hey everyone it's sarah thread sterner sorry and calm in this video we're gonna continue our series on shock by talking about anaphylactic shock and after you watch this youtube video don't forget to take the free quiz that will test you on this condition so let's get started anaphylactic shock occurs when there's an introduction of an allergen in the body and this introduction leads the mast cells or basophils to release massive amounts of histamine and other substances system-wide now histamine plays a huge role in anaphylactic shock and it causes all these particular signs and symptoms on the body that leads to a decrease in tissue perfusion so we know from all of our other shock videos whenever we have something causing decreased tissue perfusion we have shock so that's why anaphylactic shock is we have this allergen that has triggered this response in the body massive amounts of histamine is being released and we're getting decreased tissue perfusion hints we're having shock now anaphylactic shock is a type of distributive shock which means that the small vessels in the body that deliver all that nutrients specifically oxygen to the cells that make up our tissues and organs are disruptive they're having an issue distributing blood flow and this is really coming back to the effects of all this histamine that's being released some of the things that the current is massive vasodilation so those vessels are widening and blood is not really flowing also you're gonna get increased capillary permeability and this is going to shift fluid out of that intravascular space into the interstitial space and we're gonna have an issue getting blood flow to those cells now how does an allergen actually enter in the body where this whole reaction is going to take place well there's various routes that an allergen can actually enter the body number one they can enter through an injection of some type that we give the patient or inhalation the per inhales their particular allergen that can cause anaphylaxis or they can take it orally where they ingest it with like food or even some medications or the skin it comes into contact with the skin now what are some known substances that actually cause anaphylaxis that can lead to anaphylactic shock well one thing of course is food this can be anything from shellfish peanuts eggs milk or medications like IV contrast eye vaccines insects antibiotics specifically like penicillin or insect venom like bees a lot of people are allergic to bee stings latex can cause it along with physical exercise some people their inner flexes is triggered by exercise and then of course there's cases where we just don't know what the cause of the anaphylaxis is and we refer to that as idiopathic now let's talk about what is occurring in the body Deering and a phylactery shock and to do that we have to talk about the two different types of reactions that a patient can have that can lead them to enter into anaphylactic shock the first type of reaction is called an anaphylactic reaction and this is due to the immune system the immune system sees the allergens so in response to that it creates the antibody IgE so it's IgE related the other type is called anaphylactic reaction and this really isn't related to the immune system the body and this type of reaction isn't creating the antibody IgE so it's not related to it so first let's dissect anaphylactic reaction so it's related to the immune system specifically this IgE that has been created in response to the allergen so in order for this anaphylactic reaction to occur that patient has to undergo sensitization and then once that patient is sensitized to this allergen this reaction can occur so it's known as a type 1 hypersensitivity reaction so let's look at how this reaction happens so we have this allergen that enters the body and whenever it comes into the body it's going to trigger the body to produce IgE antibodies so these I GE antibodies are going to go and attach to the surface of the mast cell or beza fill and they're gonna hang out there for a while so right here whenever this occurs the patient has been sensitized this was their first exposure to the allergen now let's say next week the person is exposed to the same allergen again so they have a subsequent exposure to this allergen now what's gonna happen is that we have these IgE antibodies on this mast cell or basal film well this allergen is going to go and bind with those IgE antibodies and this is gonna trigger this cell to release histamine and other mediators and we're going to get this reaction and here in a moment we're gonna talk in depth about the role of histamine and how it affects the body and anaphylactic shock but some of the things that histamine is going to do it's going to increase capillary permeability and this is going to cause major vasodilation now with anaphylactic reaction it's not related to I GE and so the person doesn't have to be sensitized for the reaction to occur what's going to happen is that you can have various substances that can lead to an anaphylactic reaction they can be like IV contrast I in said or chemotherapy agents they get in there they can attack the membrane of the mast cell or the basal feel cause it to break down and whenever that happens histamine is going to be released so you're going to have like the same type of reaction signs and symptom wise of how you would in the anaphylactic reaction where we have IgE being responsible but the thing with this anaphylactic ide related I think she doesn't have to be sensitized because we don't need the IgE to be present on that self because it's directly going to affect that cell in this in Aflac toyed so it can happen with the very first exposure now let's talk about the signs and the symptoms that are occurring during an Aflac tech shock now as the nurse you want to be able to recognize these little subtle signs and symptoms that you may see in your patient or they may tell you to let you