ANAPHYLACTIC SHOCK

ANAPHYLAXIS

TOPIC INCLUDES:
 INTRODUCTION
 SHOCK
 IMMUNOLOGICAL CLASSIFICATION OF ALLERGIC DRUGS
 CAUSE
 SYMPTOMS
 RISK FACTORS
 TRIGGERS
 OUTLOOK
 EPIDEMIOLOGY
 PATHOPHYSIOLOGY
 PRESENTATION
 DIAGNOSIS
 INVESTIGATION
 COMPLICATIONS
 EMERGENCY SITUTATION
 MANAGMENT
 TREATMENT
 PREVENTION
SUMBITTED BY:
 BUSHRA NAEEM BPD02171028
SUMBITTED TO:
 DR. SALMAN
 ANAPHYLACTIC SHOCK
BUSHRA NAEEM
SHOCK
HISTORY:
 1737: Le Daren
First applied term ‘’shock’’ as
disorder of CNS
 1895: Warren
Descriptions of its obvious
clinical signs
 WORLD WAR III:
Physiologist
Theory of acute circulatory
disorder
 1960s: Lilehei
Dysfunction of microcirculation
DEFINITION:
A dangerous systemic pathologic
process under the effect of various
drastic etiological factors,
characterized by acute circulatory
failure including decreased
effective circulatory blood volume,
inadequate tissue perfusion,
cellular metabolism impediment
and dysfunction of multiple organs.
ANAPHYACTIC SHOCK
Anaphylactic shock is a severe TYPE-I
allergic response to
 drugs (e.g.: penicillin)
 foods (e.g., egg white, nuts,
and sea food)
 Hymenoptera venom (e.g.,
Cause:
wasp stings)
It is caused by IgE mediated release
of strong mediators such as
histamines, leukotrienes, and
platelet-activating factor secreted
from activated mast cells or
basophils.
TYPES OF SHOCK
Hemorrhage shock, Burn shock
Anaphylactic shock, Infectious
shock
Cardiogenic shock, dehydration
shock
INTRODUCTION:
For some folks with severe
allergies, when they’re exposed
to something, they’re allergic to,
they may experience a potentially
life-threatening reaction called
ANAPHYLAXIS. As a result, their
immune system release
chemicals that flood the body.
This can lead to anaphylactic
shock.
When your body goes into
anaphylactic shock, your blood
pressure suddenly drops and
your airways narrow, possibly
blocking normal breathing.
This condition is serious, if not
treated immediately results in
serious complications and even
be fatal.
Anaphylactic
shock or
Anaphylaxis
has rapid
ONSET and
might cause
death.
 ANAPHYLAXIS

IMMUNOLOGICAL CLASS: TYPE-I IMMEDIATE HYPERSENSITIVITY

 TYPE-I (immediate) REACTIONS:
ANTIBODY: TYPE-I reactions are typically mediated
by immune globulin IgE. Initial exposure
 IgE
to an antigen results in production of
MECHANISM: specific IgE antibodies that are
 Drug-hapten reacts expressed on the surface of mast cells in
with IgE antibody on the tissue and basophils in the blood. On
the surface of mast re-exposure, the antigen cross-links with
cell and basophils, two or more surface bound IgE
IMMUNOLOGICAL resulting in the
release of mediators
antibodies causing the release of several
chemical mediators.
CLASSIFICATION COMMOM CLINICAL This type of reaction can occur on re-
MANIFESTATION: exposure to small amounts of drug
OF ALLERGIC  Urticaria, anaphylaxis, administer by any route. This may affect
to single or multiple organ systems.
DRUG REACTION: bronchospasm

