Anaphylactic Shock

Anaphylactic Shock

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  Fay Ali AlBuainain RespiratoryCare Department University of Dammam Anaphylactic Shock
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  Outline Definition Mechanism of anaphylactic Pathophysiology Symptoms Treatment Cases
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  Anaphylactic shock  Anaphylacticshock is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to allergen.
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  Mechanism of anaphylactic Non- immunological - Alcohol -Exercise -Opioids Immunological IgE - Food - Venom - Penicillin - Latex Non- IgE - Radiocontast media - Some NSAISs
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  :Pathophysiology Sensitization
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  Heparin Histamin Tryptase Vasodilatation →↑blood totissue → ↓Bp and flushing Increase permeability → swelling Coordunate with WBCs •Eosinophils •Basophils •Neutrophils
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  Symptoms and signs: Skin: 90 %of episodes ⁻ Generalized hives. ⁻ Itching or flushing. ⁻ Swollen lips-tongue-uvula. ⁻ Per-orbital edema.  Respiratory: 70 % of episodes ⁻ Nasal discharge and congestion. ⁻ Change in voice quality. ⁻ Sensation of throat closure or choking. ⁻ Tridor or wheeze. ⁻ Shortness of breath and cough.  Gastrointestinal: 45% of episodes ⁻ Nausea. ⁻ Vomiting. ⁻ Diarrhea. ⁻ Crampy abdominal pain.  Cardiovascular: 45 % of episodes ⁻ Hypotonia (collapse). ⁻ Syncope. ⁻ Dizziness. ⁻ Tachycardia. ⁻ hypotension.
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  Laboratory tests:  Serumor plasma total tryptase normal range 1 to 11.4 ng/mL Plasma histamine
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  Treatment:  Epinphrin  IM0.3mg , 1:1000  IV 0.15mg , 1:10,000  Antihestsmin  Corticosteroid  Bronchodilator  Oxygen  Fluids and vasopressors, why?
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  Case study Fay Albuainain
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  Sara is a22 year old female who is brought into the ER by ambulance after sudden changes in her level of consciousness and difficulty speaking when talking to friends at a party. Her friends called 911 when she became increasingly agitated and incoherent. Vital signs on admit were:  B/P 80/62  Resp: 8 with difficulty  Pulse 120  Temp 39.2  O2 sats: 82 Patient was still conscious on admit but confused and disoriented and unable to speak. Patient was very restless and anxious. A few of her friends arrived at the emergency room and it was discovered that she had eaten some cookies that were thought to have peanuts in them right before the event occurred. Family could not been contacted to determine if Sara had a previous documented allergy to nuts/peanuts. Her friends were unaware of such an allergy in her history but never remember seeing her eating nuts of any kind
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   A previouslyhealthy 12-year-old boy is brought to the emergency department after being stung by a bee on his right forearm. He initially complained of localized pain and swelling. Fifteen minutes later, he began to complain of shortness of breath and was observed by his parents to be wheezing. He reported feeling weak and dizzy.  In the emergency department, VS: T=37.1 C, P=120, R=39, BP= 69/45.  Exam: He is drowsy and pale, but able to answer questions. Generalized urticaria is present. He has no conjunctival edema and his lips and tongue are not swollen. His voice sounds normal. He is tachycardic and hypotensive. Respiratory examination reveals mild wheezing, with fair aeration and mild subcostal retractions. Abdomen is soft and non-tender. His capillary refill time is delayed.
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  ◦ UptoDate, Anaphylaxissymptoms and diagnosis (Beyond the Basics); 2016 ◦ Anaphylaxis and Other Acute Allergic Reactions ,University of Hawaii, Brandon O. Takase, MD Jessica S. Kosut, MD;2013. ◦ Anaphylactic Case Study; Rowan Cabarrus community college; 2014. ◦ Journal of Emergency Medicine, 2015-11-01 References: