Prehospitalno zbrinjavanje anafilaktičke rekacija nakon uboda insekta - prikaz slučaja iz ambulante hitne pomoći

Abstract

Introduction/Objective Insect stings are the second most common cause of allergic reactions and anaphylaxis. Allergic reactions after insect stings (bee, wasp, hornet) can vary from local skin changes to fatal anaphylactic reactions. The objective of the article is to present prehospital treatment of an anaphylactic reaction after an insect sting in the Infirmary of the Municipal Institution for Emergency Medical Aid. Case study Half an hour before coming to the Infirmary, the 22 year old patient felt sharp pain and a burning sensation in the neck area. The pain occurred as a result of being stung by an insect, probably a hornet. The physical examination found him to be mildly disoriented, dyspneic, afebrile, sweaty and tachycardic, with pale skin and mucous membranes. His eyelids, lips, tongue and uvula were swollen. At the site of the sting (the back side of the neck) a nodus had developed measuring 3x3cm surrounded with a skin edema measuring 10x10cm and erythema. The skin of both upper and lower extremities, as well as the torso, was covered with generalized urticaria. Based on patient's history and physical findings, the diagnosis of anaphylactic reaction was made. As the first line of therapy, the patient received an intramuscular injection of Adrenalin 500μg (0,5ml diluted to the ratio of 1:1000) in the anteromedial region of his thigh. He was given oxygen by mask (6l/min) and 1000ml of Ringer's solution. After initial stabilization, the patient received the second line of therapy: antihistamines (H1 and H2 antagonists) and a slow i.v. injection of Methylprednisolone. The patient's vital signs had stabilized after the initial treatment and he was transferred by ambulance, while being constantly monitored, to the Emergency Center where he was kept under close observation for the next six hours. He was then discharged in good health, with the advice to submit to additional allergology testing. Conclusion: This case study of an all too common situation in prehospital settings accentuates the need to be familiar with protocols for anaphylactic reaction treatment and their implementation in every day work.