Anaphylactic Shock Flashcards
Patho
Severe systemic hypersensitivity reaction to a specific antigen
Allergic reaction results in histamine secretion & severe widespread vasodilation.
Affects Pulmonary, Circulatory & Integumentary Systems
Results in: Systemic vasodilation causing
Smooth muscle contraction (airway)
Triggers
Seafood and Antibiotics
Smooth muscle contraction causes
Circulatory collapse
Airway compromise: R/T smooth muscle contraction
Bronchoconstriction: R/T smooth muscle contraction
Increased mucus production
Result: Respiratory Insufficiency
What is different about anaphylactic shock
Causes smooth muscle contraction (airway)
Onset
Sudden with rapid progression
Systems Affected
Pulmonary
Circulatory
Pulmonary symptoms
Laryngeal edema
Shortness of breath
Tachypnea
Wheezing
Stridor
Cyanosis
Cough, Rhonchi
Nasal congestion
Angioedema
Circulatory symptoms
Tachycardia
Hypotension
Weak pulses
Cool, pale, clammy skin AND Flushing, red raised rash, or angioedema
Syncope
Lightheaded
Arrythmias
What causes cool, pale, clammy skin
decreased CO
How can skin issues be resolved in anaphylactic shock?
antihistamines or epi
Most concerning s/s
pulmonary related
What is the cause of pulmonary symptoms
contraction of the smooth muscles in the airways
Integumentary Effects
Tingling
Warmth
Diffuse redness, flushing.
Urticaria
Pruritus
Angioedema
Swelling around the eyes
Cool, clammy skin R/T decreased CO
Urticaria
itchy red raised rash.
Causes
Blood products
IV contrast dye
Medications
Food
Exercise
Medication that can trigger anaphylactic shock
Antibiotics
Opiates
ASA, NSAIDs
ACE Inhibitors (dialysis patients)
Anesthetics
Egg-based vaccines
What medication can you give if a pt is allergic to ACE inhibitors
ARBs
Food triggers
Nuts, seafood, eggs, tropical fruits.
Cross contamination
Cross reactions (ex: seafood-iodine)
Venom, latex, glue
Management
Remove/stop the cause/trigger
100% NRBM and possible intubation
IV Therapy
Address the primary issue
Step 1 management
Remove/stop the cause/trigger
Step 2 management
100% NRBM (ABCs) then possible intubation
Support vital functions.
Intubation
IV fluids
Step 3 Management
IV therapy: Epinephrine 1st line therapy 0.3 ml (1:1000 conc.)
Can be given IM in an emergency (EPI JET)
Cardiopulmonary resuscitation
Epinephrine 1st line therapy dosage
0.3 ml (1:1000 conc.)
Primary issues
Bronchoconstriction: nebulizer treatment
Vasodilation: vasopressor
Vascular permeability
Medications to Manage Anaphylactic Shock
Epinephrine
Antihistamines IVP
Corticosteroids
Nebulizer treatment (bronchodilators)
Epinephrine
(1:1,000 concentration)
Alpha & beta receptor properties for vasoconstriction
Alpha & beta receptor properties for vasoconstriction
Alpha 1= vasoconstrictor
Beta 2 = bronchodilator (dilates constricted bronchioles)
Alpha 1= vasoconstrictor
Beta 2 = bronchodilator (dilates constricted bronchioles)
Antihistamines IVP
Block histamine secretion
Corticosteroids
Reduces release of chemical mediators
Nebulizer Treatment
Bronchodilator
Albuterol: for bronchospasms & wheezing
Racemic epinephrine: for stridor via nebulizer:
Nursing Care
Prevention
Assessment & Update Pt. allergy record
Identify “at risk” patients.
Early recognition of reactions
Awareness of triggers
Patient education
Ensure all allergies are assessed and updated!
Be sure to ask type of reaction pts experience from allergies.
Patient Education
Prevention
Preparedness: Epi Pen
Allergy bracelet
