Allergic Reactions/Anaphylaxis

Emergency Response Team Sumbawa 2016

Anamnesis
Tn. M/24 tahun
Ps datang post disengat tawon 5 jam yang lalu, bentol
kemerahan disertai gatal (+) Muntah (+) nyeri perut (+) ,
sesak napas (-) kepala pusing (+)
 Pem fisik
1. Primary survey
A : Clear, patent
B : Spontan, simetris, nafas cepat, RR: 23x/menit
C : Nadi kuat angkat, 112x/menit, akral hangat
D : GCS 15 (E4M6V5)

2. Secondary Survey
GCS = E4M6V5, TD : 120/60 mmHg, Nadi : 112 x/menit, RR : 23 x/menit, S : 36.9oC
Leher : JVP tidak meningkat
Jantung : Ictus cordis (-), batas jantung normal, S1-2 normal, murmur (-), gallop (-)
Paru : pergerakan dada simetris, vesikuler +/+, rhonki -/- , wh -/-
Abdomen: soepel, nyeri tekan (+)
Ekstremitas : akral hangat, CRT<3 tungkai edem (-), urtikaria (+)
Tatalaksana Awal
Pasien ditempatkan di critical care (P1)
NK 02 2 lpm
Pasang monitor
IVFD RL guyur

Planing
Cek GDS : 110 mg/dl
Lab lengkap: DL
Working Diagnosis
Anaphylaxis Reactions
Tatalaksana
IVFD RL 1 liter
Inj. Ranitidin 1 amp iv
Inj. Ondansetrone 1x8 mg iv
Inj Difenhidramin 2 amp iv
Inj Dexametason 2 amp iv
Inj Adrenalin 0,3 cc IM
Observasi 2-3 x 24 jam pada kasus anafilaktik,
Kasus ringan obsv 6 jam (Berikan steroid dan antihistamin oral
3 x 24jam)
Anaphylaxis: a severe, potentially fatal, systemic allergic reaction.
The following scenarios constitute anaphylaxis:
1. The acute onset of reaction (min-hours) with involvement of the
skin, mukosal tissue or both and at least one of the following;
a. Respiratory compromise (dyspnoes, stridor, wheeze),
b. Reduce blood pressure.
2. 2 of the following occur rapidly after exposure:
Involvement of skin/mucosal tissue
Respiratory compromise
Reduce BP
Persistent GE symptoms (eg crampy abd pain, vomiting)
3. Reduce BP after exposure

Anaphylaxis reactions that occur:

Drug induced: Penicillin and NSAID common causes, ACE common causes Angioedema
Food, hymenoptera venoms, environmental reactions
 Early sign of impending anaphylaxis

1. Nasal itching or stuffiness

2. Lump in the throat (laryng or uvular oedema) or
hoarseness
3. Lightheadedness and syncope
4. Chest pain, shortness of breath and tachypnoea
5. Skin complaints
6. GE complaints: nausea, vomiting, diarrhoea with
tenesmus, crampy abd
 Drug therapy
1. Adrenaline. The following doses are advised:
a. Normotensive patient: 0,01 ml/kg (up to 0,5 ml) of 1:1000
solution IM
b. Hypotensive patient: 0,1 mg of 1:10.000 solution slowly IV
over 5 minutes.
2. Glukagon 1-5 mg IV over 5 min, when Adrenaline is CI; MI,
severe hypertension, pregnancy, patient on B blokers.
3. H1-Antihistamines: Diphenhydrramine 25 mg IM/IV (1 mg/kg)
H2- Antihistamines: Ranitidine 25-50 mg diluted in 20 ml D5%
infusion over 5 minutes
4. Nebulized Bronchodilator: Salbutamol 2 resp q 20-30 minutes
5. Corticosteroids