Describe in detail the R.E.P.A. I.R. protocol for patient management for anaphylactic shock ( anaphylaxis)
in medical emergency situation (at dental clinic). All sections of R.E.P.A.I.R must be discussed.
R: recognized signs and symptoms
E: evaluate patient’s level consciousness
P: place, position (how to placed the patient)
A: activate the CABs of CPR by checking the circulation, airway, breathing
I: implement appropriate emergency protocol for anaphylactic shock
R: Refer patient to healthcare professionals (what would you should do with patient at that time: advice, call 911,..etc)
The R.E.P.A.I.R. protocol is a structured approach for managing medical emergencies, including anaphylactic shock, in a dental clinic setting. Here’s a detailed breakdown of each step:
### **R: Recognize Signs and Symptoms**
The first step is to identify the signs and symptoms of anaphylaxis, a severe and potentially life-threatening allergic reaction. Common signs and symptoms include:
– **Skin reactions:** Urticaria (hives), itching, flushing, or angioedema (swelling, especially around the face, lips, eyes, and throat).
– **Respiratory symptoms:** Wheezing, difficulty breathing, stridor (a high-pitched sound during breathing), and chest tightness.
– **Cardiovascular symptoms:** Hypotension (low blood pressure), dizziness, fainting, or weak and rapid pulse.
– **Gastrointestinal symptoms:** Nausea, vomiting, diarrhea, and abdominal pain.
– **Neurological symptoms:** Anxiety, confusion, or loss of consciousness.
Quickly recognizing these signs is critical to prompt intervention.
### **E: Evaluate the Patient’s Level of Consciousness**
Assess the patient’s level of consciousness to determine the severity of the reaction and the urgency of the intervention.
– **Alert:** The patient is responsive and able to answer questions or follow commands.
– **Verbal:** The patient responds to verbal stimuli but may be disoriented.
– **Pain:** The patient only responds to painful stimuli, such as a pinch.
– **Unresponsive:** The patient is unconscious and does not respond to any stimuli.
Evaluating consciousness helps determine whether the patient is experiencing severe anaphylaxis that requires immediate resuscitative measures.
### **P: Place, Position the Patient**
Proper positioning of the patient is vital to maintain airway patency and circulation.
– **Conscious Patient:** If the patient is conscious and experiencing respiratory distress, they should be placed in an upright or semi-upright position to facilitate breathing.
– **Unconscious Patient:** If the patient is unconscious, place them in the supine position (lying flat on their back) with their legs elevated slightly (about 12 inches) to promote blood flow to vital organs and prevent shock.
– **Pregnant Patient:** If the patient is pregnant and unconscious, place them in the left lateral recumbent position to prevent compression of the inferior vena cava by the uterus, which can impair circulation.
### **A: Activate the CABs of CPR (Circulation, Airway, Breathing)**
Once the patient is positioned appropriately, begin assessing and supporting the essential life functions—Circulation, Airway, and Breathing.
– **Circulation:** Check the patient’s pulse. If absent, begin chest compressions immediately as per CPR guidelines.
– **Airway:** Ensure the airway is open. If the patient is unconscious, use the head-tilt-chin-lift technique to open the airway. Be prepared to perform basic airway management if necessary, such as using an oropharyngeal airway.
– **Breathing:** Check if the patient is breathing. If not, or if breathing is inadequate, provide rescue breaths or start CPR if the patient is not breathing and has no pulse.
### **I: Implement Appropriate Emergency Protocol for Anaphylactic Shock**
Immediate treatment of anaphylaxis is critical to prevent progression to fatal outcomes.
– **Epinephrine Administration:** The first-line treatment is the intramuscular injection of epinephrine (1:1000 concentration). The recommended dose for adults is 0.3-0.5 mg (0.3-0.5 mL) administered into the mid-outer thigh. For children, the dose is typically 0.01 mg/kg, with a maximum dose of 0.3 mg.
– **Repeat Epinephrine:** If symptoms persist or worsen after 5-15 minutes, a second dose of epinephrine may be administered.
– **Oxygen Therapy:** Administer high-flow oxygen (8-10 L/min) through a non-rebreather mask to support respiration and oxygenation.
– **Antihistamines and Corticosteroids:** These may be administered to manage symptoms, although they are secondary to epinephrine and not first-line treatments. Intravenous or intramuscular diphenhydramine (25-50 mg) can be used, followed by corticosteroids like hydrocortisone (100-200 mg IV).
– **Monitor Vital Signs:** Continuously monitor the patient’s vital signs (blood pressure, pulse, respiration rate) and be prepared to perform CPR if cardiac arrest occurs.
### **R: Refer the Patient to Healthcare Professionals**
After initial management:
– **Call 911:** Immediately call for emergency medical services (EMS) to transport the patient to the nearest hospital, as further treatment and monitoring in a controlled setting are necessary.
– **Continue Monitoring:** While waiting for EMS, continue monitoring the patient’s vital signs, airway, and breathing. Be ready to administer additional doses of epinephrine if needed.
– **Prepare for Transport:** Ensure the patient’s medical information and details of the treatment provided are documented and ready for transfer to EMS personnel.
– **Follow-Up Care:** Once EMS arrives, provide a handover including the time and dose of epinephrine administered, the patient’s response to treatment, and any additional interventions performed. Encourage the patient to follow up with an allergist or healthcare provider for long-term management of their allergies and to obtain an epinephrine auto-injector if they don’t already have one.
This systematic approach ensures that anaphylaxis is recognized early and managed promptly, reducing the risk of severe complications or death in a dental clinic setting.
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