The whole process of children's anaphylactic shock rescue, this is worth collecting

time:2022-12-05 05:41:03source:monlittlebaby.com author:Baby care
The whole process of children's anaphylactic shock rescue, this is worth collecting

*For medical professionals to read and reference , which is often very tricky to deal with. However, once a child suffers from anaphylactic shock, the rescue must race against time. Pediatricians are required to be clear-headed and not allow the slightest hesitation, otherwise it may lead to serious consequences. Let’s follow the author below to learn the first aid treatment of anaphylactic shock, so that we can be confident and understand. 01 Classification of shock Shock can be divided into hypovolemic shock, cardiogenic shock, septic shock, anaphylactic shock and neurogenic shock according to the etiological classification. 02 The definition of anaphylactic shock refers to shock caused by allergic reactions caused by various allergic factors, which is an immediate fatal systemic reaction of the body to allergens. Allergens can be foods, drugs, or other stimuli (such as bee stings) that sharpen the IgE-mediated hypersensitivity reaction. 03 The types of allergens that cause anaphylactic shock can be divided into haptens and antigens: 1. Haptens: such as penicillin, streptomycin, cephalosporin, lidocaine, heparin, etc., which can be combined with proteins to form antigens when entering the human body for the first time , Antigen stimulates the human body to produce corresponding antibodies, which are adsorbed on the surface of mast cells around small blood vessels and basophils in the blood, making the body in a sensitized state. 2. Antigens: such as tetanus antitoxin, diphtheria antitoxin, insulin, bee venom and other antigens, the first time entering the human body can directly stimulate the human body to produce corresponding antibodies, and the antibodies are adsorbed on the mast cells around small blood vessels and the surface of basophils in the blood , so that the body is in a sensitized state. 04 Clinical manifestations of anaphylactic shock 1. Skin and mucous membrane manifestations: The earliest and most common manifestations include skin flushing and itching, followed by extensive urticaria and/or angioedema. 2. Performance of airway obstruction: the most common performance and the main cause of death. Due to airway edema, increased secretions, and laryngeal and/or bronchospasm, children may experience throat blockage, chest tightness, shortness of breath, stridor, suffocation, cyanosis, and even death from suffocation. 3. Circulatory failure manifestations: due to insufficient effective circulating blood volume due to peripheral vasodilation, the child first has palpitations, sweating, pale complexion, thin and weak pulse, and then develops into cold extremities, cyanosis, rapid drop in blood pressure, and disappearance of pulse. , even blood pressure can not be measured, and eventually lead to cardiac arrest. 4. Central nervous system manifestations: due to brain tissue hypoxia, manifested as dizziness, numbness of face and limbs, loss of consciousness, convulsions or incontinence. 5. Other manifestations: nausea, vomiting, abdominal pain, diarrhea and fever. 05 Diagnosis of anaphylactic shock06 Rescue process of anaphylactic shock Recumbent, oxygen inhalation, ECG monitoring, establishment of venous access, and close monitoring of blood pressure changes. 2. Rescue on-site rescue, oxygen supply, establishment of venous access, and more supine position (left lateral position is recommended for vomiting, 45° sitting position for dyspnea), and lower limbs are elevated to improve blood pressure. 3. First-line treatment drugs - epinephrine ① The preferred intramuscular injection: the best position is the anterolateral aspect of the middle third of the thigh. Children use 1:1000 epinephrine, 0.01mg/kg (0.01ml/kg) each time, the maximum amount does not exceed 0.5mg. For repeated use, the general interval is 5~10min. At the same time, close observation of the child's vital signs helps to monitor the response to epinephrine therapy. ②Intravenous injection: suitable for critically ill children, such as systolic blood pressure between 0~40mmHg, or with severe laryngeal edema, children use 1:10000 epinephrine, 0.01mg/kg (0.1ml/kg) each time, the maximum dose 0.3mg, 5~10min slow intravenous bolus, observe the heart rhythm and heart rate at the same time. If there is no improvement within 5 minutes, repeat the injection of the same dose of epinephrine. 