know hey they may be going into anaphylaxis and Aflac tech shock and this will cause you to intervene so we will prevent them from actually entering into severe shock territory where they're going to have decreased tissue perfusion to their cells and organs which could lead to death so to talk about our signs and symptoms first we need to talk about histamine because histamine is what's really causing all of our problems and why you're seeing these signs and symptoms and when we talk about nursing interventions and treatment our interventions and treatments are geared to reversing the effects that this histamine has done to our body so one thing that histamine does that causes us major issues is vasodilation and when you have enough histamine you can vasodilator everything throughout this body and it's going to cause your vessels to widen and whenever vessels widen what does that do to blood pressure it drops it and this is going to decrease the amount of blood that's gonna flow to the cells that make up our tissues and organs it's going to deplete them of oxygen and they're gonna get stressed out and they're going to die because that blood is gonna be pulling and not going where it's supposed to go in addition histamine increases our heart rate so you can see tachycardia it also increases capillary permeability of your vessels so makes your vessels leaky so fluid that's in that interstate and in turn ask you ler space is going to move out and leak into the interstitial space so whenever you have this this will even further drop our blood pressure because we have like no blood volume in the inner vascular space will lead to that it's also going to cause more swelling because the fluid is going to leave the intravascular space and go into the tissue so you can have swelling this can cause issues with our airway we have the swelling up in this area you can also play a role in decreasing our cardiac output because if our fluids leaving our inter vascular space what's really draining back to the heart not a lot so that's gonna decrease cardiac outfits not gonna let have the heart the heart's not gonna have enough blood to pump through the body if we're losing fluid in addition histamine causes itching now another big thing that's dangerous that histamine causes is it causes bronchoconstriction so this is where you have narrowing of your Airways so your patient's not going to be able to breathe they will go into respiratory failure it also affects our GI system which will cause gastric secretions to increase and it increases the contraction of our smooth muscle in our GI system so we can start getting GI related signs and symptoms so whenever you're thinking about these signs and symptoms think about the system because histamine is going to affect the respiratory system cardiac system GI and skin so let's quickly go over these signs and symptoms respiratory we know we're having narrowing of our Airways so what your patient gonna look like they're gonna have difficulty breathing wheezing from where air is trying to flow through those narrow Airways you can hear that swelling in the upper Airways and they can have rapport they feel tightness and their throats hard to swallow they may even have issues speaking to you they'll be coughing also they can have watery eyes stuffy nose the lovely effects of histamine cardiac wise their blood pressure from that massive vasodilation is going to draw up they can have hypo hypotension and they can have increased heart rate from that tachycardia and because of their blood pressure going so low that hypotension they can lose consciousness as well GI system because of the increased secretions increase contraction of that GI smoothness they can have vomiting nausea diarrhea GI pain and the skin we have major vasodilation going on so and kissing me makes you itchy so your skin can be itchy red and swollen now let's wrap up this lecture and let's talk about nursing interventions and treatments for our patient with anaphylactic shock so first of all as a nurse what do you think is one of the most important things we can do to make sure our patient doesn't go into anaphylactic shock well it would be following preventative measures making sure we are always assessing our patients allergies and this is done best on admission asking them what do you allergic to have you ever had an anaphylactic reaction if so what happened during it making sure we're aware of that then we go and we document that put it where it's supposed to go so pharmacy doctors other nurses other people who are part of the healthcare team can know that this patient has these allergies and before you do anything give a patient new medication do any type of procedure that's going to be using something that's one of those known substances that can cause anaphylaxis we make sure that we're reviewing our patients allergies and always avoiding them now sometimes as we learn with anaphylactic reactions those patients don't have to be sensitized to the allergen it can happen with first exposure and with that we want to make sure that we're aware of those little subtle signs and symptoms that we were talking about with what can happen in anaphylactic shock now let's talk about nursing interventions and treatments a little bit deeper so we've established that you want to recognize those signs and symptoms because this can happen in a fact 'ok reaction can happen within seconds two minutes of exposure so to help us remember these nursing interventions and treatments let's remember the phrase act fast because it's a nurse we want to act fast if this occurs because we want to reverse the effects so a would be for allergen and airway if we know or suspect this particular thing is causing a patient's anaphylaxis we want to remove it or if they're started on a new IV antibiotic we want to stop that Medicaid until we can determine what's going on airway remember histamine can cause that bronchoconstriction so we want to