Life threatening hypersensitive drug reaction, which develops within seconds to minutes of exposure to a drug.
- Skin – erythema, intense pruritis, wheals, perspiration.
- Head/Neck/Oral – difficult phonation, angioedema of lips, tongue and throat. Conjunctivitis, vasomotor rhinitis, “hair on end” phenomena.
- Pulmonary – dyspnea, exaggerated rapid breathing with use of accessory muscles, high pitched crowing sounds (stridor) or no sounds from the patient, wheezing, peripheral cyanosis.
- CNS – increased anxiety, loss of consciousness.
- Cardio-Vascular – chest pain, tachycardia, hypotension, arrhythmias, cardiac arrest.
- Gastro-Intestinal – nausea/vomiting, fecal/urinary incontinence.
- stop dental treatment
- remove any loose items from the oral cavity
- alert emergency medical services (EMS)
- lie the patient flat; possibly elevate patient's legs if breathing is not impaired
- check, assess and record vital signs
- deliver O₂ with a full face mask
- administer a bronchodilator, such as an β₂-agonist inhaler (albuterol) x 2 puffs
- if available, provide “wide open” IV fluids (normal saline or D5/1/2 [Dextrose 5% in 1/2 normal saline]
- administer epinephrine (0.3 ml of 1:1,000 IV, IM, Sub Cut., or consider an “epi-pen”), injectable steroid (Solu-Medrol 125 mg IV, IM, Sub Cut.), histamine blocker (diphenhydramine 50 mg IM, Sub Cut.)
- initiate basic life support (BLS) and start cardiopulmonary resuscitation (CPR)
- perform a crico-thyroidotomy, if necessary and if qualified
Type I allergy from exposure to an allergen/drug. Mediated by IgE antibodies.
Histamine-inflammatory mediators released upon exposure to an allergen, which affects all systems adversely, particularly skin, gastro-intestinal, pulmonary, cardio-vascular, and central nervous systems.
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