Anaphylactic poob siab yog qhov tshwm sim sai sai rau qhov ua xua, nrog rau cov hlab ntshav tsis zoo, spasms, oxygen tsis txaus. Qhov kev poob siab tuaj yeem tshwm sim tam sim, lossis nws tuaj yeem kav ntev li ob peb teev.
Qhov qib ntawm nws qhov hnyav yog nyob ntawm tus nqi ntawm cov allergen uas tau nkag mus rau hauv lub cev. Nws tuaj yeem tshwm sim hauv ntau qhov xwm txheej:
- Thaum raug kab kab, nab. Bee sting.
- Kev siv tshuaj (kev pab thawj zaug yuav tsum muaj rau kev kho mob anaphylactic hauv kev kho hniav thaum kho hniav banal, hauv gynecology, urology, traumatology, thaum mus ntsib kws phais mob, thaum txhaj tshuaj).
- Thaum txhaj tshuaj tiv thaiv.
- Kev ua xua zaub mov. Kev kub taub hau raws caij nyoog tuaj yeem ua rau muaj qhov tshwm sim hnyav.
Kev tshwm sim ntawm anaphylaxis
- Ntxhaisdeterioration ntawm peripheral thiab central ncig, nrog rau kev txo qis hauv cov hlab ntsha. Nyob rau tib lub sijhawm, tus neeg raug tsim txom hnov mob taub hau, xeev siab, pos huab hauv qhov muag, thaum pom ntawm daim tawv nqaij daj ntseg, lub plawv dhia yog thready.
- Shock (mob thiab lom): ib tug neeg muaj mob hauv siab, ua tsis taus pa.
Qhov xwm txheej ntawm cov tshuaj tiv thaiv anaphylactic, thiab yog li kev pabcuam thawj zaug rau kev poob siab anaphylactic, nyob ntawm seb lub cev puas raug cuam tshuam. Los ntawm no, 4 hom anaphylaxis txawv:
- cuam tshuam rau daim tawv nqaij;
- nervous system (cerebral type);
- mob plawv (cardiogenic: plawv nres, myocarditis);
- kab mob ua pa (asthmatic type).
Feem ntau, kev tsis haum tshuaj ntawm hom no rov tshwm sim dua. Txhawm rau muab kev pabcuam thawj zaug rau kev poob siab anaphylactic hauv lub sijhawm, nws yuav tsum muaj cov tshuaj tsim nyog ntawm tes. Feem ntau cov neeg uas muaj kev cuam tshuam zoo li no muaj cov tshuaj no. Tsis tas li ntawd, txhua tus kws kho mob tshwj xeeb yuav tsum muaj cov khoom siv pab thawj zaug tshwj xeeb nrog nws. Tsis muaj cov khoom siv tiv thaiv kev poob siab thawj zaug ntawm tes, tsis yog ib tus kws kho mob muaj cai ua haujlwm.
pab xub thawj
Kev pab thawj zaug rau kev poob siab anaphylactic muaj cov haujlwm hauv qab no:
- Nyob ntawm qhov chaw ntawm tus neeg raug tsim txom, hu rau lub tsheb thauj neeg mob, kws kho mob, pab neeg cawm siav.
- Tshem tus neeg mob los ntawm qhov chaw ntawm kev tsis haum tshuaj nyob ntawm qhov xwm txheej: tshem rab koob los ntawmtshuaj kho mob, ntxuav lub plab ntawm cov zaub mov tsis haum, rub tawm qhov sting, sim nyem tawm cov tshuaj lom, muab rau tus neeg mob chav cua txias yam tsis muaj kev nkag mus rau cov paj ntoos tsis zoo, thiab lwm yam.
- Muab tus neeg mob tso ob txhais ceg mus rau hauv ncoo qhov siab.
- Cia tus neeg raug tsim txom ua pa cua txias (qhib lub qhov rais, yog tias nws muaj kev tsis haum rau qee yam ntawm ib puag ncig, paj ntoos, tig lub tshuab cua txias).
