Quincke edema is an acute, often allergic reaction in the form of a sharp local swelling of the mucous membranes, skin and deeply lying fiber, disrupting the work of various organs and proceeding with a high probability of life-threatening anaphylactic shock and swelling of the throat. In 50% of patients often develops together with urticaria, which is defined as a limited allergic edema with red spots on the skin that have uneven borders, and blisters.
Quincke edema usually lasts from a few minutes to a day, and then it can develop in three "scenarios" - gradually subside, from time to time relapse or rapidly build up, causing suffocation, an allergic shock and death of the patient. And in this article we will consider the symptoms and algorithms( standards) of providing the first pre-medical and emergency medical care with Quincke's edema.
The first symptoms of the
reaction The pathology develops abruptly, suddenly, often without foreshadowing this state of symptoms. To recognize the symptoms of a dangerous pathology is possible by external signs. Primary symptoms that require immediate attention:
- Acute onset, very rapid development - 10 to 20 minutes, sometimes 1 to 2 hours, in which the organs or parts of the body swell. Most often - soft facial tissues and mucous membranes.
- A marked increase in the volume of the lips, cheeks, upper eyelid( one or both), in which the patient is often unable to open his eyes.
- In addition to the face, may swell: lower jaw, neck, whose skin is as if swallowing;tongue, larynx, trachea;esophagus, stomach, intestines, urinary organs;scrotum, labia, meninges, the back of the feet and hands.
- No itching, unless swelling is combined with hives.
About the symptoms of edema Quincke will tell the video:
Typical manifestations of
Specific features of the edema:
- marked density, when pressure is applied to the swollen area to resist tight tissue, as the fluid accumulating in the subcutaneous tissue contains a large number of protein compounds that give the expressed density of the swelling area;
- strong skin tension and tension of the tissues is accompanied by bursting, burning;
- manifestation of soreness when feeling the swollen area;
- after pressing on the edged place of the fossa from pressing does not remain;
- the color of the skin in the place of flow may not change or be pink;
- with swelling of the mucous membranes of the respiratory organs, the skin of the face at the first stage turns red, later, with the increase in swelling, becomes cyanotic, especially around the nose and above the upper lip;
- if Quincke's edema is manifested with urticaria, it can be observed: itching, rash, lacrimation and inflammation of the conjunctiva, nasal congestion.
|Mucous larynx, epiglottis( 20 - 25% of patients).Life-threatening condition, especially in children due to the narrowness of the larynx, trachea and fulminant edema, blocking the breathing|| || Duration from 5 to 10 minutes to half an hour, a gradual decrease in edema with preservation of hoarseness. |
Often there is an increase in all signs with the spread of edema on the mucosa of the trachea, a clear deterioration in the patient's condition and the threat of death from suffocation
|Mucosa of the stomach, esophagus, intestines, urogenital areas|| || Changes on the skin and mucous membranes that are visible on examination usually do not reveal. |
Difficulty in diagnosis due to hidden manifestations of
|Brain and shell tissues, internal ear mucosa|| Neurological disorders: |
Features of the development of the laryngeal edema
All signs of edema in the respiratory tract are especially acute and pronounced in younger children up to 3 - 5 years. This is due to the anatomical narrowness of the pharynx, larynx and trachea and the physiological specificity of their functioning at this age.
The child's state of swelling of the throat is extremely dangerous, as the deterioration grows rapidly, almost without giving time to help.
The appearance of the stridor indicates a difficulty in getting air into the lungs, and when breathing, small patients are straining their strength. This is a critical condition, which urgently needs the help of doctors "ambulance" or even resuscitation. The rate of increase in respiratory failure, especially in infants, is threatening, and the laryngeal lumen overlap is so pronounced that it is impossible to carry out even emergency measures in the form of intubation of the trachea.
Specific features of Quincke edema in the child in the respiratory tract:
- apparent hoarseness when crying;
- rough barking cough;
- breathing with feverish breaths by ingesting air;
- the appearance of a stridor( whistle);
- cyanosis around the mouth and spout due to poor blood supply and lack of oxygen in the blood;
- frequent shallow breathing with retraction of soft areas over the clavicles, stomach;
- strong anxiety, overexcitation, and later - exhaustion, retardation;
- profuse sweating, trembling of fingers, handles, legs;
- strong palpitation;
- with a combination of laryngeal edema with bronchial obstruction and edema of the trachea all signs are very similar to an attack of asthma and false croup with laryngitis.
The following is an urgent first aid for swelling of Quincke in adults and children.
First aid for edema Quincke
Because the development of Quincke's swelling is absolutely unpredictable and very intense, the first thing that needs to be done to prevent menacing consequences is to call an ambulance, even if the patient's condition is currently satisfactory. This false stability of the state often deceives the relatives making an irreparable mistake - they wait, that with Quincke's swelling - is unacceptable.
So, let's find out what to do with Quincke's swelling, the first emergency pre-medical and medical help with him.
This video reviews 1 first aid for edema Quincke:
Before arrival of "ambulance" you need:
- to ensure maximum airflow - open windows, windows, balcony doors
- immediately stop contact with irritant allergen if known.
- With a bite of a wasp, bees - take out a stinger with tweezers.
