ANAPHYLACTIC SHOCK

 

Etiology:

  1. Hypersensitivity reaction mediated by IgE and IgG.
     
  2. The Ig attach to mast-cells and cause release of chemical mediators such as histamine, bradykinines, serotonin and leukotrines which cause vasodilatation and bronchial constriction
     
  3. Anaphylactoid shock presents with same picture but is not mediated by IgE. It is caused by NSAIDs, Codeine, Thiamine, IV contrast material. Treatment is the same.

S & S:

  1. Within minutes of exposure pt c/o pruritis , stridor, wheezing, anxiety, diaphoresis, urticaria, flushing
     
  2. Tachycardia, tachypnea, ¯BP

DX:

  1. Hx and Clinical dx
     
  2. Differentials  include: PE, MI, Asthma, PNTX, FB

Treatment:

  1. O2, IVF, Cardiac monitor
     
  2. Albuterol nebulizer
     
  3. Diphenhydramine 75mg IM or IV
     
  4. H2-blocker IV i.e. Cimetidine 300 mg IV
     
  5. Methylprednisolone (Solumedrol® ) 125mg IV or Prednisone 60mg PO
     
  6. If no hemodynamic compromise Epinephrine 0.3-0.5 mg of 1:1000 solution SQ is given
     
  7. If hemodynamic compromise exists Epinephrine 0.5-1 mg of 1:10,000 solution IV is given

Disposition:

  1. If pt is discharged, F/U with allergy clinic and ANA-Kit® prescription is given .

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