Anaphylactic shock in children: clinic, emergency care

Anaphylactic shock - (more precisely, collapse) is an acute, generalized allergic reaction with decompensated hemodynamic disturbance mediated by allergic reactions of type I (IgE-reagins or IgG). This is the most severe form of an allergic reaction and is a medical emergency. The first mention of anaphylactic shock refers to 2641 BC. er .: according to the surviving documents, the Egyptian pharaoh Menzes died from the bite of a wasp or hornet.

Clinically, anaphylactoid reaction is no different from anaphylactic shock — pseudoallergic anaphylaxis, which is not pathogenetically related to the antigen-antibody interaction, although it is caused by external causes.

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Causes of anaphylactic shock

Anaphylactic shock develops acutely after the patient contacts the intolerable allergen and is a life-threatening condition that is accompanied by a violation of hemodynamics, leading to circulatory failure and hypoxia in all vital organs. The peculiarity of anaphylactic shock is the possible development of skin manifestations in the form of urticaria, erythema, edema, bronchospasm before or simultaneously with the appearance of hemodynamic disturbances. Mortality in this state is 10-20%.

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Symptoms of anaphylactic shock

The severity of anaphylactic shock depends on the speed of development of vascular collapse and impaired brain function.

For anaphylactic shock is characterized by staging flow. In the first stage, general excitement or, conversely, lethargy, fear of death, throbbing headache, noise or ringing in the ears, squeezing pain behind the sternum, skin itching, urticarial rash, angioedema, hyperemia, sclera, tearing, nasal congestion, rhinorrhea, itching and sore throat, spastic dry cough. Blood pressure in this stage is within normal limits, CVP is at the level of the lower limit of normal.

The second stage is characterized by a decrease in blood pressure up to 60% of the age norm, hard breathing, dry scattered wheezing, a weak filling pulse, heart rate up to 150% of the age norm, a syndrome of small cardiac output develops. Confusion of consciousness, compensatory dyspnea, formation of a shock lung. Prognostically bad precursors - the appearance of acrocyanosis on the background of general pallor, hypotension and oligoanuria.

The third stage is characterized by an extremely severe condition, consciousness is absent, sharp pallor of the skin, cold sweat, oligoanuria, frequent breathing, shallow, increased bleeding of tissues are noted. Diastolic blood pressure does not determine the pulse filament, tachycardia. There is sludge syndrome, DIC.

Diagnosis of anaphylactic shock

The diagnosis of anaphylactic shock is clinical anamnestic. Differential diagnosis is carried out with other types of shock: traumatic, post-hemorrhagic, cardiogenic, septic, vasovagal collapse, generalized cold urticaria, foreign body aspiration, etc. Brachycardia, nausea, and the absence of heart rate patterns that are out of the challenge, and there is no reason to be in a case of heartbeat patterns, nausea, and no heart patterns, and there is no effect, and there is no reason that a heartbeat pattern is used for heart failure, for example, for a vasovagal collapse (fainting), bradycardia, nausea, and the absence of heartbeat patterns, for example, for heart failure, for heart failure, for heart failure, for heart failure, for heart failure, for heart failure, for heart failure, for heart failure, for heart failure, for heart failure, for heart failure, for heart failure, for heart problems . Symptoms stop after giving the patient a horizontal position with raised lower limbs.

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Urgent care for anaphylactic shock

It is necessary to lay the patient horizontally with slightly elevated legs, warm him, vigorously massage the abdomen and extremities, clean the oral cavity and airways from mucus and vomitous mass, turn the head of the child to the side to prevent aspiration. Above the point of introduction of the drug or bite (sting) it is necessary, if possible, to impose a tourniquet, weakened for 1-2 minutes. Blood pressure monitoring constantly, without removing the cuff.

A 0.1% solution of adrenaline is administered intramuscularly or intravenously at the rate of 0.01 ml / kg (not more than 0.3 ml) and prednisolone 10 mg / kg. Chloropyramine (suprastin) 2% solution or diphenhydramine (dimedrol) 1% solution - 0.05 ml / kg intravenously, intramuscularly, is prescribed. With low efficacy, repeated intravenous administration of drugs is necessary in 10-15 minutes. While maintaining the effects of bronchospasm, salbutamol inhalation of 1.25-2.5 mg (1 / 2-1 nebulas) or 2.4% solution of aminophylline (aminophylline) 4-5 mg / kg is administered intravenously. While maintaining arterial hypotension, administration of a 0.9% solution of sodium chloride (10–30 ml / kg x h) intravenously with the introduction of phenylephrine (mezaton) (1–40 μg / kg Khmin) or dopamine (6–10 μg / kg Khmin) is shown. Conduct oxygen therapy: 40-60% oxygen through the nasal catheter. With inadequate breathing. Blood pressure below 70 mm Hg, the development of laryngeal edema requires mechanical ventilation. With a low reaction to epinephrine, glucagon is used in a dose of 1-2 mg intravenously. then drip at a rate of 5-15 μg / min to obtain the effect. Glucocorticosteroids are reintroduced in refractory bronchospasm and to prevent symptoms from returning after 6–8 hours (biphasic reactions). With a good response to therapy, antihistamines are administered orally every 6 hours for two days, prednisone 1-2 mg / kg every 4-6 hours, or equivalent doses of other glucocorticosteroids.


