Anaphylactic Shock

ANAPHYLACTIC SHOCK
BUDHARAPU RAHUL
GROUP NO 52
COURSE 5
ANAPHYLACTIC SHOCK
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This type of shock is considered the most severe systemic
allergic reaction.
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It results from an immunologically mediate reaction in which
vasodilator substances released into blood.
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Vasodilator substances: histamine.
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This causes vasodilation or arterioles and venules along with
marked increase in capillary permeability.
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Anaphylaxis is a multiple system involvement including
skin ,airways, vascular system and gastro intestinal system.
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In Severe cases , it may results in complete obstruction of
airway , cardiovascular collapse and death.
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Shock is when your blood pressure drops so low that is
when your cells or organs don’t get enough oxygen
ETIOLOGY
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Pharmacological agents:
Antibiotics (penicillin) NSAIDS
(aspirin) IV contrast agents.
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Stinging insects: Ants, bees,
hornets , wasps, yellow jackets
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Food: Peanuts, seafood, wheat
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Latex: Rare and It’s not associated
with death
COURSE:
SYMPTOMS
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Anaphylaxis typically presents many different symptoms over minutes or
hours with an average onset of 5 to 30 minutes if exposure is intravenous
and 2 hours if from eating food.
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The most common areas affected include:
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skin (80–90%),
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respiratory (70%),
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gastrointestinal (30–45%),
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heart and vasculature (10–45%), and
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central nervous system (10–15%)
RESPIRATORY:
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Difficulty breathing
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Coughing
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Chest tightness
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Wheezing or similar sounds
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Increased mucus production
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Throat swelling or throat itching
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Change in voice
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Chocking sensation in throat
CARDIOVASCULAR:
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Dizziness
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Weakness
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Fainting
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Rapid, slow or irregular heart rate
●
Low BP
GASTRO INTESTINAL TRACT:
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NAUSEA
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Vomiting
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Cramps
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Diarrhea
CENTRAL NERVOUS SYSTEM:
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Anxiety
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Confusion
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Sense of impending doom(impending doom is a
sensation or impression that something tragic is
about to occur.)
LIFE THREATENING ISSUES:
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Airway: swelling, hoarseness , stridor
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Breathing: rapid breathing, wheeze , fatigue , cyanosis ,
SpO2<92%, confusion
●
Circulation: pale, clammy, low BP, faintness, drowsy or
coma
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Weak or absent central pulse
MANAGEMENT:
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Administering IM epinephrine quickly
(Repeat every 5 minutes to 10 minutes if necessary)
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Place patient in supine position with legs elevated
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Consider oxygen for all patients
●
Treatment in order of important: epinephrine , patient
position, oxygen, IV fluids, nebulized therapy, vasopressors,
anti histamines , corticosteroids , other agents.
●
Evaluate hypotension and need for IV fluids
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Individualise observation
IM EPINEPHRINE DOSING:
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Epinephrine dosing IM:
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Epinephrine from 1:1000 dilution (1mg/ml) injected as 0.2
to 0.5ml (0.01mg/kg) in children ,maximum dose 0.3 mg)
Ancillary treatment:
Second line therapy:
●
Ranitidine:50 mg in adults and 12.5 to 50 mg
1mg/kg in children diluted in 5% dextrose to a total volume
of 20ml and injected over 5 minutes intravenously.
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Nevulized albuterol:2.5 to 5mg in 3ml normal saline.
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Methyl prednisone: 1 to 2 mg/kg per 24 hours.
IV EPINEPHRINE DOSING:
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Adrenaline IV BOLUS dose:
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Titrate IV adrenaline using 50mcg boluses according to response
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The prefilled 10ml syringe of 1:10000 adrenaline contains 100mcg/ml
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A dose of 50mcg is 0.5ml which is smallest dose that can be given
accurately
●
Do not give the undiluted 1:1000 adrenaline concentration
intravenously
PREVENTION:
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Strict avoidance of potential allergens in an important preventive
measure for patient at risk of anaphylactic shock.
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Patient at risk for anaphylaxis from insects stings should avoid
areas populated by insects
●
People senate to insect bites and stings , those who have experience
food or medication reaction or those who have experience with idiopathic
or exercise induced anaphylactic reaction should always carry an
emergency kit that contain epinephrine
●
Screening for allergens before a medication is prescribed
or first administered is an important preventive measure.
●
Person predisposes to anaphylaxis should wear some form
of identification such as medical and bracelet naming
allergy to medication , food , and other substances .

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