药物过敏试验和过敏反应的处置VIP免费

药物过敏试验及过敏反应的处理MedicationallergytestandmanagementofallergicreactionTracyZhaoContent•Penicillinallergytest•Streptomycinallergytest•Tetanusallergytest•Cephalosporinallergytest•Iodineallergytest•Procaineallergytest学习目标•掌握青霉素过敏试验方法、结果判断、过敏反应的临床表现、预防和急救处理原则。•掌握TAT脱敏注射法。•熟悉青霉素过敏反应的原因。•熟悉链霉素、破伤风抗毒素、普鲁卡因、碘过敏试验的方法及结果判断。Casestudy：Onepatienthasgotpenicillinskintest5minbefore,nowhesuddenlyfeelschesttightness,shortnessofbreathwithpale,coldsweat,hisbloodpressureisat10/7.0Kpa(75/52mmHg),pulseisweak.Whatisthisphenomenon?Howdoyoumanageitifyouareanurseonduty？.MnagementofAllergicshockMnagementofAllergicshock•Themostseverealergicreactionisalsocalledanaphylaxisoranaphylacticshock1.stopmedicine.2.give0.1%adrenaline(epinephrine)viasubcutaneousinjection.3.oxygeninhalation.4.anti-allergy5.correctionofacidosis.6.expandbloodvolume.7.resuscitation.8.closeobservationofdiseaseThesoonerthatepinephrineisgiven,thegreaterthechanceforsurvival过敏反应的处理过敏反应的处理过敏反应的处理过敏反应的处理Thetreatmentonanaphylacticshockmustbeprompt,graspeveryminuteandsecond,startrescuewithoumoving,adopteffectivemeasuresandcloseobservation•Havethepersonlieflat,raisehisfeet,andcoverhimorherwithawarmblanket.giveoxygen•Giveinjectionof0.1%epinephrine0.5~1mlatonce•Ifsymptomsisnotremission,give0.1%epinephrine0.5mleveryhalfhour.•Ifcardiacarrestisoccurred,startCPRimmediately•肾上腺素是抢救过敏性休克的首选药物，具有收缩血管、增加外周阻力、提升血压、兴奋心肌、增加心输出量以及松弛支气管平滑肌等作用Giveoxygentoimprovehypoxia.conductmouth-to-mouthartificialrespirationifRespiratoryarrest,giverespiratorystimulantNikethamide,lobelineviaintramuscularinjection•asphyxiainducedbyLaryngealedema,shouldperformendotrachealintubationortracheotomyandconnectartificialrespiratorassoonaspossible•Antiallergytreatment.•Givedexamethasone5~10mgorhydrocortisonesodiumsuccinate200~400mgin5%~10%glucosesolution500mlviaintravenousinfusion•Giveantihistaminedrugs,promethazinehydrochloride25~50mgordiphenhydramine40mgviaintramuscularinjectionsGiveintravenousinfusionof10%dextroseorRinger'ssolution.•accordingtodoctor'sordersgivedopamineornorepinephrineviaintrvenousinfusionCorrectionofacidosis•AcupunctureofNeiguanZusanli,,CloseobservationandrecordingV/S,urinaryoutput,consciousness.DonotmovepatientbeforeheisnotoutofdangerEvaluatetreatmenteffect,andprovidethebasisforfurthermanagement发生机制发生机制青霉素机体皮肤、消化道、呼吸道症状及过敏性休克等组织胺缓激肽5-羟色胺血管扩张通透性增强平滑肌收缩腺体分泌增加全抗原IgE肥大细胞嗜碱性粒细胞青霉素过敏反应青霉素过敏反应的预防青霉素过敏反应的预防family幻灯片11,alergic,medicationalergictestAccuratetestsolution\StrictlymastermethodCorrectlyjudgresults现用现配药液每次注射后观察半小时做好急救的准备减少青霉稀酸的产生,防止过敏反应的发生;防止青霉素水溶液的效价在室温中下降,影响治疗效果•N:Mr.Zhao,youhavegotpneumonia.We’llgiveyousomepenicillininjections.First,I’llgiveyouapenicillinallergytest.Haveyouusedpenicillinbefore?•P:Yes,Ihave.•N:Areyouallergictoit?•P:No,never.•N:Isthereanybodyelseinyourfamilyallergictoit?•P:Ithinkthereisnobody.•N:Areyouallergictoanyotherdrugs?•P:No.•1.Allergicshock1.Allergicshock•2.Serumsicknessreaction2.Serumsicknessreaction•3.Theallergicrea...