Anaphylactic shock

Abstract

With the pathophysiology of anaphylaxis firmly in mind, the primary care physician can accurately diagnose and effectively treat this acute, life-threatening condition. The necessary drugs and equipment must be present in the office of any physician who performs skin testing, administers immunotherapy or intramuscular antibiotics, or uses local anesthetics. The drug of choice, epinephrine, must be administered as soon as the diagnosis is made, and hospitalization is necessary to guard against recurrent anaphylaxis. Preventive measures, including identification of the offending antigen, avoidance instructions, epinephrine for self-administration, and immunotherapy should be considered for all patients.

The role of epinephrine in the treatment of anaphylaxis

“…Many authors caution that intravenous epinephrine is potentially hazardous as it can produce potentially fatal tachyarrhythmias, myocardial infarction, and other complications such as intracerebral hemorrhage [24][25][26]. In spite of the inherent dangers of this route, there is an acknowledged clinical role for this mode of administration.…”

Epinephrine Administered in Anaphylaxis: The Evolution of 0.3 mg Dosage

“…As late as 1988, the dosage of 0.3 to 0.5 mL of 1:1000 solution by intramuscular (IM) injection in adults for administration immediately after diagnosis was still recommended by physicians. 4 – 6 Epinephrine used to treat anaphylaxis in pediatric cases was also commonly presented as a range, such as in the 1973 American Academy of Pediatrics guidelines which stated “0.1 to 0.3 mL of 1:1000 epinephrine was to be used for pediatric use,” 7 presumably on the basis of the child's weight. In the year 1994, the AAAAI Board of Directors published a position statement recommending 0.3 mL of 1:1000 solution due to the increased availability of the standardized dosage of epinephrine contained in EpiPen.…”