Anaphylactic Shock and Approach to Emergency Care
Anaphylactic shock is becoming a common condition in the USA, with a lifetime prevalence of 0.05–20% (Yu & Lin, 2018). Anaphylaxis that precedes anaphylactic shock is an emergency due to its severe and life-threatening nature and the fact that it occurs within a few seconds to minutes after exposure to an allergen or irritant.
The difference between anaphylaxis and anaphylactic shock is that anaphylaxis is a collective term for serious allergic reactions that have a rapid onset, while anaphylactic shock is a state of systemic hypotension and reduced tissue perfusion that occurs when anaphylaxis remains untreated (Greenhawt et al., 2019). Anaphylactic shock presents with distinct symptomatology and requires a certain approach to care.
As Greenhawt et al. (2019) highlight, anaphylactic shock symptoms are caused by systemic vasodilation, hypoperfusion, increased vasculature permeability, and cellular anoxia. Severe hypoperfusion manifests with signs that include warm peripheries, tachycardia, and low blood pressure.
Other clinical manifestations such as generalized urticaria, angioedema, pallor, and erythema are usually due to increased vascular permeability. The patient may also present with symptoms such as coughing of bloody or frothy sputum, wheezing, chest pain, hoarseness of voice, feeling of foreign body within the airway, and pain when swallowing due to pulmonary edema, and edema of pharynx and larynx.
Furthermore, bronchospasm can manifest as difficulty in breathing and wheezing. Diarrhea and vomiting may ensue due anoxia of the gastrointestinal tissue. Additionally, symptoms of hypovolemia may manifest as dizziness or fainting (Greenhawt et al., 2019). The symptoms depend on the stage/ extend of anaphylactic shock.
Diagnosis of Anaphylactic Shock vs. Other Conditions
Anaphylactic shock is primarily diagnosed through careful and detailed history-taking and physical examination (Greenhawt et al., 2019). A differentiating factor from other conditions is the history of acute onset of an illness involving skin or mucosal tissue or both, combined with respiratory compromise, reduced blood pressure, and/or symptoms of end-organ damage such as hypotonia, syncope, or incontinence.
The onset period can range from minutes to hours, and symptoms of respiratory compromise can include dyspnea, hypoxemia, stridor, or wheezing. A patient who meets these criteria is most likely suffering from anaphylactic shock (Greenhawt et al., 2019).
Management of Anaphylactic Shock
Anaphylactic shock is a medical emergency and therefore management follows the emergency medicine protocol, starting with the ABCs (De Vera & Tagaro, 2020). Maintaining the patency of the airway is essential using airway maneuvers or advanced airway management. Mechanical ventilation or non-invasive ventilation can then be put in place to assist with breathing.
Circulation management involves establishing two large bore cannulas and fluid resuscitation. At this point, epinephrine can be administered to alleviate hypotension. Medications for definitive management include the administration of antihistamines and corticosteroids to relieve allergic reactions and injections with beta-agonists to relieve bronchospasms. Management varies from patient to patient depending on the severity of their condition (De Vera & Tagaro, 2020).
Evidently, anaphylactic shock is a life-threatening condition, and therefore, early diagnosis and management is critical. Detailed history-taking and examination play an important role in diagnosis. Consequently, it should be managed as an emergency to avoid associated end-organ damage and associated mortality.
De Vera, M. J., & Tagaro, I. C. (2020). Anaphylaxis diagnosis and management in the Emergency Department of a tertiary hospital in the Philippines. Asia Pacific Allergy, 10(1), e1. https://doi.org/10.5415/apallergy.2020.10.e1
Greenhawt, M., Gupta, R. S., Meadows, J. A., Pistiner, M., Spergel, J. M., Camargo, C. A., Jr, Simons, F. E. R., & Lieberman, P. L. (2019). Guiding principles for the recognition, diagnosis, and management of infants with anaphylaxis: An expert panel consensus. The Journal of Allergy and Clinical Immunology in Practice, 7(4), 1148-1156.e5. https://doi.org/10.1016/j.jaip.2018.10.052
Yu, J. E., & Lin, R. Y. (2018). The epidemiology of anaphylaxis. Clinical Reviews in Allergy & Immunology, 54(3), 366–374. https://doi.org/10.1007/s12016-015-8503-x
Anaphylactic Shock and Approach to Emergency Care Instructions
Discuss what symptoms are associated with anaphylactic shock and how the nurse differentiates these from other conditions or issues. What steps should be taken if the nurse suspects anaphylactic shock?