Diagnosis & management of

anaphylactic shock

Fajar Waskito
Symptoms & pathologic feature of anaphylactic &
proposed mediator
Symptoms Pathologic Mediator
Urticaria, Vascular Histamine &
angioedem, permeability Eicosonoid
laryngeal & intestinal
edem
Flushing, headache & Vasodilatations Histamine &
Hypotension Eicosonoid
Palpitations Arrythmias Histamine &
Eicosonoid
Rhinorrhoe & Mucous secretion Histamine &
bronchorrhoe Eicosonoid
Epidemiology
Incidence annualy 21/100.000 persons
Atopy, Food, Medication, sting
13.230 admissions for ananphylaxis (UK-10 years)
214 death for anaphylaxis (UK-10 years)

Why should we know anaphylactic?

Can be fatal
Unpredictable & suddenly
Can happen anywhere
Frequency tends to increase
Medico legal?
Anaphylactic is severe, life threatening,
systemic hypersensitivity reactions
 Anaphylactic

Allergic Non Allergic

Physical Others
Excercise, cold Drugs

Ig E Mediated Non Ig E Mediated

Ig E, FcRI Blood products
Foods Immune aggregates
Venoms Drugs
Latex
Drugs
Grading of anaphylactic according to severity of
clinical symptoms
Grade Symptoms

Dermal Abdominal Respiratory Cardiovascular

I Pruritus, Flush,
urticaria, angioedem
II Pruritus, Flush, Nausea Rhinorrhoe Tachycardi
urticaria, angioedem Cramping Hoarseness (>120)
(not mandatory) Dyspneu Tens change (>20
systolic)
Arrythmia
III Pruritus, Flush, Vomiting Laryngeal edem Shock
urticaria, angioedem Defecation Bronchospasm
(not mandatory) Diarrhea Cyanosis
IV Pruritus, Flush, Vomiting Respiratory Cardiac arrest
urticaria, angioedem Defecation arrest
(not mandatory) Diarrhea
 Anaphylactic fatal
Recognize the symptoms
Know and avoid the triggers
Have an emergency action plan
Treat it promptly & appropriately