- Nco ntsoov tias tus neeg ntawd puas nco qab (nug nws txog ib yam dab tsi, piv txwv li, nws koom nrog qhov kev tshwm sim no, ua rau lub cev me ntsis).
- Tau qhov ua pa ntawm cov hnoos qeev, ntuav yog tias tsim nyog.
- Cia koj lub taub hau rau ntawm koj sab.
- Thaum muab kev pab thawj zaug rau kev poob siab anaphylactic, koj tuaj yeem ntsib kev ua pa thiab cov hlab ntsha raug kaw - kev kho mob sai yog tsim nyog. Lub hauv paus ntawm cov dej num no yog: indirect lub plawv massage (30 clicks) thiab dag ua pa (2 ua pa).
- Yog ob tus neeg pab, koj yuav tsum hloov txhua 2 feeb. Tsuas yog lub hauv siab compression raug tso cai kom txog thaum lub tsheb thauj neeg mob tuaj txog yog tias cov chaw pabcuam thawj zaug tsis tau kawm txog cov txheej txheem ntawm kev ua pa kom raug lossis muaj kev pheej hmoo kis mob.
- Thaum muaj qhov xwm txheej zoo li no tshwm sim hauv ib tus neeg, nws kuj raug pom zoo, yog tias ua tau, txhawm rau kuaj nws lub plawv thiab lub siab. Yog tias qhov ntsuas tsis tau txiav txim siab, qhov kev poob siab sai sai, nws tseem ceeb heev kom ua raws li kev ntsuas kev ua kom rov zoo, thovtshuaj.
- Raws li kev pabcuam thawj zaug rau kev poob siab anaphylactic, siv lub tourniquet saum toj qhov chaw txhaj tshuaj nrog cov tshuaj tsis haum. Tsis txhob hnov qab txog cov cai rau kev thov ib tug tourniquet. Nco ntsoov sau ib daim ntawv nyob rau hauv nws, nrog rau hnub thiab lub sij hawm ntawm overlay. Qhov siab tshaj plaws overlay lub sij hawm nyob rau hauv lub caij ntuj sov yog 2 teev, nyob rau hauv lub caij ntuj no 1.5 teev. Qhov zoo tshaj plaws - txhua 30 feeb, loosen lub tourniquet rau 5 feeb, txhawm rau kom tsis txhob muaj kev cuam tshuam ntawm cov hlab ntsha hauv cov ceg.
- Nws yog qhov tsim nyog ua ntej tus kws kho mob tuaj txog yuav tsum nyob ze tus neeg mob, tswj nws lub siab, muab txhua yam kev pabcuam. Pab neeg resuscitation tuaj txog yuav tsum paub: ntev npaum li cas tus neeg raug tsim txom tau nyob hauv lub xeev no, qhov tshuaj tiv thaiv dab tsi, cov ntaub ntawv hais txog kev ua haujlwm.
Muab kev pab thawj zaug rau kev poob siab anaphylactic yog qhov xwm txheej hnyav heev, nws qhov kev pabcuam raws sijhawm yuav pab kom tsis txhob tuag.
Txhua tus neeg ua haujlwm noj qab haus huv nruab nrab thiab laus yuav tsum paub cov cai rau kev saib xyuas no. Ib txwm thaum ua cov khoom siv uas tuaj yeem ua rau muaj kev tsis haum tshuaj, cov kws kho mob tshwj xeeb yuav tsum nqa cov tshuaj siv los daws qhov kev tawm tsam. Muaj cov npe tshwj xeeb ntawm cov tshuaj pab thawj zaug rau kev poob siab anaphylactic.
daim ntawv no suav nrog
Adrenaline 0, 1%, hauv ampoules ntawm ib milliliter. Kuj tseem muaj qhov tshwj xeeb EpiPens uas muaj ib koob tshuaj adrenaline
- Norepinephrine 0, 2% hauv 1 ml ampoules.
- Cov tshuaj tiv thaiv kab mob ("Suprastin", "Dimedrol", "Loratadin", "Zirtek").
- Corticosteroids (prednisolone hauv ampoules ntawm 30 milligrams, hydrocortisone hauv ampoules ntawm 4 milligrams).