4. Fluid resuscitation For children with anaphylactic shock, due to the unstable circulatory system, adequate fluid resuscitation is the key to reversing the disease and reducing the mortality rate. Clinically, 0.9% NaCl is preferred, the first dose is 20ml/kg, bolus injection within 10~20min, and then the systemic circulation and tissue perfusion (heart rate, blood pressure, pulse, capillary refill time) are evaluated. Repeated use, give the second and third doses, each dose of 10~20ml/kg, the total amount is 40~60ml/kg (for patients with cardiopulmonary diseases and heart failure, pay attention to the infusion rate). 5. The application of vasoactive drugs On the basis of adequate fluid resuscitation, if the shock is still difficult to correct, the blood pressure is still low or there is still obvious manifestations of poor perfusion, the use of vasoactive drugs can be considered to increase blood pressure and improve organ perfusion. 6. If necessary, apply glucocorticoid intravenous drip or bolus injection of glucocorticoid, such as dexamethasone 0.3~0.5mg/kg each time or hydrocortisone 8~10mg/kg each time, once every 4~6 hours . 7. Symptomatic treatment ① Keeping the airway unobstructed: It is one of the key measures for the success or failure of shock rescue. If there is laryngeal obstruction, dyspnea, or progressive decline in blood oxygen saturation, tracheal intubation should be performed immediately. ② Antihistamines: Promethazine 0.5~1mg/kg each time, intramuscular injection. ③Calcium: Add 5~10ml of 10% calcium gluconate solution to 10ml of 10% glucose solution, and inject slowly intravenously. 07 Prevention of anaphylactic shock 1. Before using the drug, ask the child whether he has a history of allergy to the drug, and do a drug susceptibility test as required. A positive drug susceptibility test is prohibited. The drug susceptibility test of the drug is contraindicated for those with a clear history of allergies. 2. For children with a history of drug allergies, unnecessary injections should be minimized, and oral preparations should be used as much as possible. 3. Children with allergic constitution should be observed for 30-60 minutes after injection, pay attention to whether there is allergic reaction, and prepare emergency rescue measures against shock to prevent delayed allergic reaction. 4. Antibiotic drugs should be used and prepared immediately, especially penicillin. Its aqueous solution is easily decomposed at room temperature to produce allergic substances, causing allergic reactions. After the drug sensitivity test, all children who receive this drug should stop using this drug. 2 For more than one day, the drug susceptibility test should be redone before taking the drug again. 08 Summary 1. Once a child develops anaphylactic shock, the disease progresses very rapidly, even life-threatening in severe cases, so every pediatrician is required to master the emergency treatment. 2. When we encounter a child with anaphylactic shock clinically, we must cut off the allergen as soon as possible, use the life-saving needle - intramuscular injection of epinephrine in time, and perform adequate fluid resuscitation to stabilize the child's vital signs . 3. The prevention of anaphylactic shock is more important than the treatment. The most fundamental way is to identify the allergens and effectively avoid them. References: [1] Wang Jiandong, Wang Huaili. Interpretation of the European Society of Allergy and Clinical Immunology Guidelines for Severe Allergic Reactions 2021 Edition [J]. China Pediatric Emergency Medicine, 2022, 29(4): 260-265. [2] Zhonghua Editorial Board of Pediatrics Journal, Pediatric Branch of Chinese Medical Association. Expert consensus on the diagnosis and treatment of allergic diseases in children [J]. Chinese Journal of Pediatrics, 2019, 57(3): 164-171. [3] American Heart Association. 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Cardiovascular Emergency [J], China Circulation Journal. 2015, 30(Z2): 8-22. [4] Xu Feng. Diagnosis and treatment of anaphylactic shock in children [J]. Chinese Journal of Practical Pediatrics , 2009, 24(11): 833-835. [5] Cardona V, Ansotegui IJ, Ebisawa M, et al. World allergy organization anaphylaxis guidance 2020 [J]. World Allergy Organ J, 2020, 13(1 0): 100472. This article was first published: Pediatrics Channel in the medical community. The author of this article: a dedicated pediatrician Responsible editor: Xiang Yu, the pediatric clinical knowledge doctor station app you want to see has 👇 1. Scan the QR code below 2. Click "Download Now" to download the doctor Station App, subscribe anytime and anywhere~ Copyright statement This article is original, please contact - End - for reprinting. 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