Anaphylaxis

Anphylactoid
Anaphylaxis shock
Allergic related conditions

Classic Anaphylaxis :
hipersensitivitas
Ig E & Ig G
sensitisasi thd allergen
antigen specific immunoglobulins
Anaphylaxis :
Severe,acute systemic allergic reaction,
ditandai dgg keterlibatan berbagai fungsi
organ ;
Cardiovasculair
Airway & breathing
Skin & GI Tract
anaphylactoid
reaksi anaphylaxis tp non-immunologi
gjl klinis
dose-dependent
anaphylaxis shock
shock akibat kolap sistem cardiovasculer
pd reaksi anafilaxis
allergic related condition
keadaan klinis akibat alergi mirip anafilaxis
: asthma, urtikaria , angioedema, dll
Etiologi
sensitisasi terjd stlh exposure allergen
Food
Vaccines
Latex
Insect stings & bites
Pollens & non pollen extracts
Drugs :


Drugs :
Antibiotika
NSAID
Kontras Radiologi
Insulin : bovine > porcine > human
Protamine
Anestesi lokal
Pelemas otot dan obat GA


Manifestasi klinis
Respirasi ;
Upper : stridor ,hoarseness, wheezing insp, insp t
swollen ; lips, uvula,tongue
Lower : wheez exp, exp t, breath sounds
Tanda vital ; RR, oksigenasi & SaO2
Gejala : sesak, gelisah, kebiruan, batuk
Hemodynamic ; shock
Hipotensi, takhikardi s/d TTU & TTB
Signs : pallor, ekstrimitas dingin, pulsasi lemah,
mottling, capillary refill
EKG monitor : SVT aritmia, iskhemi/infark miokard

Skin ;
Gejala ;Gatal, kemerahan
Sign ; urticaria, angioedema pd lips, neck, eye,
face, diaphoresis
GI T ;
Gejala ; mual / muntah, cramp & nyeri perut
Sign ; diare, emesis
Neuro ;
Gejala ; headache,dizziness, confusion
Sign ; syncope, delirium
Nasal ; sneezing, pruritus, rhinorrhea
Haematologi ; hemoconsentrasi , DIC

Tata laksana :
1. Primer / immediate
Remove offending agent
Call for HELP ( activate blue code )
O2 high flow dg masker > 10 lpm
maintain airway / keep open the airway
Head down
epinephrine / adrenaline
injeksi IV / IM / SC
berikan 0,3 0,5 mg ( 1 : 1000 ) ulang bila perlu
10 15 mnt
Pasang infus diameter terbesar yg bisa masuk
berikan koloid / kristaloid 10 cc / kgBB/grojok

2. Sekunder
Bila bronkhospasme tdk membaik stlh
adrenalin
berikan salbutamol dg dosis
Loading 250 microgram / iv
Maintenance 5 20 microgram / mnt
Atau aminophyllin 6-8 mg/kgBB selama 20 mnt
Bronkhospasme disertai shock
Hidrocortisone 300 mg/iv atau
methylprednisolone 2 g/iv
Bila msh shock , infusi 1 2 ltr/grojok
Infusi intropik / cathecolamine ;
Adrenalin 5mg/500 cc cairan ( 10 mcg/ml ) berikan
10 85 cc/jam
Noradrenalin 4mg/500 cc cairan ( 8 mcg/ml )
berikan 25 100 cc/jam
Dopamine 5 15 mcg/KgBB/mnt
Antihistamine ; chlorpheniramine 20 mg
encerkan/ iv pelan
Obat2 an lain;
H1 blocker diphenhydramine 50 mg / iv
H2 blocker ranitidine 50 mg / iv
Bila tlh lbh 20 mnt perbaikan tdk adequat
boleh diberikan Nabic 1 2 mEq/kgBB/bolus

Pencegahan
hindari penggunaan agent penyebab sesuai
anamnesa
Desensitsasi
Gunakan radiokontras dg osmolaritas rendah
Bl tak mungkin dihindari berikan ;
Berikan korticosteroid dan H1 blocker
Bila perlu ephedrine
Test diagnostik
Testing tdk perlu bl jelas ada riwayat
Bukan jaminan ( ingat anaphylactoid !)
Komplikasi :
1. Respirasi : resp arrest, aspirasi, odema paru
2. CV : shock, MI, MOF.
3. Neuro : syncope, seizures,delirium
4. Kulit : sekunder infeksi