When carrying out a specific diagnosis in a highly sensitive patient with an allergen, local (hyperemia, edema at the injection site) and general (urticaria, bronchospasm, exacerbation of the underlying disease, anaphylactic shock) reactions may appear.
After each injection of the allergen, the patient should be observed by the doctor at least 60 min. During this time, the doctor should note the skin reaction to the administration of the allergen and the general condition of the patient. In the event of remote reactions, the patient should immediately contact the medical institution and inform the doctor who conducted the allergic test.
In the room where specific immunotherapy of patients is carried out, pharmacological preparations and tools for carrying out anti-shock therapy should be located.
Assisting with general reactions and anaphylactic shock
In cases where during the introduction of an allergen with a diagnostic or therapeutic purpose, the patient experiences general weakness or agitation,anxiety, a feeling of heat throughout the body, redness of the face, rash, cough, shortness of breath, abdominal pain, it is necessary to carry out the following medical measures.
1. Immediately stop the injection of the allergen; lay the patient (head below the legs); Turn the head to the side, push the lower jaw, remove the existing dentures.
2. Apply the tourniquet above the injection site (every 10 minutes, the tourniquet should be loosened for 1-2 minutes).
3. In the limb, free from the tourniquet, 0.3-0.5 ml of epinephrine solution 0.1% is injected subcutaneously.
4. To conduct the splitting in 5-6 points and infiltration of the injection site - 0.3-0.5 ml of epinephrine solution 0.1% with 4.5 ml of sodium chloride solution 0.9%.
5. Place ice or a heating pad with cold water at the injection site for 15 minutes.
If points 1-5 are fulfilled and there is no effect:
1. Introduce epinephrine 0.1% or norepinephrine 0.2% subcutaneously or intramuscularly at a dose of 0.01 ml / kg (children 0.15-0.3 ml, adolescents and adults 0.3-0.5 ml) at intervals of 10-15 minutes. The multiplicity and dose of injected epinephrine depends on the severity of the reaction and the numbers of blood pressure. In severe anaphylactic shock, the epinephrine solution must be administered intravenously in 20 ml of a 40% glucose solution. The total dose of 0.1% epinephrine solution should not exceed 2 ml (children 1 ml).
It should be remembered that repeated administration of small doses of epinephrine is more effective than a single dose of a large dose.
2. If the patient's condition does not improve, then sympathomimetic is administered intravenously in 10 ml of sodium chloride solution 0,9% (0,01 ml / kg of epinephrine solution 0,1% or solution of norepinifrine 0,2%, or 0,1-0, 3 ml phenylephrine solution 1%). Simultaneously, intramuscularly injected any of the antihistamines in the age dosage.
3. Intramuscularly or intravenously, inject glucocorticosteroid drugs: prednisolone 60-120 mg (children 40-100 mg), dexamethasone 8-16 mg (children 4-8 mg).
4. Intramuscularly inject 2.0 ml (children 0.5-1.5 ml) of the suprastin solution 2.5%.
5. With the development of bronchospasm intravenously injected aminophylline in a dose of 4 mg / kg per 10-20 ml of 0.9% sodium chloride solution or inhalation through nebulizer ipratropium bromide + fenoteropa or budesonide (intrapia bromide + fenoterop to children under 6 years 5-10 drops per 2 ml of sodium chloride solution 0,9%, for adolescents and adults 20 drops for 2 ml of sodium chloride solution 0,9%; budesonide children 250 μg per 2 ml sodium chloride solution 0,9%, adolescents and adults 500 μg per 2 ml sodium chloride solution 0,9%).
6. Cardiac glycosides, respiratory analeptics (strophanthine, etazole hydrochloride) are administered according to the indications.
7.If necessary, suck off mucus from the respiratory tract, vomit and carry out oxygen therapy.
8. In case of acute edema of the larynx, intubation or tracheotomy is indicated. Disturbance of breathing and its stopping require intravenous slow administration of lobeline (a solution of 1% in a dose of 0.1-0.3 ml) or cytisine (0.1-0.5 ml), carrying out artificial ventilation.
Help with anaphylactic shock should be provided promptly. Otherwise, death may occur from cardiac arrest or breathing.
All patients with anaphylactic shock are hospitalized. Transportation of patients is made after removal from the threatening state by the resuscitation team, tk. in the course of evacuation, a repeated drop in blood pressure and the development of collapse are possible. After anaphylactic shock, the patient should be observed and examined in a hospital for 10-15 days because of the danger of a two-phase shock current.