Outpatient infusion is unsafe, in clinical work often see conflicts caused by infusion, so some diseases such as viral colds, common enteritis, doctors are not advocate intravenous infusion, especially antibiotics, the main reasons are 1 health insurance drugs by the government unified bidding and distribution, outpatient antibiotics are too cheap, drug purity, etc., outpatient infusion patients can not be effectively monitored, and many unpredictable Factors, so, dear patient friends, if your disease does not require intravenous infusion, please do not force the doctor to prescribe intravenous drugs for you!
Because, the risk is too great, although, drug allergy and infusion reaction is not a hospital error, involving drug manufacturers, drug quality, distribution links, etc. Also, do not contradict the doctor who deals with your allergy, because, the doctor is also lying shot, the drug is not provided by him, the doctor also does not want you to be allergic and have an accident, in addition, most of the doctors who come to deal with you are not the one who prescribes drugs to you, so please Respect the doctor, let the doctor have the energy to deal with your symptoms in a timely manner, try to improve scientific literacy and reduce unnecessary infusions.
A brief introduction to anaphylaxis related knowledge.
Anaphylaxis is an intense multi-organ involvement syndrome that occurs in a short period of time through immune mechanisms after some external antigenic substances enter the sensitized organism. The performance and degree of anaphylaxis, depending on the reactivity of the body, the amount of antigen into the pathway and so on, and there are great differences. It usually occurs suddenly and violently, and can be life-threatening if not treated promptly.
Etiology
The antigenic substances that cause the disease as allergens are.
1, xenogeneic (sexual) proteins endogens (insulin, pressin), enzymes (chymotrypsin, penicillinase), pollen infusions (pigweed, tree, grass), food (egg whites, milk, hard shelled fruits, sea food, chocolate), antisera (anti-lymphocyte serum or anti-lymphocyte gammaglobulin), proteins from occupational exposure (rubber products), bee toxins.
2, polysaccharides such as iron dextran.
3, many common drugs such as antibiotics (penicillin, cephalexin, amphotericin B, nitrofurantoin), local anesthetics (procaine, lidocaine), vitamins (thiamine, folic acid), diagnostic agents (iodinated X-ray contrast agents, iodobromophthalein), occupational exposure to chemical agents (ethylene oxide).
The majority of anaphylaxis is a typical type I allergic reaction in multiple organs of the body, especially the manifestation of the circulatory system, the external antigenic substances (some drugs are incomplete antigens, but after entering the body have combined with proteins to become full antigens) into the body can stimulate the immune system to produce the corresponding antibodies, the yield of IgE, depending on the body quality, these specific IgE has a strong pro-cellular These specific IgE have a strong pro-cellular nature and can bind to “target cells” in the skin, bronchial tubes and blood vessel walls.
Later, when the same antigen comes into contact with the sensitized individual again, it can trigger a widespread type I reaction, in which various histamines and platelet-activating factors are released and are directly responsible for the clinical manifestations such as multi-organ edema and exudation.
Occasionally, rapid-onset anaphylaxis can be seen during blood, plasma or immunoglobulin transfusions, and they have three causes.
1. The specific IgE of the blood donor reacts with the drug (e.g. penicillin G) for which the recipient is being treated.
2, selective IgA deficient person after repeated transfusion of IgA-containing blood products, can produce anti-IgA IgG class antibodies, when injected again with IgA-containing products, there is a possibility of IgA-anti-IgA antibody immune complexes, type III anaphylaxis caused by anaphylaxis.
3, used for intravenous infusion of gammaglobulin (C ball) preparations contain high molecular weight C ball polymer, can activate complement, producing C3a, C4a, C5a and other allergic toxins; and then activation of mast cells, producing anaphylaxis, a few patients in the application of drugs such as laudanum, dextrose, high ionization of X-ray contrast agents or antibiotics (such as polymyxin B), mainly by causing mast cells to de The clinical manifestations of anaphylaxis also occur after the application of drugs such as laudanum, dextrose, ionizing contrast agents or antibiotics (e.g. polymyxin B), mainly through mast cell degranulation.
Pathological changes
The main pathological manifestations of sudden death due to this disease are: acute pulmonary stasis and hyperinflation, laryngeal edema, visceral congestion, interstitial edema and hemorrhage, microscopic visualization of extreme submucosal edema in the airways, increased secretions in the small airways, bronchial and interstitial vascular congestion with eosinophilic infiltration, focal necrosis or lesions of the myocardium in about 80% of fatal cases, and congestion of the spleen, liver and mesenteric vessels with eosinophilic infiltration. The spleen, liver and intestinal vessels are also congested with eosinophilic infiltration, and a few cases may have gastrointestinal bleeding.
