anaphylaxis shock

Anaphylaxis Shock

Written by student dentist Tal Kaplan

Content: Notion Anaphylaxis shock Classification's Types of hypersensitivity

reaction's Etiology Pathophysiology Singe’s & Symptom’s Diagnosis First aid Treatment Prevention

Notion Anaphylaxis shockThe term derived from greek language ana – (without) , phylaxis – (protection). A sudden, severe allergic reaction characterized by a sharp drop in blood pressure, urticaria (skin rash), and breathing difficulties that is caused by exposure to a foreign substance, such as a drug or bee venom, after a preliminary or sensitizing exposure. The reaction may be fatal if emergency treatment is not achieved immediately, treatment including epinephrine injections. Also called anaphylactic shock.

Classification'sBy the Type of shock:

• Typical• Cardiac• Asthmatic• Cerebral• Abdominal

By type of development:

• Momentry• Easy• Medium• Grave

Type's of hypersensetivity reaction’s

Mast cell release

histamine and other mediators

Immediate hypersensitivi

ty

Antibodies directed

against cell or tissue antigens

Antibody-mediated

Antibody-antigen complex

deposit in blood

vessels

immune complex diseases

Reactions of T

lymphocytes

T cell-mediated diseases

Etiology

Idiopathic 37%Food 34%Drugs 20%Exercise 7%Latex, hormons, insect bites 2%

Etiology

Pharmlogic agents• Antibiotics (penicillin)

• Nonsteroidal anti-inflammatory drugs (Asprin)

• intravenous (IV) contrast agents

Stinging insects• Ants, bees,

hornets, wasps, and yellow jackets.

Food• Peanuts,

seafood, and wheat

Latex• Rare• No latex-

associated deaths

Pathophysiology First exposure Activation of TH2 cell → Stimulate IgE switiching

Allergen

TH2 Cell B Cell

Pathophysiology

First exposure IgE production

IgE secreting B cell IgE

First exposure IgE bind to mast cell

Pathophysiology

Second exposure Recognition Allergen

Pathophysiology

Second exposure Activation of mast cell to release

histamine and other mediators

Mediators

Allergen

Pathophysiology

Symptom's & Sing's• Typical type:

Dizziness weakness fainting

rapid, slow, or irregular heart rate

low blood pressure

Nausea vomitingcramps

Itcing swlling around the eyesItching flushing hives (urticaria)

swelling

Symptom's & Sing's• Respiratory type:

Difficulty breathing coughing chest tightness wheezing or

other sounds

increased mucus

production

throat swelling or itching change in voice or a sensation

of choking

Symptom's & Sing's• Cardiac type:

Dizziness weakness fainting

rapid, slow, or irregular heart rate low blood pressure

Symptom's & Sing's• Abdominal type:

Nausea vomiting

cramps diarrhea

DiagnosisThe diagnosis of anaphylaxis is based upon symptoms that occur suddenly after being exposed to a potential trigger.Usually in dental clinic it will be more hard to get conclusive diagnosis.

Differential diagnosis:• severe asthma attack• heart attack• panic attack• food poisoning- Those differential diagnosis are very similar to anaphylaxis shock and a doctor could get a wrong diagnosis due to lack of tools in reach to doctor hand.- An increased amount of tryptase protein can be measured in a blood sample collected during the first three hours after anaphylaxis symptoms have begun. - Tryptase levels are seldom elevated in food-induced anaphylaxis

First aidPlace patient in horizontal with legs up

position.

Establish and maintain airway.

Give oxygen via nasal airway as needed.

Place a tourniquet above the reaction site.

Epinephrine at the site of antigen injection.

Start IV to rise BP.

Treatment

• Adrenalina sol. – 0.1% 0.5 ml, if patient state doesn't improve in 10-15 min, we Introduce 1.0 ml more of sol.• Suprastine sol. – 2% 1ml.• Prednisolone sol. 30-60 mg (unique dose) or hydrocortisone 75-125 mg.• Caffeine sol. Or cordiamine, or corazoli – 20% 1-2 ml.• In case of bronchospasm: eupheline sol. – 2.4% 5-10 ml or galidore sol. – 2ml (i/m).• To maintain cardiac activity are given cardiac glycosides & diuretics: lazex sol. – 2-4 ml (i/v),Corglicon sol. – 0.06% 0.5-1 ml (i/v).• In case of cardiovascular insufficiency: strophantini sol. 0.05% 0.5-1 ml, mazatoni sol. 0.1% 1ml• Ionic sol. of NaCl 0.9% 400 ml or glucose sol. 5-10% 400 ml, in perfusion introduced dopaminsol. 200 gr or noradrenaline 0.1% 1ml.• Injection place should be infiltrated with adrenalin sol.• Artificial respiration with extern massage of the heart.

Prevention

Avoid the responsible allergen (e.g. food, drug, latex, etc.).

Keep an adrenaline kit (e.g. Epipen) and Benadryl on hand at all times.

Wear medic Alert bracelets .

Venom immunotherapy is highly effective in protecting insect-

allergic individuals.

THANK YOU, STUDENT DENTIST TAL KAPLAN