..

Fendy Dwimartyono
 Anaphylaxis
• Anaphylaxis is :
- acute,
- systemic,
- life-threatening,
- IgE-mediated allergic reaction that occurs in
previously sensitized people when they are re
exposed to the sensitizing antigen.

2
 Anaphylactic Shock
• A type of distributive shock that results from
widespread systemic allergic reaction to an
antigen
• This hypersensitive reaction is LIFE
THREATENING
 Anaphylactoid reactions:
• These reactions are clinically indistinguishable
from anaphylaxis but do not involve IgE and
do not require prior sensitization.
• They occur via direct stimulation of mast cells
or via immune complexes that activate
complement.
• The most common triggers are iodinated
radiographic radiopaque dye, aspirin, other
NSAIDs, opioids, blood transfusions, and
exercise.
4
Common Cause
 Pathophysiology
• Antigen
– Induces antibody formation
– Examples
• Drugs (antibiotics)
• Foods (nuts, shellfish)
• Insect venoms
• Animal serum
• Incompatible blood types
 Pathophysiology
• Antigen enters body
– Ingestion, absorption, inhalation, injection
• Antibodies produced
• Attach to surface of mast or basophil cells
• Mast cells become sensitized
 Pathophysiology
• Mast cells
– In all subcutaneous/submucosal tissues,
– Including conjunctiva, upper/lower
respiratory tracts, and gut
• Basophils
– Circulate in blood
 Pathophysiology
• Antigen reenters body
• Attaches to antibodies on mast or basophil cells
• Mast cell degranulates, releases
– Histamine
– Leukotrienes
– Slow reacting substance of anaphylaxis (SRS-A)
– Eosinophil chemotactic factor (ECF)
 Vasodilation
• Decreased peripheral vascular resistance
• Hypotension
• Tachycardia
• Peripheral hypoperfusion
 Increased Capillary Permeability
• Tissue edema, urticaria (hives), itching
• Laryngeal edema
– Airway obstruction
– Respiratory distress
– Stridor
• Fluid leakage from vascular space
– Hypovolemic shock
 Smooth Muscle Spasm
• Bronchospasm • Bladder Spasm
– Respiratory distress – Urinary urgency
– “Tight Chest” – Urinary incontinence
– Wheezing
• GI Tract Spasm
– Nausea, vomiting
– Cramping, diarrhea
Clinical Signs
Management Anaphylactic Shock
• Early Recognition, treat aggressively
• ABC
• IV EPINEPHRINE
• Antihistamines
• Corticosteroids
• Position of comfort
• Transport
• PREVENTION
 Management
Stop or remove inciting agent
- eg. stop iv infusion of drug.
Place patient in supine position with legs elevated.
Give supplemental oxygen. Use 100% via non
rebreather.
Give salbutamol via nebulizer.
IV fluid volume resuscitation. May need 1 -2 liter
bolus N/S.
 Shock

Shock is a severe condition that occurs when not enough blood flows through
the body, causing very low blood pressure, a lack of urine, and cell and tissue
damage.
 Management
Airway:
Use high flow oxygen with nebulized salbutamol
Intubate if any indication of impending airway
obstruction or angioedema.
Remember with angioedema these may be difficult
intubations.
Be prepared for Cricothyrotomy.
If normotensive can use standard RSI protocol.
If hypotensive use ‘shock intubation’ protocol.
 Management
Epinephrine 0.3 – 0.5 ml IM (lateral thigh and use 1
cc syringe)
Is the most important treatment.
There are NO absolute contraindications to
epinephrine use.
If no response start IV
Use 9 cc NaCL 0.9% in 10 cc syringe. Add 1 cc of
1:10,000 cardiac ampule.

Makes 10 mcg/ml. Give 5-10 mcg IV (0.5-1 cc IV)

 Management
• Antihistamines—both AH1 and AH2 should be given
until symptoms resolve.
• H1 blockers (eg, diphenhydramine 50 to 100 mg IV) q4h
• H2 blockers (eg, cimetidine 300 mg IV or ranitidine 50 mg IV)
q8h.
• Inhaled β-agonists are useful for managing
bronchoconstriction;
• albuterol 5 to 10 mg by continuous nebulization can be
given.
• Corticosteroids have no proven role but may help
prevent late-phase reaction in 4 to 8 h;
• methylprednisolone 125 mg IV initially is adequate.

24
 Clinical Scenario 1
27 year old male with known peanut allergy
inadvertently ate a sauce that had peanut oil.
Within 1 minutes he developed hives, generalized
flushing, feeling unwell and sweaty.
He presents to the ER looking ill, flushed and hives on
his face and neck.
BP 110/75, HR 140, Sats 98% RR 28/min
Thank You

Selamat
Mengikuti
Blok Trauma