Anaphylactic Shock Management in Abdominal Hydatid Cyst Rupture

Initial Treatment of Anaphylactic Shock

The American College of Surgeons recommends administering adrenaline (epinefrina) immediately via intramuscular injection in the lateral thigh at a dose of 0.01 mg/kg (concentration 1mg/mL) up to a maximum of 0.5 mL, which can be repeated every 5-15 minutes as needed 1
The American Heart Association suggests establishing intravenous access, administering supplemental oxygen, and continuously monitoring vital signs 1, 2
The administration of 1-2 liters of normal saline solution at a speed of 5-10 mL/kg in the first 5 minutes is recommended by the European Resuscitation Council 1, 3
Crystalloids or colloids should be administered in 20 mL/kg boluses, followed by slow infusion, as recommended by the American College of Surgeons 1

The combined use of H1 and H2 antagonists is superior to the use of each one separately, according to the American Academy of Allergy, Asthma, and Immunology 1
The administration of diphenhydramine (25-50 mg) by slow intravenous injection in combination with ranitidine (50 mg diluted in 5% dextrose to a total volume of 20 mL) injected intravenously over 5 minutes is recommended by the American Academy of Allergy, Asthma, and Immunology 1, 4
Corticosteroids equivalent to 1-2 mg/kg of (methyl)prednisolone should be administered every 6 hours, as recommended by the American College of Surgeons 1, 3
The use of corticosteroids has been associated with reduced hospital stay, although they have not been shown to prevent return visits to the emergency department, according to the American Academy of Allergy, Asthma, and Immunology 6

After a severe reaction, close observation for at least 24 hours is recommended by the American Heart Association 1
Vital signs should be monitored, and recurrent symptoms should be controlled until complete resolution, as recommended by the American College of Surgeons 1, 7
Biphase anaphylaxis can occur up to 72 hours after the initial reaction (average of 11 hours), justifying prolonged observation, according to the American Academy of Allergy, Asthma, and Immunology 7
The risk of biphase reaction is higher in patients who required more than one dose of epinefrina to treat initial symptoms, as reported by the American Academy of Allergy, Asthma, and Immunology 7

If hypotension persists despite epinefrina and fluid resuscitation, consider vasopressors:
In patients receiving beta-blockers, consider glucagon 1-5 mg intravenously over 5 minutes, followed by infusion (5-15 μg/min), as recommended by the American Academy of Allergy, Asthma, and Immunology 1, 4
For bradycardia, administer atropine 600 μg intravenously, as recommended by the American Heart Association 1

Do not delay the administration of epinefrina, as this has been associated with fatalities from anaphylaxis and a higher risk of biphase reactions, according to the American Academy of Allergy, Asthma, and Immunology 7
Do not use antihistamines or corticosteroids as first-line treatment instead of epinefrina, as recommended by the American College of Surgeons 2
Do not administer epinefrina intravenously in situations that are not cardiac arrest without adequate monitoring, as recommended by the American Heart Association 2
Do not discharge prematurely without adequate observation to detect biphase reactions, as recommended by the American Academy of Allergy, Asthma, and Immunology 2