaphylactic shock is accompanied by convulsions and loss of consciousness.

If the above-described symptoms are detected, first aid for anaphylactic shock involves immediately calling an ambulance and taking immediate action yourself before doctors arrive.

First aid for anaphylactic shock

First, you need to lay the victim down so that his legs are higher than his head. This is necessary to improve blood flow to vital organs. It is also necessary to provide access to fresh air to the patient.

If the victim has lost consciousness, it is necessary to turn the head to the side and, if possible, move the lower jaw forward. This will promote the flow of saliva and help prevent possible choking. Apply cotton wool with ammonia to your nose for 5 seconds and call a doctor.

Secondly, you need to stop the allergen entering the body. Here the actions depend on how it entered the victim’s body.

If the cause is an insect bite, then apply ice or a cold compress to the bite site. In some specialized literature you can find recommendations to use a paste made from soda and water for a compress. When stung by bees, before applying a compress, you need to carefully remove the sting.

At the same time, you should not squeeze the bite site, as this will speed up the penetration of the poison into the body and, therefore, intensify the allergic reaction. If possible, you can apply a tourniquet above the bite site for no more than 25 minutes.

If the cause of anaphylactic shock is a food allergy or a reaction to pills, first of all, it is necessary to rinse the stomach. Before this, it is strictly forbidden to give the victim anything to drink, as water can speed up the absorption of the allergen.

At this point, sorbents can be used from medications, for example, activated carbon with a dosage depending on the age of the victim and his body weight from 4 to 10 tablets. As for medications, it is strictly forbidden to give the victim diuretics, as the result will be an even greater drop in pressure.