make sure we're managing that airway and giving them high flow oxygen you're also going to beacon doing continuous monitoring of their vital signs then c4 call rapid response or initiate any the emergency system wherever you're at you want to get this patient treatment you need help when caring for this patient you can't do it all by yourself so you're gonna start CPR if that is needed until help arrives then t4 Trendelenburg position this position is going to help with what's going on remember we have massive vasodilation we have a drop in blood pressure and the Trendelenburg position is where you lay the patient supine with their legs elevated now you want to be wary of this position if you have a patient who's actively vomiting and if they're having really major airway issues because this could make it worse over there vomiting you may want to lay them on their side so they don't aspirate the emesis so what this position is going to do is it's going to increase the venous return to the heart so that blood return to the heart and increase our cardiac output and blood pressure then f4 first line drug is epinephrine remember epinephrine for anaphylactic shock this drug can be administered I am or sub-q the dose can be repeated if needed also if the patient's just having a really severe reaction with severe hypotension they're in the hospital setting where we can give them IV they may can have this the IV route and what this epinephrine is going to do is it's going to cause vasoconstriction which is what this patient needs so it's going to compress those vessels this is going to help increase blood pressure it's going to reduce that swelling that's occurring and it's also going to cause bronchodilation and we need this because remember those Airways were narrowing next is a for administer per MD order the following drugs now the drugs used for anaphylactic shock it really depends on what's going on with the patient how severe every this is but you want to be familiar with what can be given during anaphylactic shock and one thing of course is IV fluids because what happened with all this hissing well it caused our vessels leak so fluid left that intravascular space went to the interstitial tissue and we need fluid back in there so fluids can be ordered this will help replace that compartment and increase our blood pressure another thing is albuterol like a nebulizer a respiratory treatment and this will help dilate those Airways because we had bronchoconstriction so if that patient has persistent breathing issues albuterol can be given another thing is antihistamines and this is great because we have a histamine problem so these antihistamines are gonna reverse the effects of histamine and we're talking about like h1 or h2 blockers h1 would be diphenhydramine which is benadryl that can be given or an h2 blocker would be Redentor ranitidine which would be like zantac you can give that and reverse the effects another drug is like corticosteroids this would be given to prevent a recurrent attack later on it's not going to give you like immediate treatment so remember what was that first line drug epinephrine that's really the big one that we want to remember with that then s4 stay and monitor the patient if you have a patient who's went into anaphylactic shock they appear that they have recovered and you want to watch them very closely because they are at risk for what's called a biphasic anaphylaxis and this is where the in a factor reaction will occur again even if they're not exposed to that allergen so this can happen hours after the initial attack and the signs and symptoms that they may get during this attack may be less worse or the same so that's why we tell people who have been at home they've had anaphylactic reaction they've had to use their EpiPen that they need to get treatment immediately because they're at risk for developing another attack and lastly tea for teach as a nurse we play a vital role in helping our patients understand what anaphylaxis is what anaphylactic shock is and how to avoid it in the future so what are some things we can teach our patient to help them with this so one thing would be of course is the importance of avoiding this particular allergen and that they may need allergy tests to determine if they're allergic to anything else also the importance of wearing medical alert bracelets in case they pass out where someone could see hey this person is allergic to this so maybe having anaphylaxis we need to call help and to make everyone aware that will be providing care to them of their allergen especially with your pediatric patients if they have like a peanut allergy the parent needs to know that the teachers the school any caregivers need to know of this child's allergy in addition you want to educate the patient about always carrying an EpiPen no matter what activity you're doing always carry it with you have easy access to it in regards to epi pens you want to make sure that the patient's aware that they do expire that they need to replace them when they're expired and they need to know how to prepare and administer the injection patient doesn't need to learn how to inject the medication when an anaphylactic reaction is happening so epi pens come in trainer devices and you can use a trainer device to teach your patient and have them demonstrate how to use this so some highlights of how to administer this epinephrine can be injected through the clothes if needed with this EpiPen and when they inject they need to hold it in place for three seconds so that medication can drip into that muscle fully and then they remove it and after injection they'll want to massage the injection site for at least ten seconds what's this going to do it's going to increase the absorption then they want to call 911 and get care okay so that wraps up this lecture over anaphylactic shock thank you so much for watching don't forget to 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