The four golden first aid steps for anaphylactic shock that everyone should learn

Immediately cut off contact with allergens, immediately intramuscularly inject 1:1000 epinephrine, lay the patient down while dialing 120, and observe physical signs throughout the process and perform cardiopulmonary resuscitation if necessary. If you do these four steps correctly, the survival rate can increase to over 90%. Even if you have no medical background at all, you can get started quickly.

I still get scared when I think about the case I encountered while working the night shift in the emergency department last week: a 16-year-old girl went to eat Japanese food with her friends and took a bite of tempura wrapped in chopped peanuts. Within two minutes, her face turned red, she couldn't speak, and she waved her hands because she was holding back. Her friends who were traveling with her were so panicked that they handed her ice water to help her breathe, and supported her against the wall and patted her back. By the time she was sent to the hospital, she was already unconscious and her larynx was swollen to the point where a laryngoscope could not be inserted. Fortunately, there was an asthma patient in the traveling party who brought an epinephrine pen with him, and he pricked her thigh on the way, thus gaining time for rescue.

Many people's understanding of allergy first aid is still limited to "taking loratadine". This is true in ordinary allergy scenarios where there are only rashes, itching, and non-suffocation. But when it comes to the shock stage of dizziness, breathlessness, loss of speech, and drop in blood pressure, antihistamines are only auxiliary, and even feeding the medicine may delay time and cause aspiration. Adrenaline is the only first-line rescue drug. This point of domestic and foreign guidelines has been unified for many years, but many popular sciences still put taking anti-allergic drugs as the first priority. If the priorities are reversed, big trouble will occur. I've also read about Hijikata saying that people with anaphylactic shock need to pinch people's philtrum or prick their fingers to bleed. It really makes people frown. You can't pinch people to open up the swollen and blocked respiratory tract, right? Don't believe these heresy if you really encounter the situation.

Talking about the first step of cutting off allergens, many people's first reaction is to "induce vomiting if they eat it, and pull out the needle if it's transfused." In fact, there are many practical details to pay attention to here: if you are suffering from allergies caused by intravenous infusion, don't pull out the indwelling needle at the same time, just pull out the front end of the infusion tube. Later, when you get to the hospital for rescue, you will have to use this channel to administer medication. If you pull it out, it will waste time to re-tie it.； If you are allergic to something you eat, don't force people to dig their throats to induce vomiting. People in a state of shock have poor swallowing reflexes, and the food residue that induces vomiting can easily choke the airway and cause suffocation. The gain outweighs the loss. Just don't touch the remaining allergens. ； If you are exposed to inhaled allergens such as pollen or paint, just help the patient to a clean and ventilated area. Do not toss the patient back and forth.

The next most critical thing is to inject epinephrine. There are many popular sciences on the Internet now that say to inject the deltoid muscle of the arm. In fact, the latest guidelines recommend intramuscular injection in the anterolateral thigh. The muscles in this location are thick and the absorption rate is twice that of the arm. It can be administered to both adults and children. The normal dose is 0.3~0.5mg. If the symptoms are not relieved after 15 minutes, you can give it another injection. Many people are worried that "I'm not a doctor, will something happen if I get the wrong injection?" To be honest, the mortality rate of anaphylactic shock can reach 15%. Even if your judgment is slightly wrong, you will be a little flustered and your hands will shake after the injection, and it will be metabolized in half an hour. It is better than losing your life. Of course, if you only have a few scattered rashes that don’t itch or hold back, don’t treat them blindly or turn a small problem into a big trouble. The epinephrine pens available on the market now are basically pre-filled with a concentration of 1:1000. They can be inserted directly into the outer thigh without adjusting the dosage. Families with a history of severe allergies can definitely prepare one.

After the injection or if you really can't find epinephrine, don't help the person sit up, let alone let him stand and walk. Many people find it "comfortable to sit up because they are so suffocated". However, during anaphylactic shock, the blood pressure is already low, and the blood supply to the brain will be worse when sitting up, and it is easy to faint and aggravate the symptoms. It is best to lie flat with your feet slightly propped up on a bag or your coat raised about 15 degrees to increase the amount of blood returned to the heart. If you are really suffocating too much, you can lift your upper body a little, but never sit upright. If the patient is unconscious, turn his or her head to one side to prevent vomitus from getting into the trachea. When calling someone, don’t just shout vaguely “Help”, directly say “Someone is in anaphylactic shock, do you have an epinephrine pen? Please call 120 for me and tell me the specific address! ”, clear instructions are much more useful than vague calls for help, and there won’t be a bunch of people surrounding you not knowing what to do.

For the rest of the time waiting for the ambulance, don't stand there. Feel the carotid artery for beating and chest heaving every few dozen seconds. If he suddenly loses breathing and pulse, do cardiopulmonary resuscitation immediately. Don't wait for the medical staff to come. The golden 4 minutes of cardiac arrest are in your hands. I met a primary school teacher before. During a spring outing, she encountered a student who suffered from peanut allergic shock. She kept pressing CPR for 12 minutes while the ambulance was stuck on the road. In the end, the child was rescued without any neurological sequelae. She handled the situation very beautifully.

I have been in the emergency department for almost 10 years, and I have seen too many cases that could have been saved. Either they were delayed for 10 minutes by giving anti-allergic drugs blindly, or they did not dare to take epinephrine and waited for the ambulance, and finally missed the golden time. Really, these four steps are not complicated, and you don’t even need to memorize too many precise numbers. As long as you know “don’t give medicine blindly, give priority to adrenaline, don’t let him sit, and call 120 immediately”, it is enough to save a life. After all, no one knows which will come first, tomorrow or the accident. If you remember one more knowledge point, you might be able to help the people around you one day.