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Anaphylactic Shock

 

Anaphylaxis, or anaphylactic shock, is a severe allergic reaction. Common allergens are penicillin and bee/wasp venom.
Mediators (i.e., histamine, leukotrienes, prostaglandins) are released from mast cells. Flushing and an itchy skin, a red rash (urticaria), shortness of breath and hypotension are present.
Sometimes swelling of the tongue, pharynx and larynx (laryngeal edema) and wheezing (bronchospasm) occur.

Treatment :

1. Immediate intravenous normal saline is begun to raise the blood pressure;
2. High flow oxygen by mask is monitored by pulse oximetry;
3. Epinephrine 0.4 cc subq (peds: 0.01 cc/kg) (1:1000), or for severe shock 1 to 10 cc (1:10,000) slow IV push;
4. An antihistamine such as diphenhydramine 50 mg IV (peds: 1 mg/kg) is given;
5. Methylprednisolone 125 mg IV (peds: 1 mg/kg)is administered;
6. A histamine receptor blocker such as ranitidine 50 mg IV (peds: 0.5 mg/kg) is given over 5 min, and
7. A nebulized beta-agonist (i.e., albuterol) is administered for bronchospasm.