- txhais tau tias nce ntshav siab ("Ephedrine" 5% hauv ampoules, "Mezaton" 1%).
- Broncholytics (relieving bronchospasm) - "Eufillin" 2, 4% hauv ampoules.
- Cardiac glycosides ("Strophanthin" 0.05%, "Korglikon" 0.06% hauv ampoules).
- Tonics (10% caffeine).
- Ua pa stimulants ("Cordiamin").
- Rau cov hlab ntsha (hauv / hauv), intramuscular (hauv / m) infusions ntawm cov tshuaj, lub cev. kua, qabzib tov 5%, infusion systems. Cawv, hnab looj tes, koob txhaj tshuaj tsis muaj menyuam, cov ntaub so ntswg, kho cov nplaum nplaum kuj tseem xav tau.
Nursing care
Tus kws saib mob muab tshuaj rau cov neeg mob ib txwm nqa tshuaj pab thawj zaug rau kev poob siab. Nws yuav siv sij hawm mus rau hauv tus account qhov muaj peev xwm ntawm anaphylactic shock yuav tshwm sim. Tus kws saib xyuas mob thawj zaug: meej thiab sib koom ua ke:
- Tus kws saib xyuas neeg mob yuav tsum nres, tsis txhaj tshuaj ntxiv.
- Hu rau tus kws kho mob sai.
- Tau ib qho tourniquet rau qhov chaw txhaj tshuaj rau saum qhov chaw txhaj tshuaj.
- Muab tus neeg mob lub cev tsim nyog (puag, tso nws txhais taw rau hauv ncoo).
- Muab tus neeg mob lub taub hau rau ib sab, rub tawm cov hniav,thawb lub puab tsaig qis rau pem hauv ntej, tso pa tawm.
- Yog tias tsim nyog, pib tshuab cua tshuab, lub plawv massage (indirect).
Anaphylactic shock yog qhov mob tuag taus. Rau kev pab thawj zaug, tus nais maum siv tau:
- Nrog rau kev daws ntawm adrenaline 0.1%: subcutaneously txhaj ib nrab milliliter. Kev taw qhia rau hauv cov leeg gluteal lossis femoral tau tso cai. Nws tseem yog ib qho tseem ceeb rau puncture qhov chaw txhaj tshuaj nrog cov allergen nrog cov nram qab no muaj pes tsawg leeg: dilute ib nrab ib milliliter ntawm adrenaline 0.1% nyob rau hauv ib tug syringe nrog 5 milliliters ntawm saline. tov, nyob rau hauv li tsib mus rau rau qhov chaw. Ntawm no - thov dej khov.
- Kev nkag mus sai rau tus neeg mob cov leeg yog qhov tseem ceeb heev hauv kev poob siab anaphylactic. Kev pab thawj zaug: tus kws saib xyuas neeg mob qhov kev ua haujlwm algorithm kuj suav nrog cov tshuaj txhaj tshuaj. Tus nais maum yuav tsum muab kev nkag mus sai rau tus neeg mob cov hlab ntsha. Ua li no, nws catheterizes ib txoj hlab ntsha thiab txhaj saline drip. Txhaj tshuaj ntawm prednisolone, 60-150 milligrams nyob rau hauv 20 milliliters ntawm saline intravenously (nyob rau hauv lub xam ntawm 1-2 milligrams ib kg ntawm tus neeg raug mob hnyav). (Dexamethasone 8-32 milligrams, 100-300 milligrams hydrocortisone ib leeg lossis cov leeg tau txais.
- Nws raug nquahu kom txhaj 5 milliliters ntawm 1% "Dimedrol", 2 milliliters ntawm 2% "Suprastin" rau hauv cov leeg.
Kev pab kho mob
- Nws yog ib qho tsim nyog yuav tsum tau nqa cov tshuaj rau hauv lub venous catheter: lub cev. ib tug tov nrog ib tug tag nrho ntim ntawm tsawg kawg yog 1 liter, yog hais tias ua tau, txhaj 0.5 litres ntawm saline. ntsev thiab 0.5 l"Refortana GEK".
