Precautions for use
In particularly sensitive patients, a systemic allergic reaction and anaphylactic shock can occur. In this regard, in the office, where specific diagnostics and specific immunotherapy of patients are carried out, there should be pharmacological preparations and tools for emergency care.
Assisting with general reactions and anaphylactic shock
After the introduction of the allergen, symptoms of clinical manifestations of hypersensitivity to the allergen may develop. With parenteral administration of an allergen, it is possible to develop an immediate-type reaction, incl. anaphylaxis, which manifests itself in the form of urticaria and vascular edema, laryngeal edema, shortness of breath and suffocation. These symptoms often occur after feeling generalized itching, burning sensation, skin flushing, and a sense of fear of death.
As a result of anaphylactic shock, non-occuring bronchospasm, asphyxia due to edema of the upper respiratory tract, and collapse can develop.
In this case, urgent medical measures are required.
Prehospital care for anaphylactic shock
1. Immediately stop the introduction of the allergen that caused the reaction, put the patient on the couch (head below the legs), turn the head to the side, push the lower jaw, remove the existing dentures.
2. Apply the tourniquet in place above the injection of the allergen, if possible.
3. In finiteness, free from the tourniquet, add 0.3-0.5 ml of 0.1% adrenaline solution intramuscularly (IM) or intravenously (IV) (children 0.01 mg / kg, maximum to 0.3 mg ).If necessary, the administration of these doses is repeated at intervals of 10-20 minutes. The total dose of epinephrine should not exceed 1 ml of 0.1% solution. The multiplicity and dose of adrenaline administered depends on the severity of the shock and blood pressure. Repeated administration of small doses of epinephrine is more effective than single administration of a large dose.
4. Finish the injection site with 0.3-0.5 ml of adrenaline solution (1 ml of 0.1% solution of epinephrine diluted in 3-5 ml of sodium chloride solution 0.9%).
5. Apply an ice pack to the injection site.
6. Provide access to fresh air or give oxygen. If the rhythm of breathing is disturbed or if it is difficult, perform artificial ventilation (IVL).
7. Urgent call the doctor, simultaneously called the resuscitation team.
Before the arrival of the resuscitation team, it is necessary to provide medical care and carry out constant monitoring of hemodynamic parameters and the state of the function of external respiration (FVD).
Hospital care for anaphylactic shock
1. In extremely serious condition of the patient and with severe hemodynamic disorders, 5 ml of 0.01% solution of epinephrine are injected slowly into IV, when the effect is achieved, the administration is stopped. Children 0,1 ml / kg 0,01% solution is injected slowly for several minutes.
2. If blood pressure (BP) does not stabilize, urgently begin intravenous drip injection of norepinephrine (phenylephrine, dopamine) 0.2% 1.0-2.0 ml per 500 ml of 5% glucose solution for infusion or sodium chloride solution of 0.9%.
3. Intravenously injected glucocorticosteroids: prednisolone - 60-180 mg (children 5 mg / kg) or dexamethasone - 8-20 mg (children 0,3-0,6 mg / kg), or hydrocortisone - 200-400 mg (children 4-8 mg / kg). As of the introduction of hormones, repeat and continue at least 4-6 days to prevent allergic reactions by immunocomplex or delayed type.
4. Only with the stabilization of blood pressure intramuscularly enter 2.0 ml of a 2% solution of chloropyramine (children 6-12 months - 0.25 ml, 1-6 years - 0.5 ml, 7-18 years - 0.5-1.0 ml) or 0.1% clemastine (children 0,025 mg / kg / day for two injections).
5. Symptomatic therapy according to indications. At bronhospazme 10.0 ml of a 2.4% solution of aminophylline on sodium chloride solution 0.9% (2-3 mg / kg for children) is injected intravenously. If necessary, enter cardiac glycosides, respiratory analeptics.
6. If necessary, suck from the respiratory tract accumulated secret and vomit, begin oxygen therapy.
7. In acute edema of the larynx, intubation or tracheotomy is indicated.
All patients with anaphylactic shock are subject to compulsory admission for a period of at least 10 days in order to continue monitoring and treatment, In 2-5% of patients who have had anaphylactic shock, late allergic reactions are observed.
Doses of drugs administered and the tactics of the doctor are determined by the clinical picture, but in all cases it is necessary, first of all, the introduction of adrenaline, glucocorticosteroid preparations. The administration of preparations of phenothiazine series and calcium preparations is contraindicated.