1.Signs and symptoms
Symptoms and diagnosis
(1) Blood pressure drops sharply to the level of shock, i.e., 10.7/6.7 kPa (80/50 mmHg) or less. If the systolic blood pressure drops sharply to 10.7 kPa (80 mmHg) from the original level in a patient with hypertension, it can be considered to have entered a state of shock.
(2) The state of consciousness begins with fear, panic, irritability, dizziness or loud shouting, and may appear amblyopia, yellow vision, hallucinations, diplopia, etc.; then the consciousness is hazy, and even complete loss of consciousness, and the reflexes to light and other reflexes are weakened and lost.
With a drop in blood pressure and impaired consciousness, it can be called shock, both of which are indispensable, if there is only the manifestation of shock. It is not enough to say that it is anaphylactic shock.
(3) Prodromal symptoms of allergy include flushing of the skin or transient pale skin, chill, etc.; itching of the peripheral skin or palms, numbness of the skin and mucous membranes, mostly numbness of the lips and extremities, followed by a variety of rashes, mostly in the form of large wind clusters, and in severe cases, large subcutaneous angioneurotic edema or swelling of the skin all over the body, in addition, edema of the mucous membranes of the nose, coma, and throat can occur, and sneezing, runny nose, mute voice, dyspnea, laryngospasm. Many patients also have esophageal blockage, abdominal discomfort, accompanied by nausea, vomiting, etc.
(4) History of allergen exposure History of medication, especially drug injection, and other specific allergen exposure before the onset of shock, including food, inhalers, contacts, insect chelipeds, etc.
For general anaphylaxis, through the above four points that can confirm the diagnosis, anaphylaxis sometimes occurs extremely quickly, sometimes lightning-like, so that the symptoms of allergy, such as performance is not obvious, as for the diagnosis of the specific cause of anaphylaxis should be carefully examined, because when the patient shock, often at the same time use a variety of drugs or contact with a variety of suspected allergenic substances, so it is difficult to conclude; in addition, in the process of confirming In addition, in the process of conducting allergy tests to confirm the diagnosis of drugs and so on.
In addition, in the process of conducting allergy tests to confirm the diagnosis of drugs and other allergic test may also appear false positive results or re-shock and other serious consequences, so should be careful, if you must do, should strive to be safe, where highly allergenic substances or patients are highly sensitive to their allergenic substances, should be first by the patch, scratch test, or use conjunctival test, sublingual mucous membrane containing test, intradermal injection test method must be strictly controlled; in the process of testing to strictly control the dose, and should be prepared for anti-shock, etc. The preparation of resuscitation.
2.Treatment with drugs
Prevention of the most fundamental way to clarify the allergens that cause the disease, and effective lack of prevention and avoidance. However, it is often clinically difficult to make a diagnosis of specific allergens, and many patients belong to the allergic-like reactions that do not occur by immune mechanisms. For this reason, attention should be paid to.
① Consult the allergy history in detail before using the drug, and positive patients should make a prominent and detailed record on the first page of the medical history.
② Minimize the use of unnecessary injectable drugs and use oral preparations as much as possible.
③ Observe the allergic patient for 15-20 minutes after injection of the drug. Before having to receive drugs that may induce the disease (such as sulfur contrast agent), it is advisable to use antihistamines or prednisone 20-30 mg.
The skin prick test should not be used for positive drugs, and if it is necessary to use them, the “hyposensitivity test” or “desensitization test” can be tried. The principle is to gradually increase the dosage of the desensitized drug from a very small dose to the patient under the protection of antihistamine and other drugs until the patient develops tolerance. During the desensitization process, close observation by medical staff is necessary, and all emergency rescue measures such as aqueous epinephrine, oxygen, tracheal intubation and intravenous corticosteroids must be prepared.
Emergency Precautions
Once a patient has drug anaphylaxis, immediately stop the drug, resuscitate in place, and quickly report to the doctor, and proceed as follows.
1.Lie flat immediately, follow the doctor’s prescription for subcutaneous injection of epinephrine 1 mg, or less if appropriate for children, and pay attention to keep warm.
2.Give oxygen inhalation, artificial respiration should be given according to medical advice in case of respiratory depression, and tracheotomy should be performed if necessary.
3.If cardiac arrest occurs, immediately perform cardiac resuscitation and other resuscitation measures.
4.Establish intravenous access quickly to replenish blood volume.
5.Closely observe the patient’s consciousness, vital signs, urine output, and other clinical changes.
6.Accurately record the resuscitation process.