Signs and symptoms of anaphylaxis and management in the dental office :
Signs and symptoms of anaphylaxis : Anaphylaxis is characterized by-
- hypotension or shock, and
- urticaria or angioedema.
- It is a medical emergency in which death may result from respiratory obstruction, circulatory failure, or both.
management in the dental office :
- With the first indication of anaphylaxis, 0.2—0.5 cc of 1/1000 aqueous epinephrine should be injected subcutaneously orintramuscularly, and emergency services should be contacted.
- The injection of epinephrine may be repeated every 20—30 minutes, if necessary, for as many as 3 doses. Oxygen at a rate of 4 L!min must be delivered with a face mask.
- The patient must be continuously monitored, and an intravenous line containing either Ringer’s lactate or normal saline should be infused at 100 cc/hour.
- If the patient becomes hypotensive, the intravenous infusion should be increased.
- If airway obstruction occurs from edema of the larynx or hypopharynx, a cricothyrotomy must be done.
- If the airway obstruction is due to bronchospasm, an albuterol or terbutaline nebulizer should be administered or intravenous aminophylline, 6 mg/kg, infused over 20—30 minutes.