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Anaphylactic shock |
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Symptoms and Signs: ¨ Facial flushing ¨ Itching ¨ Numbness ¨ Cold extremities ¨ Nausea ¨ Abdominal pain (sometimes) ¨ Wheezing ¨ Cold clammy skin ¨ Thin thready pulse Loss of consciousness may occur, with extreme pallor which progresses to cyanosis as respiratory failure develops. It can be difficult to distinguish anaphylaxis from acute asthma—go through management for acute asthma then start on management for anaphylaxis. Adrenaline is a bronchodilator.
Prevention Avoid potential allergens. Take a full medical history. Ensure patient is supine when giving any injection, to prevent fainting.
Management ¨ Place patient supine with legs raised, if possible ¨ 1ml of 1:1000 adrenaline IM or SC. Repeat every 15 minutes until improved. Do not give IV in this concentration as it will induce ventricular fibrillation ¨ Up to 500mg of hydrocortisone IV ¨ Up to 20mg of chlorpheniramine slowly IV ¨ Oxygen by mask
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Anaphylaxis can follow the use of any drug although penicillins are the commonest offender. It is more likely to occur after patenteral use of a drug. There is a 10% cross over in allergic response between penicillins and cephalosporins. |