Anaphylactic shock in children

Anaphylactic shock (anaphylaxis) is a painful condition. It is accompanied by a sharp increase in the sensitivity of the body. Sensations are manifested when the allergen is reintroduced. These include any kind of protein of an alien nature. In addition, anaphylactic shock can cause:

And others. Anaphylactic shock is dangerous for the life of adults and children. It is among the most severe manifestations of allergic reactions.

It takes very little time for manifestations to become critical - starting with a few seconds, but not more than 2 hours. No matter how the allergen contacted the patient. The more of it - the worse will be the patient's condition.

Symptoms of childhood anaphylactic shock

Symptoms of anaphylactic shock in children are related to how the disease develops. First, the allergen enters the body. In case of skin contact, itching, swelling, etc. occur. If the disease develops due to the product, then the corresponding symptoms begin. There are several manifestations of the disease:

Signs of anxiety, fear.

Numbness of lips and facial muscles.

Violation of the gastrointestinal tract.

Constriction in the chest.

Vaginal discharge (in adults).

Pulse becomes filiform.

If the last symptom is observed, there is a risk of death. It is necessary to immediately give first aid and bring the patient to life. Choking death occurs in 5-30 minutes. Vital organs decompose in 24-48 hours. These are irreversible changes that must be prevented immediately. There are cases when death occurs as a result of changes in the kidneys (glomerulonephritis), which require more time for pathology. Also, after a long time, damage can be diagnosed:

gastrointestinal tract (intestinal bleeding),

brain cell death (edema, hemorrhage)

In most cases, the shock is biphasic. First, there is some improvement in health, and then dramatically lowered blood pressure. Patients who have suffered such a shock, spend at least 12 days in the hospital.

There are situations when children can first notice certain manifestations of the disease. They are observed immediately after contact with the allergen (urticaria, itching, dizziness, etc.). They are called symptoms of "anxiety."

What to do with anaphylactic shock in a child?

Immediately you need to call an ambulance. This is done at the first symptoms. This is especially important when you know in advance about an atypical reaction to an allergen. In such a case, the ambulance dispatcher is warned that he needs to send a specialized brigade to the call.

When the allergen is known - the patient needs to be isolated from him, to carry out prophylaxis: to ventilate the room, or to treat the wound, depending on its nature. If it is a bite, a plait is placed over it, cooling something. The patient should as soon as possible take a horizontal position.

You need to give your child a dose of antihistamine medication, following the instructions. Give him any of the antihistamines (tavegil, suprastin, claritin). If you do not know which medicine is usually given to the child, give what is available.

Tavegil (syrup) children 1-3 years old do not give more than 2-2.5 ml twice a day. Patients 3 to 6 are given no more than 5 ml, and those who are 6 to 12 years old need 5-10 ml. Also, between the ages of 6 and 12 years old, pills can be given - one half twice a day; teens and adults are given a whole tablet.

Suprastin for those who are 1–12 months old is given 5 mg (0.25 ml), at the age of 2–6 years the dose increases to 10 mg (0.5 ml), while patients of 7–14 years old need 10–20 mg (0.5–1 ml). The size of a daily dose should not exceed 2 mg / kg.

Next is to observe the child. Be sure to regularly measure indicators of pulse and pressure, frequency and rhythm of breathing.

It is required to remember the exact time of the onset of anaphylactic shock and report it to the doctor. It is necessary to tell as precisely as possible when the manifestations of the state of the disorder began and mention the names of the medicine that was given to the patient before the arrival of the specialist.

How to treat anaphylactic shock in children?

When anaphylactic shock is diagnosed, the child urgently needs an injection of adrenaline. This will help relieve allergies. Usually, patients suffering from such attacks are well aware of their problem. A child rarely can use the necessary medicine on his own.

If the reaction occurs for the first time, you need to immediately call an ambulance. Before their arrival, you must achieve airway patency. It is necessary to eliminate mucus and vomit from the oral cavity, to prevent retraction of the tongue. If the victim is conscious, you cannot demonstrate your anxiety to him. The tone should remain smooth. If the access is an aerosol inhaler - it must be applied. He stops an attack of bronchial asthma, a corticosteroid hormone pill (prednisone, dexamethasone) will also help. This will help alleviate the symptoms of shock, and therefore wait for the arrival of doctors.

The child is immediately lying down, with raised limbs. Then the fluid from the heart pump does not leak. Whenever possible, use an oxygen therapy mask from two to four liters for a minute period.

Adrenaline in the intramuscular or subcutaneous form is the first step of emergency treatment. Depending on the conditions of assistance, different forms of the drug are used - standard injections in ampoules, intravenous administration, etc. After hospital treatment, it is necessary to eliminate the danger of contact with allergens.

In the future may develop:

  • allergic stenosis of the larynx,
  • bronchospasm
  • hemodynamic disturbances - falling blood pressure, arrhythmias,
  • dyspeptic syndrome,
  • Quincke's edema. Usually, 2–3 syndromes predominate, and death is most often caused by acute respiratory failure.

There are fulminant forms of shock with a fatal outcome for 5 to 10 minutes. The cause of death is acute hemodynamic insufficiency and asphyxia.

Watch the video: Anaphylaxis Emergency (January 2020).