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

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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 of emergency care for anaphylactic shock.

First symptoms of

Time of onset of

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;
• sensitivity of a person to this allergen;
• physiological, anatomical features, existing diseases, predisposition to allergies of all kinds;
• age and weight;
• existing internal pathologies;
• hereditary predisposition to acute allergic manifestations.

For example,

• For example, an insect venom, a drug injected intramuscularly or intravenously, causes an immediate reaction, the symptoms of which develop between 1 and 2 to 30 minutes.
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• 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:

Common signs of

In describing the basics of AS( anaphylactic shock), regardless of the form of the pathology, they are first generalized so that close relatives, friends, colleagues and the patient themselves can quickly navigatecritical 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 is often accompanied by severe 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 - a 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 contraction of the heart muscle( tachycardia) or bradycardia( abnormal slowing of the heartbeat), rhythm disturbance( arrhythmia);
• drop in blood pressure, blurred vision, blurred vision, double vision;
• panic reactions with pronounced fear of death, suffocation;
• with 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

Symptoms depending on the type of anaphylaxis

Typical( about 53%)

Symptoms:

• hypotension( blood pressure drop below normal);
• redness or pallor, blue lips;
• possible rash, swelling of any areas( especially dangerous - edema 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;
• shortness of breath, 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.
• cramps 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 puffiness 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:

• dilated pupils that do not respond to light;
• pulse weak threadlike;
• rapid or slow heart rate outside normal range;
• 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 entire skin with a feeling of extreme heat);
• Or "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.

Leading pathosymptom - a violation of cardiovascular activity followed by acute heart failure.

With early diagnosis and active treatment - the forecast is favorable.

Asphyxic( 17%)

Symptoms of respiratory failure:

• cough paroxysmal dry;
• hoarse voice, wheezing;
• hindered surface breathing with stridor( whistle) and convulsive ingestion of air;
• sensation of swelling of the throat, neck, foreign object in the respiratory tract;
• sensation 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 because of 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, bronchoectatic disease, emphysema.

The prognosis is determined by the degree of respiratory failure. When the delay in taking measures, the patient dies of 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;
• a slight decrease in blood pressure( not lower than 70/45 mm Hg).

Other typical symptoms are less pronounced.

Leading symptoms are the 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 not other forms end safely.

Caused by physical activity( 2-5%)

Symptoms:

• skin itching;
• hot flushes to the head, fever, erythema( redness), rash or blistering rash( hives);
• edema of the face, neck;
• abdominal pain and diarrhea;
• shortness of breath, 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 nurse actions and the first time in emergency and 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 in 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 severe.

First aid for anaphylactic shock

First aid at home, at work, in children's institutions

Adrenaline intake

Before the arrival of the "first aid", all actions must be clear and consistent.

• Many doctors recommend the immediate introduction 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 wait with 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 about pre-medical care for anaphylactic shock will be told by this video:

Immediate actions of

However, it is necessary to act as quickly as possible and perform the following:

1. Remove allergen source: remove stinger, stop intramuscular injection.
   • to tighten the vein( without squeezing large arteries) at a 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;
   • all belts, unbutton buttons, loosen neckties, if necessary - tear off clothes, so as not to restrict breathing, baby - to untangle.
2. If the patient breathes, he is laid on his back, lifting his legs to redirect the 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 backrest.

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 to 2 mg per kilogram of body weight, the norm for newborns is 2 to 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. Intramuscular, slow, deep into the buttock. If no improvement is observed, medication is given again after 15 to 30 minutes.
• . Antihistamines to suppress the body's response to histamine release:
  • Suprastin. Adults median doses of 40 to 60 mg. Initial infant dosages: from birth to year 5 mg;from a one-year-old age 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 the I generation as the most effective in critical situations.

If it is not possible to make an intramuscular injection, the ampoule is carefully broken, filled with a syringe with medicine and, taking the needle off the syringe, poured out under the tongue - in the corner of the mouth, controlling 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.

A critical situation before the arrival of the "fast"

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 preparation and its action

Where and how much to enter

Adrenaline. In 1 ampoule, 1 ml of solution 0.1% Increases blood pressure, narrowing peripheral vessels. Strengthens cardiac output, increasing contractile activity of the heart. Relieves spasm of bronchi and bronchioles. Suppresses the secretion into the blood of substances that regulate allergic manifestations( histamine, acetylcholine), as well as bradykinin, which contributes to a critical drop in pressure in shock.

To be administered intramuscularly to any site( and through clothing - too).The optimal place of introduction is the outer middle part of the thigh. Can be administered under the skin. Adult single dose: 0.3 - 0.8 ml. Pediatric is 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 breathing and unconsciousness, the solution is poured under the tongue in the same dosages - it will suck in the blood 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 injection syringes 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 airways become swollen and do not allow air to pass through, the ventilation of the lungs before the injection of epinephrine is done is often ineffective. 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

Heart muscle massage is carried out by deeply punching( 4 - 5 cm) with the palms criss-crossed in the chest in the heart zone. The pressure is not carried out by the muscles of the hands, but by the whole mass of the body 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 pressure, inhale through the mouth with the patient's nose squeezed and the head thrown back, again 4 pushing;it is possible to blow air in and out of the nose, but this method is less effective, since 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 care

A patient with symptoms of 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 swelling, 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 rate of 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 NaCl solution, applying 0.2 - 1.0 ml in 30 - 60 seconds. Sometimes the medicine is injected directly into the trachea.

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

Other preparations

1. Glucocorticosteroids - intravenously. Prednisolone, Dexamethasone in the dosages indicated above.
2. Antihistamines are 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 bronchospasm.
4. Oxygen therapy( supply of oxygen under pressure) is performed with signs of cyanosis( blue skin), the appearance of 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 1-2 ml, Mannitol 15%( 1-1.5 gramsper kilogram of body weight).
8. Relanium 2 - 4 ml with the appearance of seizures.
9. Reopoliglyukin - for elimination 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 watch this video of Elena Malysheva about helping with anaphylactic shock: