Anaphylactic Shock | Shock (Part 6)
Summary
TLDRIn this sixth lesson of the shock series, Eddie Watson delves into distributive shock, focusing on anaphylactic shock. He explains that it occurs when the immune system overreacts to an allergen, leading to a massive histamine release. The process involves sensitization after the first exposure and a severe reaction upon re-exposure. Symptoms include hypotension, swelling, increased heart rate, and bronchoconstriction. Treatment involves addressing airway, breathing, and circulation, administering epinephrine for its sympathetic effects, and considering IV fluids, antihistamines, corticosteroids, and albuterol to manage symptoms and prevent rebound reactions.
Takeaways
- 📚 The lesson is part of a series on shock, specifically focusing on distributive shock types.
- 👨🏫 Eddie Watson is the presenter for the series of lessons on shock.
- 🔔 Viewers are encouraged to subscribe and hit the Bell icon for updates on new lessons.
- 🔍 Distributive shock encompasses anaphylactic shock, neurogenic shock, and septic shock, each with unique causes but similar underlying mechanisms.
- 🌟 Excessive vasodilation and leaky blood vessels are common contributors to the shock state in distributive shock types.
- 🌱 Anaphylactic shock is initiated by an immune system response to allergens, which can be ingested, injected, or absorbed through the skin.
- 🛡️ Immunological reactions involve initial sensitization to an allergen, leading to the production of IgE antibodies that attach to mast cells.
- 🚨 Non-immunological reactions, like anaphylactic reactions, occur without prior sensitization and trigger a direct response from mast cells.
- 💊 The primary treatment for anaphylactic shock includes epinephrine to increase systemic vascular resistance and bronchodilation.
- 🩺 Additional treatments may involve IV fluids to replace leaked intravascular fluid, antihistamines, corticosteroids, and albuterol for respiratory support.
- 📈 The script provides a detailed explanation of anaphylactic shock, its causes, symptoms, and treatment modalities.
Q & A
What is the main topic of the sixth lesson in the series on shock?
-The main topic of the sixth lesson is distributive shock, which includes anaphylactic shock, neurogenic shock, and septic shock.
What are the common underlying causes of distributive shock?
-The common underlying causes of distributive shock are excessive vasodilation and leaky blood vessels.
What does the term 'anaphylactic shock' mean in the context of this lesson?
-Anaphylactic shock refers to a shock state that results from the immune system's response to an allergen, which paradoxically works against the body's own processes.
How does an allergen typically trigger an anaphylactic shock?
-An allergen can enter the bloodstream through injection, ingestion, or absorption through the skin, triggering a cascade of events that lead to a shock state.
What are the two types of anaphylactic shock causes mentioned in the script?
-The two types of anaphylactic shock causes are immunological, which requires sensitization, and non-immune mediated, which does not require sensitization.
What happens during the sensitization process in an immunological anaphylactic reaction?
-During sensitization, the allergen interacts with a B-cell, which produces antibodies (IgE) that attach to mast cells, preparing the body for a potential anaphylactic reaction upon future exposure to the allergen.
What is the role of histamine in an anaphylactic reaction?
-Histamine is massively released following an allergen's interaction with antibodies on mast cells, leading to systemic effects such as vasodilation, increased capillary permeability, bronchoconstriction, and decreased AV node conduction.
What are the typical signs and symptoms of anaphylactic shock?
-The typical signs and symptoms of anaphylactic shock include decreased blood pressure, swelling, increased heart rate, bronchoconstriction, flushing of the skin, itchiness, and rhinorrhea.
What is the first-line treatment for a patient with anaphylactic shock?
-The first-line treatment for a patient with anaphylactic shock is the administration of epinephrine, which helps to increase systemic vascular resistance and promote bronchodilation.
What other treatments are commonly considered for anaphylactic shock besides epinephrine?
-Other treatments for anaphylactic shock include IV fluids to replace leaked intravascular fluid, antihistamines (like Benadryl) targeting H1 receptors, H2 receptor antagonists (like Zantac), corticosteroids, and albuterol for bronchial smooth muscle relaxation.
Why might corticosteroids be administered in the treatment of anaphylactic shock?
-Corticosteroids are administered not for immediate reaction management but with the thought of preventing rebound anaphylaxis, although evidence supporting this is limited.
Outlines
📚 Introduction to Distributive Shock
The video begins with a welcome from presenter Eddie Watson, introducing the sixth lesson in a series on shock. The focus of this lesson is distributive shock, which encompasses anaphylactic, neurogenic, and septic shock. These conditions share similar underlying causes, leading to excessive vasodilation and leaky blood vessels. The video promises to delve into each type, starting with anaphylactic shock, and encourages viewers to subscribe and enable notifications for updates on the series.
🌟 Understanding Anaphylactic Shock
This paragraph delves into anaphylactic shock, a condition triggered by an immune system response to allergens. The term 'anaphylactic' is broken down into its root words, 'ana' meaning against and 'phylaxis' meaning protection, suggesting a protective response gone awry. The body's reaction to allergens, which can be ingested, injected, or absorbed, leads to a massive release of histamine. The causes are divided into immunological and non-immune mechanisms, with the former being more common. The immunological response involves an initial exposure that sensitizes the body by producing IgE antibodies, which then bind to mast cells. A subsequent exposure triggers a cascade of events, including cytokine release and histamine production, leading to systemic effects such as vasodilation, increased capillary permeability, bronchoconstriction, and decreased AV node conduction, culminating in shock.
🚑 Signs, Symptoms, and Treatment of Anaphylactic Shock
The paragraph discusses the signs and symptoms of anaphylactic shock, which include decreased blood pressure, systemic swelling, increased heart rate, bronchoconstriction, flushing, itching, and rhinorrhea. As shock progresses, additional symptoms typical of shock states may appear. The treatment approach for anaphylactic shock is outlined, emphasizing the importance of addressing airway, breathing, and circulation (ABCs), which may involve intubation and ventilation. Epinephrine is highlighted as the first-line treatment to stimulate a sympathetic response, increasing systemic vascular resistance (SVR) and promoting bronchodilation. Intravenous fluids are used to replace leaked intravascular fluid, and antihistamines like Benadryl target H1 histamine receptors. H2 receptor antagonists like Zantac may also be used, along with corticosteroids to potentially prevent rebound anaphylaxis, and albuterol for refractory wheezing. The paragraph concludes by underscoring the importance of recognizing and treating anaphylactic shock promptly.
👋 Conclusion and Future Lessons
In conclusion, the video provides a comprehensive overview of anaphylactic shock, its causes, symptoms, and treatment. The presenter thanks viewers for watching and encourages them to like the video and share their thoughts in the comments. They also invite viewers to watch the next lesson on neurogenic shock or explore other educational series on hemodynamics. The video aims to enhance understanding and provide valuable insights into managing anaphylactic shock.
Mindmap
Keywords
💡Distributive Shock
💡Anaphylactic Shock
💡Histamine
💡Immunological Response
💡Non-Immunological Response
💡Cytokines
💡Epinephrine
💡Intravenous (IV) Fluids
💡Antihistamines
💡Corticosteroids
💡Albuterol
Highlights
Introduction to distributive shock and its three types: anaphylactic, neurogenic, and septic shock.
Explanation of the underlying cause of distributive shock involving excessive vasodilation and leaky blood vessels.
Definition and breakdown of anaphylactic shock with its root words 'ana' meaning against and 'phylaxis' meaning protection.
Description of anaphylactic shock as a result of the immune system working against the body's own processes.
Mechanism of anaphylactic shock involving allergens, histamine release, and the immune response.
Differentiation between two causes of anaphylactic shock: immunological and non-immune mediated.
Process of sensitization following the first exposure to an allergen and the subsequent anaphylactic reaction.
Role of mast cells and antibodies (IgE) in the development of anaphylactic shock.
Effects of histamine binding to H1 and H2 receptors, leading to vasodilation, increased capillary permeability, bronchoconstriction, and decreased AV node conduction.
Signs and symptoms of anaphylactic shock, including hypotension, swelling, increased heart rate, and bronchoconstriction.
Importance of focusing on patient's ABCs (airway, breathing, circulation) in the treatment of anaphylactic shock.
First-line treatment for anaphylactic shock with epinephrine to increase SVR and promote bronchodilation.
Administration of IV fluids to replace fluid lost due to leaky vessels in anaphylactic shock.
Use of antihistamines like Benadryl targeting H1 histamine receptor sites in the treatment of anaphylactic shock.
Consideration of medications like Zantac and corticosteroids in the management of anaphylactic shock.
Discussion on the potential use of albuterol for relief in refractory wheezing during anaphylactic shock.
Summary of anaphylactic shock, its causes, symptoms, and treatment strategies.
Transcripts
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[Music]
all right welcome everybody I want to
welcome you to our six lesson in the
series of lessons on shock and in this
lesson we're going to begin our dive
into the category of shock types that we
refer to as distributive shock and my
name is Eddie Watson and I am gonna be
your presenter for this series of
lessons and so as always in order to
stay up to date on our lessons as they
become available make sure and subscribe
to our channel below and also don't
forget to hit that Bell icon in order to
be notified when those new lessons
become available okay so when we talk
about distributive shock we're really
talking about three different types of
shock States we can divide that up into
anaphylactic shock neurogenic shock and
septic shock now each of these types of
shock has their own causes and unique
pathophysiology but essentially the
underlying cause for the shock state
it's going to be very similar and so
what's going to end up happening in
distributive shock is you're going to
end up with excessive vasodilation as
well as you're gonna have leaky blood
vessels and so again for the three types
of distributive shock that we're going
to talk about they all are going to
achieve this as well as other things
through different processes but these
two things that excessive vasodilation
and the leaky blood vessels are what's
going to contribute to that shock state
all right and so with that said let's go
ahead and move on to the first type of
distributive shock that we are going to
talk about and that is going to be
anaphylactic shock and so like with all
the rest of these that we've done we are
going to break this down into its root
words which we can break down into Anna
and flexus Anna essentially means
against and flexes is protection
and so really you can think about
anaphylactic shock as being a shock
that's a result of our immune system so
our body's protection system but at this
point it's now working against our own
body and our own processes and so really
to sum up what's happening in
anaphylaxis is you end up with some sort
of allergen and when the body sees this
and responds to this you end up with a
massive release of what we call
histamine and so this allergen can
really come in many forms it can be
either something that's injected it can
be ingested or it can even be absorbed
through the skin but essentially the end
result is that that allergen will enter
into the bloodstream and trigger a
cascade of events that will ultimately
lead to a shock state and these
allergens can come in many forms it can
be food allergies such as peanuts or
shellfish it can be from bee stings or
even medications that we give and so now
if we look at the causes for
anaphylactic shock there's essentially
two types which we are going to break
down further here in just a minute the
first and most common one is going to be
the immune illogic and this is going to
be what we refer to as anaphylaxis and
the second one is going to be our
non-immune illogic and this is what
you're going to hear referred to as
anaphylactic
anaphylaxis or the immunological
response is going to be the most common
all right so at this point let's go
ahead and talk about what's actually
happening inside of our body with these
reactions so here we're going to go
ahead and draw out a blood vessel and so
the first one we're going to talk about
is our immune illogic reaction or the
anaphylaxis
so essentially you end up
this allergen that has now entered into
the bloodstream and so the first time
that your body sees this what's going to
happen is it's going to interact with a
b-cell and the whole purpose of this
b-cell is to recognize this allergen and
to create these proteins that we call
antibodies and they're essentially these
why look and proteins and they're also
referred to as IgE and these antibodies
main purpose is to be able to interact
with the allergen and so what happens
after this first exposure in the
creation of these antibodies is these
antibodies will go and they'll attach to
our mast cells and these mast cells are
really what's known as our immune system
mediators and so when this happens in
this process goes through its course
this is what we call being sensitized
and so in order for this reaction to
progress to an anaphylaxis reaction or
anaphylactic shock as we're actually
going to have to have another exposure
to this same allergen and so once again
the allergen will enter into the blood
system and now what will happen is that
allergen will actually go and because of
these antibodies that were produced and
what will happen as the allergen will go
ahead and bind to one of the antibodies
on one of the mast cells and this is
really where the cascade of events
begins to take place and so the first
thing that happens is it's going to
release these cytokines and the whole
point of these cytokines is to recruit
our white blood cells and so when these
white blood cells and mast cells come
together what you're gonna get is a
massive release of histamine and so it's
going to happen as this histamine is
going to bind with a couple histamine
receptors we have our our h1 and our h2
receptors and so when the histamine
binds with these receptor sites each
one's going to have their own unique
response and so when we talk about the
h1 receptor site the first of these that
we're going to see
is an increase in our capillary dilation
and so really if we go back to our blood
vessel here if we think about that we're
talking about an increase in the size of
this capillary and so this is going to
cause these vessels to dilate out which
is going to increase their size and
again you've got to think that this is
happening systemically throughout the
entire body and so this is going to
ultimately lead to a massive drop in our
systemic vascular resistance which
essentially means we are going to have a
massive drop in our blood pressure so
the next thing that we're going to see
is an increase in our capillary
permeability and so what's happening is
these cells in the endothelial lining
the spacing in between them is going to
start to open up and this is going to
cause fluid from our intravascular space
to leak out of our blood vessels and
when this fluid leaks out and collects
up out here this is going to cause
swelling and once again this is
happening throughout the entire body so
you're going to have swelling throughout
the entire body the next thing that
we're going to see specifically with the
h1 receptors is we're going to see an
increase in the bronchial smooth muscle
cell contraction and so in the lungs
what you're gonna see is
bronchoconstriction and so when you take
this combined with the swelling that
you're also going to see as a result of
those leaky blood vessels around the
airway this is where you're going to
begin to really get concerned for your
patients ability to support their own
airway and finally the fourth and last
thing that we will see as a result of
the h1 activation is you're going to see
a decrease in the conduction of the AV
node so now with our h2 receptor site
active the first you're gonna see an
increase in our gastric acid product
production and so you're gonna have a
buildup of the gastric acid in your
patient this could also lead to nausea
and vomiting for them and ultimately an
aspiration risk but the other thing that
you could also see as a result of this
is our vascular smooth muscle
relaxation and so again this smooth
muscle relaxation is going to lead to a
further decrease in our SVR and
ultimately a further decrease in our
patient's blood pressure and so that
essentially is what's going on with the
immunological response and what is
ultimately leading to our shock state
now for the second cause this is our non
amino logic or what we call the
anaphylactic response the important
distinction to note with the
anaphylactic
is unlike the anaphylaxis reaction this
doesn't require an initial sensitization
so essentially what happens is again we
have some sort of allergen that enters
into the bloodstream but what happens in
this case is this allergen is gonna
interact directly with a receptor on the
mast cell and this is again gonna
trigger that same cascade of events of
releasing cytokines and recruiting white
blood cells ultimately leading to the
massive release of histamine and
ultimately the same concerns and
conditions that would lead to the state
of shock that we just discussed again
very important to note though that the
anaphylactic reaction can happen on the
first time a person is exposed to this
particular allergen as opposed to with
the anaphylaxis reaction they're going
to have to have that initial exposure in
order to be sensitized and then have a
second exposure in order to trigger this
cascade of events and so now let's go
ahead and talk about some of the signs
or symptoms that your patient might
exhibit and so just like with every
other type of shock you're gonna have a
decreased blood pressure or hypotension
the other important sign that you're
going to see massively and systemically
with your patient is that swelling as
the body attempts to compensate for this
hypotension you're going to see an
increased heart rate and again as a
result of the histamine release you're
going to have the bronco construction
they may also have flushing of the skin
itchy Ness and rhinorrhea
which is a runny nose and again as the
shock state progresses and continues you
will see all the typical signs that you
would see in a patient who is exhibiting
shock which we did cover in the first
lesson and so finally now let's go ahead
and move on to our treatment and so for
our treatment there's going to be
several things that we're going to be
looking for or trying to do and so the
first of these and probably the the most
important is as you can remember with
this type of shock one of the things
that you're most notably going to see is
is that swelling throughout the entire
body and particularly that combined with
our bronchoconstriction that we're
really going to be concerned for our
patients airway so we're going to make
sure we're focusing on our patients ABCs
so airway breathing circulation and this
ultimately could mean intubation and
ventilation
now for really our first line treatment
for a patient with anaphylactic shock
is going to be the initiation of
epinephrine and so here what we're
really looking for is that sympathetic
response and so here we're going to be
looking for that constriction of blood
vessels to increase our SVR as well as
we're going to be looking for the
response of the bronchodilation and
these two things are going to work to
open our patient's airway as well as
supporting their blood pressure and when
we talk about the administration of
epinephrine the first line is to go with
the intramuscular injection and then if
we find ourselves in a state of
cardiovascular collapse that hasn't been
responsive to the I M injection then
that's when we might consider IV form of
the medication as well so next we're
going to want to look at giving our
patients IV fluids and so think back to
those leaky vessels the fluid has
shifted out of the intravascular space
and so we want to look to replace that
and we also might look at giving them a
medication in the class of an
antihistamine and our primary medication
is going to be directed at the h1
histamine receptor sites so this is
going to be our benadryl and other
things of that sort but you may also
find times we're giving a medication
that has an impact on the h2 receptor
sites and this would be something like a
zantac which is normally going to be
used to reduce the gastric acid
production but in the cases of
anaphylaxis it can also be used in
conjunction with our h1 antihistamines
and finally a couple other things you
might see is the application of
medication such as our corticosteroids
the important thing to know is steroids
aren't going to have any impact on the
reaction that's currently going on there
is some thought around the prevention of
rebound anaphylaxis but there really
hasn't been a whole lot of evidence to
support this but this is often a common
course of treatment especially
considering that as many as 20% of
patients can have a rebound and
Laxus reaction and so finally one of the
more common medication Jame also see is
going to be our albuterol
now while this medication in the midst
of the anaphylaxis reaction is not going
to relieve that bronchial smooth muscle
contraction in a patient who's having
refractory wheezing and having
difficulty breathing it may provide them
some relief alright so that sums up our
discussion on our anaphylactic shock and
again we talked about how this is a
result of an interaction with an
allergen leading to a massive release of
histamine which ultimately leads to our
shock state we talked about the two
different causes immunological
non-immune illogic as well as the signs
and symptoms that you would look to see
if you had a patient who was in
anaphylactic shock and finally we talked
about some of the treatment modalities
that you would be looking to do for your
patient I do hope that this explanation
has helped to make this a little bit
more understandable for you and as
always I do want to thank you for
watching this video and I hope you found
this lesson useful for you now please if
you do like the video and you did find
it useful make sure and hit that like
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get the word out about our Channel and
in the comments below tell us your
favorite part of this video as well as
feel free to ask any questions that you
may have finally make sure and check out
the next lesson in our series which is
going to be on neurogenic shock or you
can also check out another one of our
great series of lessons on hemodynamics
thank you so much for watching and we'll
see you in the next lesson
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