Internal illnesses. Treatment of anaphylactic shock (most important)

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Internal illnesses. Treatment of anaphylactic shock (most important)

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56. TREATMENT OF ANAPHILACTIC SHOCK

In anaphylactic shock, it is necessary to quickly assess the patency of the airways, indicators of external respiration and hemodynamics. The patient should be laid on his back with raised legs. At a stop of breath and blood circulation immediately start cardiopulmonary resuscitation.

A tourniquet is applied above the injection site, every 10 minutes it is loosened for 1-2 minutes. A solution of adrenaline 1: 1000 is injected subcutaneously into the shoulder or thigh: for adults - 0,3-0,5 ml, for children - 0,01 ml / kg.

The injection site of the injected allergenic drug (with the exception of the head, neck, hands and feet) is chipped with 0,1-0,3 ml of adrenaline solution 1: 1000. In case of arterial hypotension, 1 ml of adrenaline solution 1: 1000 is diluted in 10 ml of saline, the resulting solution 1:10 is given intravenously over 000-5 minutes. After that, if necessary, an infusion of adrenaline 10: 1 can be carried out. For this, 1000 ml of adrenaline 1: 1 is diluted in 1000 ml of a 250% glucose solution. The initial rate of administration is 50 μg / min, in the absence of side effects, the rate increases to 1 μg / min.

To prevent the resumption of symptoms of an anaphylactic reaction, H1-blockers are prescribed: diphenhydramine - 1-2 mg / kg intravenously (for 5-10 minutes), intramuscularly or orally. A single dose should not exceed 100 mg. Then the drug is taken at 25-50 mg orally every 6 hours for 2 days.

Additionally, H2-blockers of histamine receptors can be prescribed: cimetidine is used in a dose of 300 mg (for children 5-10 mg/kg) intravenously slowly, intramuscularly or orally every 6-8 hours, ranitidine in a dose of 50 mg intravenously slowly or intramuscularly every 6-8 hours h or 150 mg orally every 12 hours (children 2-4 mg/kg). If arterial hypotension and breathing problems persist, the patient is transferred to the intensive care unit, where the following medication measures are carried out:

1) intravenous fluid infusion through a catheter with a maximum diameter: 5% glucose solution in 0,45% sodium chloride solution - 2000-3000 ml / m2 per day. Within 1 hour, 500-2000 ml of liquid is injected, for children - up to 30 ml / kg .;

2) for bronchospasm, b2-adrenergic stimulants are used: 0,5-1,0 ml of 0,5% salbutamol solution; if bronchospasm persists, aminophylline 4-6 mg/kg is administered intravenously over 15-20 minutes;

3) if there is no effect from the treatment, adrenergic stimulants are prescribed: norepinephrine intravenously, 4-8 mg of norepinephrine is dissolved in 1000 ml of a 5% glucose solution in water or saline, the maximum rate of administration should not exceed 2 ml/min if the patient is taking glucagon , additionally β-blockers are prescribed 5-15 mcg/min intravenously;

4) instead of norepinephrine, dopamine may be prescribed, more often in patients with heart failure: 200 mg of dopamine is dissolved in 500 ml of a 5% glucose solution, administered intravenously at a rate of 0,3-1,2 mg / kg per hour;

5) with a pronounced edema of the upper respiratory tract, tracheal intubation or tracheostomy is indicated;

6) corticosteroids are prescribed in the early stages: hydrocortisone is administered at a dose of 7-10 mg/kg intravenously, then 5 mg/kg intravenously every 6 hours, the duration of treatment is no more than 2-3 days;

7) after stabilization of the condition, the administration of liquid and medication continues for up to several days (depending on the severity of the condition).

Author: Myshkina A.K.

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Coffee hurts shopping 22.06.2022

People spend a lot of money while shopping, not only because they do it on an empty stomach and do not make a list, but also because they use caffeine.

If you're trying to cut down on impulse buying, a new study by experts has found that you should definitely refrain from drinking coffee.

A study by the University of South Florida found that caffeine affects not only what you buy, but also how much money you spend when shopping. The team of scientists conducted the experiment in retail stores, an industry that increasingly adds coffee shops near entrances.

In their study, experts found that shoppers who drank a cup of caffeinated coffee before going shopping spent about 50% more money and bought almost 30% more goods than those who drank decaffeinated coffee or water.

During the experiment, scientists installed coffee machines at the entrance to retail stores and home improvement stores in France and department stores in Spain.

“It is important to understand that caffeine, being a powerful stimulant that releases dopamine in the brain, excites the mind and body. As a result, a person becomes incredibly energetic, impulsive and less able to control himself, which leads to many unnecessary purchases and a lot of wasted money,” the host explained. study author Dipayan Biswas of the University of South Florida.

During the experiment, scientists installed coffee machines at the entrance to retail stores and home improvement stores in France and department stores in Spain. More than 300 shoppers received a free cup of coffee upon entry. One half drank coffee containing about 100 mg of caffeine, and the other half decaffeinated or water.

Then, leaving the stores, the participants shared their receipts with the specialists. For example, the team found that people who drank caffeinated coffee bought significantly more goods and spent more money than those who drank decaffeinated coffee or water.

People who drank a cup of caffeinated coffee before going shopping spent about 50% more money.

Moreover, scientists have found that caffeine also affects what kind of goods a person buys. Those who drank caffeinated coffee bought more non-essential items, such as scented candles and perfumes. However, the difference between the two groups was minimal when it came to essential items such as kitchen utensils or storage baskets.

After conducting another experiment that dealt with online shopping, the experts got similar results. They divided 200 business school students into those who drank caffeinated coffee and those who did not, and asked them to select items from a pre-prepared list of 66 options. As a result, those who used caffeine made more impulse purchases.

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