- Yog tias muaj kev pheej hmoo ntawm hypotension, nws yuav tsum rov txhaj tshuaj 0.5-1.0 milliliters ntawm adrenaline 0.1% rau hauv cov leeg, 15-20 feeb tom qab thawj zaug txhaj tshuaj. Koj tuaj yeem ua qhov no txhua 15-20 feeb.
- Yog tsis muaj kev cuam tshuam, dopamine txhaj. Rau 400 milliliters ntawm ib txwm saline, 200 milligrams ntawm dopamine yog muab intravenously los ntawm drip, maj mam heev (2-11 tee ib feeb) kom txog rau thaum lub systolic siab mus txog 90 millimeters mercury.
- Nrog rau kev loj hlob ntawm lub plawv tsis ua hauj lwm, cardiac glycosides (strophanthin 0.05% 1 milliliter los yog corglicon 0.06% 1 milliliter) yog siv intravenously rau lub cev. solution.
- Yog tias muaj kev txhim kho ntawm bradycardia (lub plawv dhia qis dua 55 ib feeb), kev pab thawj zaug rau kev poob siab anaphylactic suav nrog kev txhaj tshuaj subcutaneous ntawm ib nrab milliliter ntawm 0.1% atropine. Yog tias qhov mob tshwm sim, rov ua dua qub tom qab tsib mus rau kaum feeb.
- Rau cov teeb meem ua pa, txhaj 10 milliliters ntawm "Eupyllin" 2, 4% hauv saline rau hauv cov leeg, lossis rau hauv cov leeg nrog 24% tshuaj.
- Ua kom siab, lub plawv dhia, qhov ua pa ntawm kev tswj xyuas tas li.
- Nyob zoo rau tus neeg raug tsim txom mus rau kev saib xyuas hnyav.
Anaphylactic shock hauv menyuam yaus
Yog hom mob hnyav tshaj plaws ntawm tus kab mob ua xua uas muaj kev hem thawj rau tus menyuam lub neej. Kev poob siab anaphylactic yog qhov txaus ntshai vim muaj mob hnyav hauv plawv, vascular, ua pa thiab lub paj hlwb.
hom kev tsis haum no tuaj yeem tshwm sim los ntawm zaub mov, tshuaj, kab tom, thiab lwm yam.
Symptomatics
Tus me nyuam pib kiv taub hau, qaug zog, hws txias. Cov menyuam yaus thaum lub sijhawm no muaj kev ntshai, ua daj ntseg. Daim duab ntawm kev txhim kho ntxiv ntawm anaphylaxis zoo ib yam li cov neeg laus: hypotension, suffocation tsim, tus me nyuam tsis nco qab, lub mem tes yog thready. Cov txheej txheem tuaj yeem nrog convulsions.
Qee zaum qhov kev poob siab txawv. Nyob rau hauv rooj plaub no, koj tuaj yeem saib reddening ntawm daim tawv nqaij, tus me nyuam txham, hnoos, hais tias nws kub, nws yog ib qho nyuaj rau ua pa. Mob plab yuav tshwm sim.
Yog li, hauv kev kho menyuam yaus, cov qauv hauv qab no ntawm anaphylaxis tuaj yeem paub qhov txawv:
- Hom - ntshav siab, ua pa tsis ua haujlwm, tsis nco qab, qaug dab peg, tawv nqaij tshwm sim.
- Asphyxial - qhov tseem ceeb ntawm kev ua pa tsis ua haujlwm vim qhov ua pa ntawm lub ntsws, kev loj hlob ntawm bronchospasm.
- Hemodynamic - muaj kev cuam tshuam lub plawv dhia, nrog rau kev hnov mob, lub plawv suab yog muffled, siab te, mem tes ua thready.
- Cerebral - tus me nyuam tsis nco qab, ua pa atherosclerosis ploj mus, cerebral edema tshwm sim, convulsions.
- Abdominal - cov tsos mob ntawm lub plab mob, uas yog vim li cas daim ntawv no tuaj yeem ua rau qhov tsis raug ntawm kev kuaj mob.
