Basic information for health care students about anaphylactic shock, which can be managed easily in the emergency department.

1. Fay Ali AlBuainain
Respiratory Care Department
University of Dammam
Anaphylactic Shock

2. Outline
Definition
Mechanism of anaphylactic
Pathophysiology
Symptoms
Treatment
Cases

3. Anaphylactic shock
 Anaphylactic shock is a severe, potentially life-threatening
allergic reaction. It can occur within seconds or minutes of
exposure to allergen.

4. Mechanism of
anaphylactic
Non-
immunological
- Alcohol
-Exercise
- Opioids
Immunological
IgE
- Food
- Venom
- Penicillin
- Latex
Non- IgE
- Radiocontast
media
- Some NSAISs

5. :Pathophysiology
Sensitization

6. Heparin
Histamin
Tryptase
Vasodilatation →↑blood to tissue
→ ↓Bp and flushing
Increase permeability → swelling
Coordunate with WBCs
•Eosinophils
•Basophils
•Neutrophils

8. Symptoms and signs:
 Skin: 90 %of episodes
⁻ Generalized hives.
⁻ Itching or flushing.
⁻ Swollen lips-tongue-uvula.
⁻ Per-orbital edema.
 Respiratory: 70 % of
episodes
⁻ Nasal discharge and congestion.
⁻ Change in voice quality.
⁻ Sensation of throat closure or
choking.
⁻ Tridor or wheeze.
⁻ Shortness of breath and cough.
 Gastrointestinal: 45% of
episodes
⁻ Nausea.
⁻ Vomiting.
⁻ Diarrhea.
⁻ Crampy abdominal pain.
 Cardiovascular: 45 % of
episodes
⁻ Hypotonia (collapse).
⁻ Syncope.
⁻ Dizziness.
⁻ Tachycardia.
⁻ hypotension.

9. Laboratory tests:
 Serum or plasma total tryptase
normal range 1 to 11.4 ng/mL
Plasma histamine

10. Treatment:
 Epinphrin
 IM 0.3mg , 1:1000
 IV 0.15mg , 1:10,000
 Antihestsmin
 Corticosteroid
 Bronchodilator
 Oxygen
 Fluids and vasopressors, why?

11. Case study
Fay Albuainain

12. Sara is a 22 year old female who is brought into the ER by ambulance after
sudden changes in her level of consciousness and difficulty speaking when
talking to friends at a party. Her friends called 911 when she became
increasingly agitated and incoherent.
Vital signs on admit were:
 B/P 80/62
 Resp: 8 with difficulty
 Pulse 120
 Temp 39.2
 O2 sats: 82
Patient was still conscious on admit but confused and disoriented and unable to
speak. Patient was very restless and anxious. A few of her friends arrived at
the emergency room and it was discovered that she had eaten some cookies
that were thought to have peanuts in them right before the event occurred.
Family could not been contacted to determine if Sara had a previous
documented allergy to nuts/peanuts. Her friends were unaware of such an
allergy in her history but never remember seeing her eating nuts of any kind

13.  A previously healthy 12-year-old boy is brought to the emergency
department after being stung by a bee on his right forearm. He
initially complained of localized pain and swelling. Fifteen minutes
later, he began to complain of shortness of breath and was
observed by his parents to be wheezing. He reported feeling weak
and dizzy.
 In the emergency department, VS: T=37.1 C, P=120, R=39, BP=
69/45.
 Exam: He is drowsy and pale, but able to answer questions.
Generalized urticaria is present. He has no conjunctival edema and
his lips and tongue are not swollen. His voice sounds normal. He is
tachycardic and hypotensive. Respiratory examination reveals mild
wheezing, with fair aeration and mild subcostal retractions.
Abdomen is soft and non-tender. His capillary refill time is delayed.

14. ◦ UptoDate, Anaphylaxis symptoms and diagnosis (Beyond the Basics); 2016
◦ Anaphylaxis and Other Acute Allergic Reactions ,University of Hawaii, Brandon O. Takase,
MD Jessica S. Kosut, MD;2013.
◦ Anaphylactic Case Study; Rowan Cabarrus community college; 2014.
◦ Journal of Emergency Medicine, 2015-11-01
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