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ANAPHYLACTIC SHOCK

Posted by SAMUEL ISABIRYE on February 18, 2013 at 8:40 AM

Acute hypersensitivity reaction

 

Cause

 

z

Allergy to pollens, some drugs (eg. penicillins,

vaccines, aspirin) or certain foods (eg. eggs, fish,

cow’s milk, nuts, some food additives)

 

z

Reaction to insect bites, eg. wasps and bees

 

Clinical features

 

z

Sudden collapse

z

Hypotension

z

Excessive sweating

z

Thin pulse

 

Differential diagnosis

 

z

Other causes of shock, eg. bleeding, severe

dehydration

 

Management

HC2

 

f

Determine and remove the cause

 

f

Keep patient warm

 

f

Secure the airway

 

f

Restore the BP: lay the patient flat and raise the

feet

 

f

adrenaline (epinephrine) injection 1 in 1000

(1mg/mL) 0.5-1mg IM

 

- repeat initially (several times if necessary)

every 10 minutes according to BP, pulse rate and

respiratory function until improvement occurs

-child: see dose table below

f

Administer 100% oxygen

-this is of prime importance

f

Give an antihistamine as useful adjunctive

treatment, eg. promethazine hydrochloride

25-50mg by deep IM or slow IV (give <25mg/min

as a diluted solution of 2.5mg/mL in water for

injections, max: 100mg)

 

393

UCG 2010

 

 

 

18. Miscellaneous conditions

child

1-5 yrs: 5mg by deep IM

5-10 yrs:6.25-12.5mg by deep IM

 

- repeat dose every 8 hours for 24-48 hours to

prevent relapse

To prepare the diluted solution: dilute each 1mL

of promethazine hydrochloride injection

25mg/mL with 9mL of water for injections

 

In severely affected patients:

 

f

hydrocortisone 200mg IM or slow IV stat

child <1 yr: 25mg; 1-5 yrs: 50mg; 6-12 yrs:

100mg

 

- helps to prevent further deterioration

f

Repeat adrenaline and hydrocortisone every

2-6 hours prn depending on the patient's

progress

 

f

sodium chloride 0.9% infusion 20mL/kg by IV

infusion over 60 mins

 

- start rapidly then adjust rate according to BP

Child adrenaline doses for IM injection

 

Age Vol of adrenaline 1 in 1000 (mL)

(yrs) Normal Underweight

<1 0.05 0.05

1 0.1 0.1

2 0.2 0.1

3-4 0.3 0.15

5 0.4 0.2

6-12 0.5 0.25

>12 0.5-1 0.5-1

 

Note:

 

.

Adrenaline: IM is the route of choice

 

- absorption is rapid and more reliable than SC

394

UCG 2010

 

 

 

18. Miscellaneous conditions

 

Categories: None

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3 Comments

Reply SAMUEL ISABIRYE
2:12 AM on December 14, 2013 
Online revision!
Reply SAMUEL ISABIRYE
3:55 PM on September 30, 2013 
Surely this is a learning session
Reply SAMUEL ISABIRYE
4:50 PM on July 6, 2013 
revive with yr phone!