Kev kho mob
Kev pab thawj zaug rau kev poob siab anaphylactic hauv cov menyuam yaus suav nrog cov haujlwm uas yuav tsum tau muaj nyob rau hauv thoob ntiaj tebqauv. Lub hom phiaj ntawm kev kho mob yog los kho cov ntshav ncig, oxygen saturation ntawm lub cev. Ib txoj haujlwm tseem ceeb kuj yog txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau ua kom tsis txhob muaj teeb meem lig.
Thaum ua kev kho mob rau tus menyuam, nws yog ib qho tseem ceeb uas yuav tsum tau coj mus rau hauv tus account lub hnub nyoog thiab qhov hnyav ntawm tus neeg mob me. Kev pab thawj zaug rau kev poob siab anaphylactic - algorithm ntawm kev ua hauv kev xyaum menyuam yaus:
- Tshem kom nkag mus ntawm cov tshuaj tsis haum rau hauv lub cev. Txhaj tshuaj epinephrine 0.1% ntawm 0.3 mus rau ib nrab milliliter ntawm qhov chaw txhaj tshuaj.
- Tau ib qho tourniquet rau qhov cuam tshuam ntawm ceg ceg, saum qhov chaw txhaj tshuaj nrog cov tshuaj ua xua uas ua rau cov tshuaj tiv thaiv.
- Tso tus me nyuam nqes, tig taub hau mus rau sab.
- Txhaj adrenaline rau hauv cov leeg ntawm tus nqi ntawm 0.01 milliliter ib 1 kilogram (tsis ntau tshaj 0.5 milliliter).
- Txhaj "Dimedrol" 1% rau hauv cov leeg gluteal ntawm tus nqi ntawm 1 milligram ib 1 kg. Nws raug tso cai siv "Tavegil" lossis "Suprastin" raws li cov lus qhia ntawm hnub nyoog ntau npaum.
Pipolfen tsis tuaj yeem siv rau hauv kev kho menyuam yaus, vim nws yog tshuaj tiv thaiv ntshav siab.
Ntxiv mus, kev siv tshuaj corticosteroids yog qhov tsim nyog (dexamethasone 0, 3-0, 6 milligrams ib kg, hydrocortisone 4-8 milligrams ib kilogram, prednisone 2-4 milligrams ib kg.
Ntxiv mus, tau muab kev nkag mus rau venous, txhaj cov nyiaj saum toj no hauv cov nyiaj tsim nyog rau hauv cov hlab ntsha. Tus nqi ntawm cov tshuaj txhaj tshuaj, nrog rau tus nqi ntawm cov kua dej, nyob ntawm qhov siab ntawm tus neeg mob me.
Sib ntausbronchospasm
Kev pab thawj zaug rau kev poob siab anaphylactic - algorithm ntawm kev ua los tiv thaiv bronchospasm:
- Oxygen therapy.
- Kev siv cov tshuaj Eufillin rau hauv cov hlab ntsha, ntawm tus nqi ntawm 3-5 milligrams ib kilogram ntawm tus menyuam.
- nqus tau nrog Salbutamol, Berotek.
Yog tias tus menyuam yaus ntsib kev ntxhov siab, siv Sibazon, Diazepam, Droperidol.
Kev tswj kom meej ntawm cov ntshav siab, qhov ua pa ntawm lub ntsws, thiab kev ua haujlwm ntawm lub plawv yog xav tau tas li.
Txoj kev cawm seej hauv Pediatrics
Yog tias tsim nyog, kev zaws lub plawv tsis ncaj ncees tau ua nrog rau kev ua pa. Ntau zaus nias ntawm lub hauv siab ntawm tus menyuam:
- txog rau ib xyoos - ntau dua 120 zaug hauv ib feeb, ua ke 1 ua pa - 5 nyem;
- ntawm ib mus rau xya xyoo - 100-200 zaug ib feeb, ua ke 1 ua pa - 5 clicks;
- tshaj xya xyoo - 80-100 zaug ib feeb, ua ke 2 ua pa - 15 clicks.
