In cases where during the introduction of a mixed allergoid the patient develops general weakness or agitation, anxiety, a feeling of heat throughout the body, redness of the face, rash, cough, shortness of breath, abdominal pain, the following measures should be taken.
Prehospital care for anaphylactic shock
1. Immediately stop the introduction of the mixed allergoid pollen hedgehog, fescue, timothy, put the patient on the couch (head below the legs), head to the side, push the lower jaw, remove the existing dentures.
2. Apply the tourniquet in place above the allergoid injection, if possible.
3. Finish the injection site with 0.3-0.5 ml of the adrenaline solution (1 ml 0.1% solution of adrenaline diluted in 3-5 ml of sodium chloride solution for injection 0.9%).
4. Apply an ice pack to the injection site.
5. Enter 0.3-0.5 ml of 0.1% solution of adrenaline (children 0.05-0.1 ml / year of life) in / m or IV with an interval of 5-10 minutes. The multiplicity and dose of adrenaline administered depends on the severity of the shock and blood pressure. The total dose of epinephrine should not exceed 1 ml of 0.1% solution. Repeated administration of small doses of epinephrine is more effective than single administration of a large dose.
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 the extremely serious condition of the patient and with severe violations of hemodynamics, slowly inject 5 ml of 0.01 ml% solution of adrenaline, when the effect is achieved, the administration is stopped. Children 0.1 ml / kg 0.01% solution slowly for a few minutes.
2. If blood pressure 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 for injection 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 inject 2.0 ml of a 2% solution of chloropyramine (1-12 months - 0.25 ml, 1-6 years - 0.5 ml, 7-18 years - 0.5-1 ml) or 0, 1% Clemastin (children 0,025 mg / kg / day for two injections).
5. Symptomatic therapy according to indications. In bronchospasm, 10.0 ml of a 2.4% solution of aminophylline on a solution of sodium chloride for injection 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. Patients receiving β-adrenoblockers showed additional administration of salbutamol and / or glucagon in / in 1 ml.
8. 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% patients who have experienced anaphylactic shock, there are late allergic reactions.
Doses of injectable drugs and tactics of the doctor are determined by the clinical picture, but in all cases, first of all, the introduction of adrenaline, glucocorticosteroid preparations.The administration of preparations of phenothiazine series and calcium preparations is contraindicated.