I. Identifying Patient Abnormalities:
(1) Immediately discontinue medication, maintain intravenous access, position the patient supine, initiate on-site emergency care, and promptly notify the physician.
(2) Monitor vital signs: measure blood pressure, pulse, respiration, and temperature. Administer medications as prescribed based on the situation.
(3) Administer 10 mg of dexamethasone intramuscularly or intravenously as prescribed.
(4) For drug allergies, immediately administer 0.5–1.0 mL of 0.1% epinephrine hydrochloride subcutaneously or deep intramuscularly. If symptoms persist, repeat 0.5 mL subcutaneously or intravenously every 30 minutes until the critical period passes.
(5) Administer continuous low-flow oxygen. If respiratory depression occurs, immediately perform mouth-to-mouth resuscitation and administer respiratory stimulants such as nicotinamide or physostigmine intramuscularly. Perform tracheotomy if laryngeal edema impairs breathing.
(VI) Administer 200 mg hydrocortisone or dexamethasone immediately per medical order. Administer vasoactive agents such as dopamine or alamine based on clinical condition.
(VII) For infusion reactions, manage according to infusion reaction protocols. For febrile reactions, slow infusion rate and notify physician.
(8) For circulatory overload, avoid excessive infusion rates. If symptomatic, position the patient sitting upright with legs dangling. Administer pressurized oxygen humidified with 20–30% alcohol vapor.
(10) If air embolism is suspected, position the patient in left lateral decubitus with head-down, feet-up position and administer oxygen.
(11) Closely monitor and document the patient's temperature, pulse, respiration, blood pressure, urine output, and other clinical changes.
II. Prodromal Symptoms of Anaphylactic Shock
Systemic Symptoms: Oral paresthesia, restlessness, weakness, sense of collapse, headache, chills, cold sweats, sudden aphasia;
Cardiovascular Symptoms: Rapid pulse, palpitations;
Neurological Symptoms: Limb and lip numbness, convulsions, dizziness, tinnitus;
Respiratory symptoms: Throat tightness, sneezing, reflex coughing, chest tightness, wheezing;
Infusion reactions: (1) Pyrogenic reaction: Symptoms include chills, rigors, and fever. Severe cases present initial rigors followed by high fever (40–41°C) with nausea, vomiting, headache, and tachycardia.
Prevention and Treatment: Slow the infusion rate or stop the infusion immediately and notify the physician.
(2) Pulmonary Edema (Circulatory Overload) Symptoms: Sudden onset of dyspnea, tachypnea, cough, frothy sputum or frothy bloody sputum, and wet rales in the lungs.
Prevention and Treatment: (1) During infusion, ensure the drip rate is not too fast and the volume is not excessive;
(2) If symptoms appear, immediately position the patient sitting upright with legs dangling to reduce venous return;
(3) Administer pressurized oxygen humidified with 20–30% alcohol for inhalation;
(4) Administer sedatives, vasodilators, and potentiators like digitalis as prescribed;
(5) Apply tourniquets to limbs sequentially if necessary.
(3) Phlebitis symptoms: Appearance of cord-like red lines, localized tissue redness, swelling, burning sensation, and pain.
Prevention and treatment: (1) Strictly adhere to aseptic technique. For vasoactive medications, systematically rotate injection sites.
(2) Elevate and immobilize the affected limb; apply warm compresses with 95% alcohol or 50% magnesium sulfate solution locally.
(IV) Air embolism symptoms: The patient experiences abnormal chest discomfort, develops dyspnea and severe cyanosis, and a loud, persistent "bubbling sound" may be heard on auscultation over the precordial area.
Prevention and Treatment: (1) Position the patient in left lateral decubitus with head-down, feet-up elevation;
(2) Administer oxygen inhalation;
(3) Closely monitor during pressurized infusion; nursing staff must not leave the patient's side.
Skin and mucosal symptoms: Flushing, rash, conjunctival hyperemia, edema.
III. Anaphylactic Shock Emergency Protocol
Anaphylactic Shock: 0.1% epinephrine hydrochloride 0.5-1.0 mL IV, followed by 1 mL IM or SC injection; repeat antihistamines if necessary;
Medications: Intramuscular injection of 25–50 mg diphenhydramine to ensure airway patency; tracheotomy and oxygen administration if necessary. Intravenous infusion of 200–400 mg hydrocortisone in 100 mL glucose solution; vasoactive agents as indicated.
Diagnostic Criteria and Emergency Measures for Anaphylactic Shock
Diagnosis: 1.History of allergic exposure; 2. Symptoms include chest tightness, sensation of throat constriction, followed by dyspnea, cyanosis, and sense of impending doom; severe cases may cough up pink frothy sputum; 3. Often accompanied by severe abdominal cramps, nausea, vomiting, or diarrhea; 4. Altered consciousness, limb numbness, convulsions, aphasia, urinary/fecal incontinence, weak pulse, and hypotension.
Emergency Treatment: 1. Administer epinephrine immediately; 2. Rapid intravenous injection of corticosteroids; 3. Volume expansion; 4. Oxygen therapy or hyperbaric oxygenation; 5. Administer calcium preparations and antihistamines; 6. Promptly manage laryngeal edema, pulmonary edema, cerebral edema, etc.
Measures: 1. 0.5–1.0 mL 0.1% epinephrine IM or IV; 2. 1–4 mg norepinephrine dissolved in 500 mL solution IV drip;3. Dexamethasone 10–20 mg mixed with 100 mL 5% glucose solution (IV infusion); 4. Calcium gluconate 10% solution 20 mL, slow IV injection; 5. Aminophylline 0.25 g mixed with 40 mL 50% glucose solution, slow IV injection; 6. Balanced crystalloid solution: 500–1000 mL IV infusion.