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Anaphylaxis:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Epinephrine, establishment of airway, I.V. volume expanders, steroids, diphenhydramine, CPR if cardiac arrest occurs
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
anaphylaxis:
Treatment and special considerations
(Handbook of Diseases)
Anaphylaxis is always an emergency. It requires an immediate injection of 0.1 to 0.5 ml of epinephrine 1:1,000 aqueous solution, repeated every 5 to 20 minutes as necessary.
If the patient is in the early stages of anaphylaxis and hasn’t yet lost consciousness and is still normotensive, give epinephrine I.M. or subcutaneously (S.C.), helping it move into the circulation faster by massaging the injection site. For severe reactions, when the patient has lost consciousness and is hypotensive, give epinephrine I.V.
Maintain airway patency. Observe the patient for early signs and symptoms of laryngeal edema (stridor, hoarseness, and dyspnea), which will probably necessitate endotracheal tube insertion or a tracheotomy and oxygen therapy.
If the patient is experiencing cardiac arrest, begin cardiopulmonary resuscitation, including closed-chest heart massage, assisted ventilation, and sodium bicarbonate; further therapy depends on the patient’s response.
Watch for hypotension and shock, and maintain circulatory volume with a volume expander (plasma, a plasma expander, saline solution, or albumin) as needed. Stabilize blood pressure with the I.V. vasopressors norepinephrine and dopamine. Monitor blood pressure, central venous pressure, and urine output as a response index.
After the initial emergency, administer such medications as S.C. epinephrine, a longer-acting epinephrine, a corticosteroid, and I.V. diphenhydramine for long-term management and aminophylline I.V. over 10 to 20 minutes for bronchospasm.
Caution: Rapid infusion of aminophylline may cause or aggravate severe hypotension.
CLINICAL TIP: Even after the acute anaphylactic event has been controlled, patients must be counseled about the risks of delayed signs and symptoms. Any recurrence of shortness of breath, chest tightness, sweating, angioedema, or other signs and symptoms must be reported immediately.
To prevent anaphylaxis, teach the patient to avoid exposure to known allergens. If the patient has a food or drug allergy, he must learn to avoid the offender in all forms. If the patient has an allergy to insect stings, he should avoid open fields and wooded areas during the insect season and should carry an anaphylaxis kit whenever he goes outdoors. Show him how to use the kit. (See Showing patients how to use an anaphylaxis kit.) What’s more, if the patient is prone to anaphylaxis, he should wear a medical identification bracelet identifying his allergies.
If a patient must receive a drug to which he’s allergic, prevent a severe reaction by making sure he receives careful desensitization with gradually increasing doses of the antigen or advance administration of steroids.
A patient with history of allergies should receive a drug with a high anaphylactic potential only after cautious pretesting for sensitivity. Closely monitor the patient during testing, and make sure you have resuscitative equipment and epinephrine ready.
If any patient needs a drug with high anaphylactic potential (particularly a parenteral drug), make sure he receives each dose under close medical observation.
Closely monitor a patient undergoing diagnostic tests that use radiographic contrast dyes, such as cardiac catheterization, excretory urography, and angiography.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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