If anaphylaxis has progressed

SYMPTOMS: t anaphylactic shock, the
Symptom of anaphylaxis typically symptom includes:
start with 5-30 min of coming into  Struggling to breath
contact with the allergen.  Dizziness
Warning signs affect more than one  Confusion
part of boy may include:  Sudden feeling of
 Red rash, with hives weakness
 Swollen throat  Loss of TRIGGERS OF
 Wheezing
 Passing out
consciousness ANAPHYLAXIS:
 Nausea, vomiting
Common triggers include:
 Abdominal pain
 Certain medications such as
 Tingling hands
penicillin
 Runny nose
 Insect stings
 Suddenly feeling to warm
 Foods such as:
Tree nuts
RISK FACTORS: Shellfish
Milk
RISK FACTOR OF SEVERE
Eggs
ANAPHYLACTIC SHOCK INCLUDE: In rare cases EXERCISE and aerobic
 A PREVIOUS ANAPHYLACTIC activity can trigger it.
REACTION Sometimes a cause for this is never
 ALLERGIES OR ASTHMA identified. This type of anaphylaxis is
 A FAMILY HISTORY OF called IDIOPATHIC.
ANAPHYLAXIS

OUTLOOK FOR
ANAPHYLACTIC SHOCK
EPIDEMIOLOGY
COMMON: incidence is around
1 in 20,000 per year.
It can be extremely dangerous
or even fatal.
If you’re at risk of anaphylaxis
work with your doctor to come
up with emergency plan
You should always take the
allergic medications
prescribed by your doctor.
Suggest carrying an EpiPen in
case of future attack. They
may also help you identify
what caused the reaction so
you can avoid triggers in the
future.
PATHOPHYSIOLOGY OFANAPHYLAXIS
SENSATION PHASE:
Our body defense system encounters allergen and makes immunoglobin IgE
against it.
No clinical features occur.
EFFRCTOR PHASE:
Allergen cross-links IgE on surface of mast cells
Results in widespread degranulation and release of histamines which mediates infla-
mattery broncho spams, vasodilation, increased capillary permeability and tissue
edema.
 ANAPHYLACTIC SHOCK

• PRESENTATION OF ANAPHYLAXIS

Acute onset:exact
speed will depend
on the trigger; IV
medications will
cause a more
rapid onset than
orally ingested
triggers
Airway:
Exposure:
Stridor
Urticaria
•Hoarse voice
•Angioedema
•Dysphagia
HOW TO
PRESENT
ANAPHYLACT-IC
SHOCK Breathing:
Disability;
Respiratory
Confusion distress
•Agitation •Dyspnoea
•Loss of •Wheeze
consciousness Circulation; •Cyanosis
Pale
•Clammy
•Light-headedness
•Tachycardia
•Hypotension

PRESENTATION:
It has total six points:
 Acute onset Circulation
 Airway Disability
 Breathing Exposure
 ANAPHYLACTIC SHOCK
INVESTIGATION:
Circulation continue- Investigation of anaphylaxis
DIAGNOSIS:  Hypovolemic shock can be done by:
Diagnosis can be done by this method:  Cardiogenic shock Arterial blood gases (ABG)
AIRWAY:  Obstructive shock Full blood count
Airway of passage can be checked Urea and electrolytes
 Foreign body inhalation Mast cell tryptase
 Croup (child only) Take 3 samples ASAP
 Epiglottis after 1-2 hr. /24hr
 Laryngospasm
Beneficial in making
BREATHING:
retrospective report
 ASTHMA
CIRCULATION:
 Syncope
 Septic shock
 Neurogenic shock
 ANAPHYLACTIC SHOCK

COMPLICATIONS: IT INCLUDES:
 SHOCK
 RESPIRATORY FAILURE
 CARDIAC ARREST
 ARRHYTHMIAS
 KIDNEY FAILURE

EMERGENCY SITUATION:
WHAT TO DO IF SOMEOE HAS ANAPHYLAXIS:
! It is alarming situation and should be treated promptly. If someone has anaphylaxis you should do

Use an adrenaline auto-injector if the person has one

: but make sure you know how to use it correctly first.

Call 999 for an ambulance immediately (even if they

start to feel better):mention that you think the person
has anaphylaxis

Remove any trigger if possible:for example, carefully

remove any stinger stuck in the skin.

