MILITARY PHARMACY AND MEDICINE

© Military Pharmacy and Medicine • 2012 • 4 • 71 – 76systemic excretion of myoglobin, potassium andother products released by damaged tissues.Patients with serious thermal injuries oftenrequire surgical intervention.Further management and prognosisImmediate commencement of resuscitation inyoung patients with cardiac arrest caused by electricshock often brings positive outcome. Thereare reports of effective resuscitation even afterprolonged ALS. All patients after serious electricshock and patients with circulatory or respiratoryproblems, loss of consciousness, cardiac arrest,electrocardiographic abnormalities, soft tissueinjuries and burns require hospital monitoring.Anaphylactic shockIt seems that phenomena related to anaphylaxisare increasingly more common. It is certainlyassociated with growing frequency of allergiesover the course of two or three past decades.Radosław Ziemba: Cardiac arrest under special … Part II: poisoning …blood pressure and are rarely caused by primaryheart disease or intravenous administration ofadrenaline. Anaphylactic reactions present withvarious degrees of severity and can developquickly, slowly or, rarely, in a biphasic manner.Rarely, symptoms may be delayed (it happens incase of latex allergies) or persist over 24 hours.Such reactions may be associated with expositionto various agents. The most frequent causesinclude insect bites, reactions to drugs, contrastagents or some foods. Peanut and hazelnut allergiesare particularly dangerous.Muscle relaxants can induce anaphylaxis andanesthetic agents constitute an important causeof anaphylactoid reactions. Absence of establishedsymptoms and wide scope of clinical picturecan pose diagnostic difficulties. In any case,it is necessary to acquire full medical history(with particular focus on past allergic reactions)and perform physical examination. Special attentionshould be paid to the condition of the skin,heart rate, blood pressure, upper airways andauscultation.Diagnosis of anaphylactic reactionsThere is no generally accepted definition of anaphylacticreaction. The term “anaphylaxis” usuallyrefers to immoglobulin E (IgE)-mediatedhypersensitivity reactions occurring in typicalsituations. Anaphylactoid reactions are similar,but are not associated with hypersensitivity. Forsimplicity, we will use the term anaphylaxis forboth types of reactions unless they are clearlydistinguished. Their symptoms and managementare similar, so this distinction is only importantwhen considering further treatment. Bothof those reactions may be associated with variousdegrees of angioedema, urticaria, dyspneaand hypotension. Some patients die due to acute,irreversible bronchospasm or laryngeal edema.Among other symptoms are the following: rhinitis,conjunctivitis, abdominal pain, vomiting,diarrhea, sense of unrest. There is usually skindiscoloration: patient’s face becomes red or pale.Cardiovascular depression is a common symptom,particularly when it comes to reactions tointravenous agents or insect stings. It is caused byvascular dilatation and movement of plasma intothe extravascular space. Circulatory failure orarrhythmias are associated mainly with a drop inhttp://military.isl-journals.comIf possible, peak expiratory flow should be measuredand documented. Distinguishing betweenanaphylaxis, panic attack or vasovagal episodecan be sometimes difficult. All of these phenomenacan occur, e.g. after vaccination. Full clinicalassessment facilitates making this distinction.Comments on managementThere is a common agreement that adrenaline isthe most important drug used in managementof anaphylactic reactions. As an alfa receptorantagonist, it abolishes peripheral vessel dilatationand reduces the edema. Its activity towardbeta-receptors causes airway dilatation, increasescontractility of cardiac muscle and inhibits histamineand leukotriene release.Adrenaline is most effective if administeredimmediately after the occurrence of a reaction,but is not devoid of risk, particularly when givenintravenously. Intramuscular adrenaline is avery safe drug. Undesirable effects are incrediblyrare and the only case of myocardial infarctionfollowing its intramuscular administrationinvolved a patient with high risk of coronaryartery disease. At times, there is doubt whetherthe complication (e.g. myocardial ischemia) is a71