Edema of the brain with anaphylactic shock
Anaphylactic shock is the most dangerous immediate manifestationhypersensitivity reactions. Most often it is of medicinal origin, but it can be caused by the use of vaccines, serums, skin diagnostic tests, bites of some insects, and food allergens. The death rate from drug anaphylactic shock is 0.002% per 1000 people per year. Clinical manifestations of anaphylactic shock can occur suddenly and lead to death within 5-10 minutes.
Clinical picture and diagnosticsanaphylactic shock.
There are 5 clinical variants of drug anaphylactic shock:
1) a typical form;
2) hemodynamic variant;
The typical form is the anaphylactic shock. The patient's condition deteriorates sharply, appearfear of death, nausea, vomiting, cough. Appear and progress is a sharp general weakness, itching of the skin, a sensation of tidal flow to the head, pressure behind the sternum, difficulty in inhaling, disturbing consciousness, even to the point of losing it. Pulse is frequent, threadlike, sometimes arrhythmic. AD progressively decreases, diastolic pressure is not determined. Tones are deaf. In the lungs, wet wheezing is heard, and later the picture of pulmonary edema develops. With an extremely severe, "lightning-fast" shock, there is a picture of sudden cardiac arrest.
Hemodynamic variant anaphylactic shock characterized by the appearance of pain in the areaheart, sharp decrease in blood pressure, deafness of tones, filiform pulse, arrhythmias. The skin is pale, in some cases acquires a marble shade. With the correct timely diagnosis and treatment, the outcome is favorable in most cases.
AT clinical picture asphic variant anaphylactic shock the acute respiratoryinsufficiency due to edema of the mucous membrane of the larynx, bronchospasm, pulmonary edema. The severity of the disease and the prognosis are determined by the degree of respiratory failure.
Cerebral variant anaphylactic shock. which is much less common, is characterized bydisorders of the central nervous system with signs of psychomotor agitation, fear, impaired consciousness, seizures, respiratory arrhythmia; sometimes there are phenomena of cerebral edema with a picture of epileptic status. The prognosis in many cases, with the correct medical tactics, is favorable.
Significant diagnostic difficulties may present the abdominal variant anaphylactic shock. which is characterized by the appearance of symptoms of an acute abdomen. At the same time, a shallow disorder of consciousness, a slight decrease in blood pressure, and lack of bronchospasm are observed.
Differential diagnostics should be carried out with other types of shock, myocardial infarction, a mild attack of bronchial asthma, acute diseases of the abdominal cavity, cerebral hemorrhage, etc.
The fate of a patient with anaphylactic shock directly depends on the timeliness and completeness of the emergency medical care.
Emergency medical care at anaphylactic shock should be aimed at:
1) relief of acute disorders of circulation and respiratory functions;
2) compensation of adrenocortical insufficiency;
3) neutralization and inhibition in the blood of biologically active substances of the antigen-antibody reaction;
4) blocking the receipt of an allergen drug into the bloodstream;
5) maintenance of vital functions of the body, resuscitation in severe conditions or clinical death.
Mandatory emergency anti-shock therapy anaphylactic shock :
1. Conducted at the site of the shock. Drugs are administered intravenously or (if possible) by intramuscular injection. If anaphylactic shock has arisen at intravenous drip introduction of a medicine - an allergen, the needle is left in a vein and through it medicines are entered.
2. Discontinue the medication that caused anaphylactic shock .
3. Lay the patient, turn his head to the side and push the lower jaw to prevent tongue and tongue asphyxiation. If the patient has dentures, they must be removed.
4. Adrenaline is administered in a dose of 1 ml of a 0.1% solution (instead of injecting an allergen drug). If the blood pressure does not increase, after 10-15 min adrenaline is injected again into 0.5 ml.
5. Prednisolone is administered at the rate of 1-2 mg / kg body weight of the patient. You can enter 4-20 mg dexamezaton or 100-300 mg hydrocortisone.
6. Enter 2-4 ml of a 2.5% solution of pipolphene (the use of pifolen is contraindicated in anaphylactic shock, by any drug from the phenothiesin group), or 2-4 ml of a 2% solution of suprastin, or 5 ml of a 1% solution of dimedrol.
7. With bronhospazme and difficulty breathing, 1-2 ml of 24% solution of euphyllin is injected.
8. With heart failure, cardiac glycosides or diuretics are administered.
9. When anaphylactic shock from penicillin injected once 1 million units. penicillinase in 2 ml isotonic sodium chloride solution.
10. When an allergen drug is administered, a tourniquet is placed above the injection site into the limb region. Place the introduction of the allergen splice adrenaline, diluted with isotonic sodium chloride solution (1:10). When administered orally, an allergen drug is washed with a stomach if the patient's condition allows. When instigating an allergenic medicine in the nose or conjunctival bag, rinse it with running water and drip 0.1% solution of adrenaline and 1% hydrocortisone solution.
Intensive care with anaphylactic shock
1. In the absence of the effect of mandatory anti-shock measures, intensive therapy is carried out, preferably in the conditions of a specialized department.
2. Do venepuncture, venesection and inject drugs intravenously.
3. With a sharp decrease in the vascular tone, 1 ml of 0.2% noradrenaline solution or 1 ml of a 0.1% solution of epinephrine, or 1-2 ml of a 1% solution of mezatone or 2.5 mg of angiotensinamide (hypertensin) with a glucose solution is administered dropwise or in jet.
4. In the asphic version of the drug anaphylactic shock bronchodilators are injected (2-3 ml of 24% or 20 ml of a 2.4% solution of euphyllin, 5 ml of a 10% solution of diprofylline, 2 ml of a 0.5% solution of isadrin, 1-2 ml of a 0.05% solution of alupent).
5. Prednisolone is administered at the rate of 1-5 mg / kg body weight, dexamethasone 12-20 mg, hydrocortisone 125-500 mg.
6. Diphenhydramine, or suprastin, or pipolfen is administered in 5-6 ml.
7. Doses of diuretics (lasix, furosemide) or cardiac glycosides (digoxin, celeanide, strophanthin) depend on the patient's condition.
8. Medicines are administered with glucose, isotonic sodium chloride solution or plasma-replacing fluids.
9. Suck off the mucus and free the airways from possible tongue twisting by tilting the head back.
10. Introduce humidified oxygen, passed through the defoamer (alcohol), using a nasal catheter.
11. In the absence of effect, all medications are administered repeatedly every 10-15 minutes.
Resuscitation at anaphylactic shock.
1. Closed heart massage.
2. Artificial respiration by mouth-to-mouth.
3. Intubation or tracheostomy.
4. In acute asphyxia, artificial ventilation with respiratory apparatus.
5. Insertion of a catheter into one of the central veins (jugular or femoral) for infusion therapy and the introduction of anti-shock medications.
6. With closed heart massage, after every 5 minutes of massage, 4% sodium bicarbonate solution is administered at the rate of 2-3 ml / kg body weight.
7. When cardiac arrest, adrenaline is injected intracardiacally.
8. With epileptic status and normal BP, 1-2 ml of a 2.5% solution of aminazine or 2 ml of a solution of Relanium are injected.
9. Resuscitation measures are carried out by a specialized team or physicians who have received special training.
10. After relief of acute symptoms anaphylactic shock it is necessary for 1-2 weeks to treat with desensitizing, dehydrating, detoxifying and corticosteroid agents.