- position patient sitting( do not put) in a comfortable position, calm;
- of a small child must be taken in hand, ensuring a direct position of the baby's back;
- remove from the neck, chest, waist all pulling and pressing garments;
- adult patients and babies from 3 years of age give an abundant alkaline drink that removes the allergen from the body( a mixture of soda - 1 g with 0.5 liters of water, narzan, Borjomi);
- apply antiallergic agents in tablets( Suprastin, Pipolphen, Tavegil, Fenkarol, Diazolin, Fenistil in drops).If the child is already 2 years old, Claritin is allowed( 2.5 mg, corresponding to 2.5 ml of baby syrup or quarter of the pill), Fenkarol( from 2 years - 0.005 mg), other medicines in pediatric dosage.
If development of edema followed after bite, injection of medication into the arm:
- tighten( not tight) bandage place above the bite / injection area( up to 30 minutes without clamping large vessels);
- to the site where the medicine was injected( a sting entered), apply a cold - a heating pad, ice, to slow the spread of the allergen by blood, to stop the buildup of swelling.
Babies and patients of any age with signs of edema of the larynx, throat, esophagus, all drugs, if possible, injected, as this is more effective, and with the flow of the stomach and intestines, the absorption of medicines is disrupted.
- Antihistamines may slightly ease the condition, but to cancel the call for emergency medical care is completely unacceptable.
- As a sorbent that slows the absorption of allergens and toxins, it is worth using Polysorb, Polypefan, Enterosgel, activated charcoal( usually 1 to 2 tablets per 10 kg of weight).
- A child up to 3 years old can grind up to 3 tablets of coal and mix with 150 ml of water, give Smektu( 1 packet to infants up to 12 months, 2 packs twice a day for children 2 to 3 years), Enterosgel( 1 teaspoon to infants up to a year, 2spoons for children 1 - 3 years).
In emergency cases of obvious deterioration in the condition of laryngeal edema( especially in children), in order not to allow the death of the patient, it is necessary, without waiting for an ambulance, to inject intramuscularly hormonal means:
- Prednisolone. Adults - up to 300 mg, newborns calculate the dose according to the formula 2 - 3 mg per 1 kg of the weight of the baby, children older than the year and schoolchildren from 7 years in the same dosage.
- Dexamethasone to adults is 60 to 80 mg, to small patients in a strictly calculated dosage by weight: 0.02776 to 0.1666 mg per kilogram.
What is the urgent first aid and the algorithm of action for swelling of Quincke, read further.
A patient of any age who shows signs of an edema of the airways is immediately hospitalized. In acute period, therapy is complex, aimed at eliminating allergies, removing edema, reducing the body's response to histamine( a hormone mediator that actively regulates the process of acute allergic reactions).
Emergency therapy for laryngeal edema:
- urgent subcutaneous / intravenous adrenaline injection of 0.1% to prevent a critical drop in blood pressure. Adults 0.3 - 0.8 ml, the highest dose under the skin - 1 ml( per day - up to 5 ml).Children - depending on the age of 0.1 - 0.5 ml.
- use of hormones that are required to quickly relieve swelling and restore breathing, especially if the swelling is combined with a giant urticaria. The main drugs are injected slowly( if intravenously - 3 minutes, if intramusculary - then deep into the buttock): Prednisolone to adults 60 to 90 mg, Dexamethasone 20 to 80 mg( up to 4 times per day), Hydrocortisone 75 to 125 mg.
- A single dose of Prednisolone for children per 1 kg of weight: 2 to 12 months at 2 to 3 mg, from year to 14 years - 1 to 2 mg. If necessary - pour the medicine again after 20 - 30 minutes.
- Children's dose of Dexamethasone per day for 1 kg of the baby's weight - 0,02776 - 0.1666 mg.
- introduction of diuretics intravenously: Lasix 40 - 80 mg;Furosemide 1% 1 - 2 ml, Mannitol solution 15%( per kilogram of weight 1 - 1.5 g), urea 30%( 0.5 - 1.5 g / kg body weight);
- the use of antihistamines intramuscularly( intravenously) to reduce the sensitivity of the body to the allergen, and use antiallergic drugs of the first generation with a sedative effect, because, despite the shortcomings, they are most effective:
- Suprastin, given that the dose of 1 kg of weight can notbe above 2 mg: an adult on average 40 to 60 mg. Initial doses to children: 1 - 12 months: 5 mg;from year to 6 years: 10 mg;from 6 to 14: 10 to 20 mg.
- Also use Diphenhydramine, Tavegil, Pipolphen.
- with bradycardia( anomalous slowing of the heartbeat) do 0.1% of atropine 0.1% in 0.25-0.5 mg - 1 mg. Children are prescribed strictly according to the age criteria and weight of 0.05-0.5 mg once. In severe cases, the drug is injected every 10 to 15 minutes.
- if there are signs of bronchospasm, use intravenous infusion of Euphillin with Dexamethasone, bronchodilators;
- oxygen therapy is actively used in the appearance of cyanosis( blue skin and mucous membranes with oxygen deficiency in the blood), dry, wheezing, dyspnea( frequent, difficult breathing with severe violation of depth, rhythm, frequency);
- method aimed at active removal of allergens, toxins of their body - hemosorption( extrarenal removal of toxins from the blood by passing blood through the sorbent);
- to prevent a sharp drop in pressure use infusion of saline, colloidal solutions( a mixture of 0.5-1.l of saline, 0.5 liters of hydroxyethyl starch, 0.4 liters of polyglucin);
- in cases of development of the edema of Quincke in the stage of asphyxiation( suffocation), the patient on the spot is followed by an immediate operation - tracheostomy( conicotomy).
Elena Malysheva in this video will tell you how not to die with Quinck's swelling: