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Anaphylaxis

Anphylactoid Anaphylaxis shock Allergic related conditions

Classic Anaphylaxis

hipersensitivitas Ig E & Ig G sensitisasi thd allergen antigen specific immunoglobulins Anaphylaxis : Severe,acute systemic allergic reaction, ditandai dgg keterlibatan berbagai fungsi organ ;
Cardiovasculair Airway & breathing Skin & GI Tract

anaphylactoid reaksi anaphylaxis tp non-immunologi gjl klinis dose-dependent anaphylaxis shock shock akibat kolap sistem cardiovasculer pd reaksi anafilaxis allergic related condition keadaan klinis akibat alergi mirip anafilaxis : asthma, urtikaria , angioedema, dll

Etiologi sensitisasi terjd stlh exposure allergen


Food Vaccines Latex Insect stings & bites Pollens & non pollen extracts Drugs :

Drugs :
Antibiotika NSAID Kontras Radiologi Insulin : bovine > porcine > human Protamine Anestesi lokal Pelemas otot dan obat GA

Manifestasi klinis
Respirasi ;
Upper : stridor ,hoarseness, wheezing insp, insp t swollen ; lips, uvula,tongue Lower : wheez exp, exp t, breath sounds Tanda vital ; RR, oksigenasi & SaO2

Gejala : sesak, gelisah, kebiruan, batuk Hemodynamic ; shock


Hipotensi, takhikardi s/d TTU & TTB Signs : pallor, ekstrimitas dingin, pulsasi lemah, mottling, capillary refill EKG monitor : SVT aritmia, iskhemi/infark miokard

Skin ;
Gejala ;Gatal, kemerahan Sign ; urticaria, angioedema pd lips, neck, eye, face, diaphoresis

GI T ;
Gejala ; mual / muntah, cramp & nyeri perut Sign ; diare, emesis

Neuro ;
Gejala ; headache,dizziness, confusion Sign ; syncope, delirium

Nasal ; sneezing, pruritus, rhinorrhea Haematologi ; hemoconsentrasi , DIC

Tata laksana : 1. Primer / immediate Remove offending agent Call for HELP ( activate blue code ) O2 high flow dg masker > 10 lpm maintain airway / keep open the airway Head down epinephrine / adrenaline injeksi IV / IM / SC berikan 0,3 0,5 mg ( 1 : 1000 ) ulang bila perlu 10 15 mnt Pasang infus diameter terbesar yg bisa masuk berikan koloid / kristaloid 10 cc / kgBB/grojok

2. Sekunder
Bila bronkhospasme tdk membaik stlh adrenalin berikan salbutamol dg dosis
Loading 250 microgram / iv Maintenance 5 20 microgram / mnt Atau aminophyllin 6-8 mg/kgBB selama 20 mnt

Bronkhospasme disertai shock


Hidrocortisone 300 mg/iv atau methylprednisolone 2 g/iv

Bila msh shock , infusi 1 2 ltr/grojok Infusi intropik / cathecolamine ;

Adrenalin 5mg/500 cc cairan ( 10 mcg/ml ) berikan 10 85 cc/jam Noradrenalin 4mg/500 cc cairan ( 8 mcg/ml ) berikan 25 100 cc/jam Dopamine 5 15 mcg/KgBB/mnt

Antihistamine ; chlorpheniramine 20 mg encerkan/ iv pelan Obat2 an lain;


H1 blocker diphenhydramine 50 mg / iv H2 blocker ranitidine 50 mg / iv

Bila tlh lbh 20 mnt perbaikan tdk adequat boleh diberikan Nabic 1 2 mEq/kgBB/bolus

Pencegahan
hindari penggunaan agent penyebab sesuai anamnesa Desensitsasi Gunakan radiokontras dg osmolaritas rendah Bl tak mungkin dihindari berikan ;
Berikan korticosteroid dan H1 blocker Bila perlu ephedrine

Test diagnostik Testing tdk perlu bl jelas ada riwayat Bukan jaminan ( ingat anaphylactoid !)

Komplikasi :
1. 2. 3. 4. Respirasi : resp arrest, aspirasi, odema paru CV : shock, MI, MOF. Neuro : syncope, seizures,delirium Kulit : sekunder infeksi