Lie the person down flat:unless they're unconscious,

pregnant or having breathing difficulties.

Give another injection after 5 to 15 minutes:if the

symptoms do not improve and a second auto-injector
is available.
 ANAPHYLACTIC SHOCK

MANAGEMENT:
The best way to manage your condition are: INITIAL MANAGEMNT

 Avoid allergen FURTHER MANAGMENT

 Prepare for emergency

INITIAL MANAGEMENT FUTHER MANAGMENT

Shout for help Observe for at least 6 hours

Call an anesthetist early Beware biphasic reactions
If necessary, put out a cardiac arrest call Provide three days prescription
Remove allergen if necessary, Conside r adrenaline auto injector
Lie patient flat and raise their legs Refer to allergy specialist
Give adrenaline IM and repeat after 5 min if no/minimal response to previous dose

adult 6-12yr child<6

•500ug •300ug •150ug

•0.5ml of •0.3ml of •0.15ml of
1:1000 1:1000 1:1000
Patients on b-blocker may exhibit attenuated response so may give GLUCAGON 1-2
Mg IV or IM
Assessment of patient from ABCDE
Maintain a patient airway
Give nebulize adrenaline as a temporizing measure
Attach monitoring
Pulse oximetry
Non-invasive BP
Three-lead cardiac monitoring
Obtain IV access and take blood
Give IV fluid challenge and repeat as a necessary
ADULT 500-1000ml
CHILD 20mg/kg
Give chlorphenamine IM or IV slowly
Give hydrocortisone
Consider nebulized salbutamol
 ANAPHYLACTIC SHOCK

TREATMENT
 ADERNALINE AUTO INJECTORS:
The first step in treating anaphylactic shock will likely be injecting epinephrine (adrenaline)
Immediately. This can reduce of severity of allergic reaction.
Three main types of adrenaline auto injectors are used:
EpiPen
Jext
Emerade
 POISITONING
Most people should lie flat
Pregnant women should lie on left side
People having trouble with breathing should sit up
Avoid a sudden change to an upright posture such as stand and sit position

 IN HOSPITAL
You need to go hospital for observation at least 6-12 hours
While in hospital:
Oxygen mask maybe used to help breathing
Fluids maybe given directly to help increase in blood pressure
Additional medicines such as steroids given to relive symptom
Blood test maybe carried out to confirm anaphylaxis
Treatment algorithm:
 ANAPHYLACTIC SHOCK

PREVENTION:
FOR PREVENTION OF ANAPHYLACTIC SHOCK, YOU MUST

 IDENTIFY TRIGGERS:
Identify trigger by common test such as SKIN PRICK TEST and BLOOD TEST.
 AVOID TRIGGERS:
You can avoid triggers such as food triggers by reading label and instructions written on it and wasp triggers by moving
away them.
 TAKE MEDICINESALTERNATIVE:
Use alternatives of medicines such as PENECILLIN alternative available in market is MACROLIDE.
 CARRY ADERNALINE AUTO INJECTORS:
Carry auto injectors for safety measurement.

REFERENCES:

ANAPHYLACTIC SHOCK.MEDICALLY REVIEWED BY ALANA BIGGERS M.D. MPH-WRITTEN BY ANA

GOTTER- UPDATED ON MARCH 22,2019

KODA-KIBLE & YOUNG’S APLLIED THERAPEUTICS: THE CLINICAL USE OF DRUGS. LIPPINCOTT
WILLIAMS & WILKINS. ANAPHYLAXIS AND DRUG ALLERGIES. CHAPTER 03 PAGE# 42-64 EDITION 10Th

https://www.oxfordmedicaleducation.com/emergency-medicine/anaphylaxis/

https://www.nhs.uk/conditions/anaphylaxis/prevention/

https://www.webmd.com/allergies/understanding-anaphylaxis-treatment

https://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis