First aid for an anaphylactic shock

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Clinical situation:

Your elderly neighbor, a 70-year-old woman, complained of feeling unwell. Upon questioning, you found out that she complained of difficulty breathing and severe weakness after a bee sting. Prior to this, the patient experienced anaphylactic shock three times due to a bee sting. The patient has an epinephrine auto-injector. Provide first aid.

Equipment for the practical skill:

• simulated patient;
• epinephrine auto-injector.
• first aid kit.
  

The procedure for performing a practical skill

• Call 103 for emergency help. Tell the dispatcher that you suspect anaphylaxis.
• Help the person to lie down unless they are experiencing breathing difficulties. In that case, help them to sit down.
• If she becomes pale with a weak pulse, help her lie down with legs raised and treat for shock.
• If the casualty has an autoinjector of epinephrine, help her use it.  The best place for injection is the middle of the outer side of the thigh. The injection can be administered through clothes if the clothes are not thick.
• If she is unable to take the medication, administer it to her yourself:
  • hold the injector with your fist;
  • pull off the safety cap;

• put the injector tip (needle side) against the casualty's outer middle third of thigh

• push the tip firmly until it clicks, releasing the medication (it can be delivered through clothing).

• hold for ten seconds, remove the autoinjector;
• massage the injection site for ten seconds.
• Monitor vital signs – level of response, breathing, and pulse – while waiting for help to arrive.
• Repeated doses of epinephrine can be given at five-minute intervals if there is no improvement or the symptoms return.
• If medical attention is not available but blood pressure levels return to normal, give the person loratadine 10 mg or desloratadine 5 mg in tablet orally (do not use these antihistamine medications until blood pressure levels return to normal).