ANAPHYLACTIC ANAPHYLACTIC REACTIONREACTION

ANAPHYLACTIC SHOCKANAPHYLACTIC SHOCK• DEFINED: Acute systemic

hypersensitivity reaction that occurs within seconds to minutes after exposure to a variety of foreign substances

• SUCH AS: medications (penicillin, IVP dye), stinging insects

• CAUSED BY: an antigen antibody response

Clinical manifestationsClinical manifestations• Wide range of clinical manifestations

SKIN MANIFESTATIONSSKIN MANIFESTATIONS• flushing, • sense of warmth,• diffuse erythema, • generalized itching, • uriticaria (hives), • facial angioedema • leading to respiratory edema

RESPIRATORY SIGNSRESPIRATORY SIGNS• nasal congestion, • itching, • sneezing, • coughing, • bronchospasm, • edema of the larynx, • tightness of the chest,• wheezing, dyspnea, cyanosis

CARDIOVASCULAR CARDIOVASCULAR • Tachycardia• Bradycardia• PERIPHERAL VASCULAR COLLAPSE:

pallor, imperceptible pulse, decreasing BP, circulatory failure leading to coma, death

PREVENTIONPREVENTION• Determine what patient allergic too

through sensitivity testing via allergist

• Wear medic alert bracelet• Carry epi-pen, check expiration date

GASTROINTESTINALGASTROINTESTINAL• Nausea, vomiting, colicky abdominal

pains or diarrhea

NURSING DIAGNOSISNURSING DIAGNOSIS• Decreased cardiac output• Impaired gas exchange• Risk for fluid volume deficit• Anxiety

EMERGENCY MANAGEMENTEMERGENCY MANAGEMENT• Establish an airway while another person

gives epinephrine; administer oxygen• Epinephrine SQ or IV provides rapid

relief of hypersensitivity reaction and may be repeated

• EPINEPHRINE: given to restore vascular tone and raise arterial BP; vasoconstricts

• DOSE: 1:1000 sol (0.3ml SQ q 5-15 min)• DOSE: 1:10,000 sol (0.5-1mg IV q 5 min)

EMERGENCY TX CONTINUEDEMERGENCY TX CONTINUED• Remove the antigen (blood, penicillin IV,

or other antibiotic)• Benadryl IV push – antihistamine effect,

reverses histamine effects (vaso-dilation and broncho-constriction)

• Solu-Medrol IVPB as an anti-inflammatory

• Pepcid IVPB to prevent gastric irritation from steroids

EMERGENCY TX CONTINUEDEMERGENCY TX CONTINUED• Check if patient is on beta-adrenergic

blocking drugs such as Inderal; • These drugs decrease the

effectiveness of the epinephrine• Patient may have a recurrence of

symptoms 6-8 hours after initial anaphylactic reaction