Escolar Documentos
Profissional Documentos
Cultura Documentos
Shock
Management
Anaphylaxis
Anaphylaxis is an acute, systemic,
life-threatening, IgE-mediated
allergic reaction that occurs in
previously sensitized people when
they are re exposed to the
sensitizing antigen.
Anaphylactic Shock
A
Etiology
Pathophysiology
Interaction of antigen with IgE on
basophils and mast cells :
triggers release of histamine,
leukotrienes, and other mediators
that cause:
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, Ig, and exercise.
Anaphylactic vs
Anaphylactoid
the skin,
upper or lower airways,
cardiovascular system, or
GI tract.
10
Features of anaphylaxis
Neurologic
Dizziness, weakness, syncope, seizures
Ocular
Pruritus, conjunctival injection,
lacrimation
Upper airway
Nasal congestion, sneezing, hoarseness,
stridor, oropharnygeal or laryngeal edema,
cough, obstruction
Lower airway
Dyspnea, bronchospasm, tachypnea, accessory
muscle use, cyanosis, respiratory arrest
11
Features of anaphylaxis
Cardiovascular
Tachycardia, hypotension, arrhythmias,
myocardialischemia/infarction, cardiac arrest
Skin
Flushing, erythema, pruritus, urticaria,
angioedema,maculopapular rash
Gastrointestinal
Nausea, vomiting, abdominal pain, diarrhea
Reproduced with permission from STA
Communications Inc. (Allergy &
Asthma2000;13[3]:23-35).
12
Differential diagnosis of
anaphylaxis
13
Differential diagnosis of
anaphylaxis
14
Differential diagnosis of
anaphylaxis
Nonorganic diseases
Hyperventilation syndrome, panic
attacks, vocal cord dysfunction,
15
Diagnosis
Diagnosis is clinical.
Risk of rapid progression to shock
leaves no time for testing
Although mild equivocal cases can be
confirmed by laboratory measurement
16
Recognition, treat
aggressively
AIRWAY
IV
SUPPORT
EPINEPHRINE (open airways)
Antihistamines
Corticosteroids
IMMEDIATE
WITHDRAWAL OF ANTIGEN IF
POSSIBLE
PREVENTION
Shock
Treatment
Epinephrine given immediately
Sometimes intubation
IV fluids and vasopressors for
hypotension
Antihistamines (AH1 and AH2)
Inhaled -agonists for
bronchoconstriction
Corticosteroids
19
Epinephrine 1
Epinephrine 2
21
Epinephrine 3
23
24
25
Be prepared
Identify those at risk
Training in recognition
Posters in operating room
Guidelines in treatment
Guidelines for investigation
Drugs for the immediate treatment of
an anaphylactic reaction should
always easily available
Kits for blood sampling readily
available
Prevention
Prevention
29
Thank you
and be careful
2.
1.
31
Answer
1.
2.
3.
32