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Discussion

Anaphylactic shock

can someome help me answer this question?

after receiving penicillin intravenously, a 32-year-old male patient has an anaphylactic reaction. the nurse understands that therapeutic management includes what critical items?

i have this question on an anatomy assignment. i can not find the answer. i am not sure where to look. thanks

Featured Replies

look at the histamine process, usually a result of lymphocytes or mast cells. Always monitor the airway as swelling can close the trachea.

  • Author

Thank You I did find some info. Although I do have one more question. I will post it. I just can't figure it out.

can someome help me answer this question?

after receiving penicillin intravenously, a 32-year-old male patient has an anaphylactic reaction. the nurse understands that therapeutic management includes what critical items?

i have this question on an anatomy assignment. i can not find the answer. i am not sure where to look. thanks

how about:

discontinue pcn iv

get ready for pt to crash - low bp, constricted airway.

consider high flow o2 (nonrebreather, bag valve mask if needed, possibly et intubation)

consider epi 1:1000 sq or 1:10,000 ivp if anaphylactic reaction gets nasty

consider benadryl ivp or im to counter histamine release

position pt for shock

obtain large bore iv access in case fluid boluses are required.

most of this stuff is to counter constricted/secretion filled airways & restore some circulating fluid volume after the capillaries start dumping fluid.

Not sure how detailed your answer needs to be, but the most common drug used (especially in the OR) is epi. You always need to maintain, or open an airway, monitor heart rythme and BP and all that. But epi is the drug of choice to reverse the effects of the reaction...

  • Experts

In anaphylaxis the following happens:

  1. Immunoglobulins IgM and IgG recognize and bind to the invading antigen.
  2. Activated IgE on the basophils promotes the release of histamine serotonin and leukotrienes
  3. Mast cells release more histamine and esosinophil chemotactic factor of anaphylaxis which creates venule weakening lesions
  4. Histamine causes endothelial cell destruction and fluid leak into the alveoli of the lungs
  5. Mediators cause an increase in vascular permeability which causes fluid leakage from the vessels
  6. Endothelial cell damage causes basophils and mast cells to release heparin and mediator-neutralizing substances. At this point, anaphylaxis is irreversible.

Immediate management includes maintaining a patent airway and giving oxygen to maximize tissue perfusion. Epinephrine 1:1000 aqueous needs to be injected within minutes and repeated every 5 to 20 minutes. If breathing doesn't improve an emergency tracheostomy may be necessary. Once breathing is stabilized a longer acting epinephrine product needs to be given as well as histamine blockers. The patient is not out of the woods for 24 hours and needs to be watched for reoccurrence of symptoms during that time.

Don't forget about the solumedrol (steroids) to decrease the inflammatory response

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