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 systematic approach for managing anaphylactic shock in a medical emergency, such as in a dental clinic. This protocol ensures a structured and effective response to a life-threatening situation. Here’s a detailed description of each step:
R: Recognize Signs and Symptoms
The first step in managing anaphylactic shock is to recognize its early signs and symptoms. Anaphylaxis can develop rapidly, often within minutes of exposure to an allergen. Key signs and symptoms include:
- Skin reactions: Hives, itching, flushed or pale skin
- Swelling: Particularly of the face, eyes, lips, throat, or tongue, which may cause difficulty in breathing
- Respiratory distress: Wheezing, shortness of breath, difficulty breathing, or a tight feeling in the chest
- Circulatory symptoms: Rapid, weak pulse, hypotension (low blood pressure), dizziness, or fainting
- Gastrointestinal symptoms: Nausea, vomiting, diarrhea, or abdominal pain
- Other symptoms: A sense of impending doom, confusion, or anxiety
E: Evaluate the Patient’s Level of Consciousness
After recognizing the signs and symptoms, immediately evaluate the patient’s level of consciousness. This step helps determine the severity of the reaction and the urgency of intervention. The levels of consciousness can range from fully alert to unresponsive:
- Alert: The patient is fully conscious and responsive, but may be distressed or anxious.
- Drowsy or confused: The patient may have a reduced level of consciousness, indicating a more severe reaction.
- Unconscious: The patient is unresponsive, which is a critical situation requiring immediate intervention.
P: Place, Position the Patient
Proper positioning of the patient is crucial in managing anaphylaxis:
- Conscious patient: Place the patient in a comfortable position, usually seated upright if experiencing breathing difficulties, or in a supine position (lying flat) if there’s no respiratory distress. Elevating the legs can help maintain blood flow to vital organs if the patient is hypotensive.
- Unconscious patient: If the patient loses consciousness, place them in the supine position. If they are vomiting or there’s a risk of aspiration, turn them onto their side (recovery position).
A: Activate the CABs of CPR
The next step is to activate the CABs of CPR:
- Circulation: Check the patient’s pulse to assess circulation. If there’s no pulse, initiate chest compressions immediately.
- Airway: Ensure the airway is clear. If the patient is unconscious and not breathing, open the airway using the head-tilt, chin-lift maneuver.
- Breathing: Assess the patient’s breathing. If they are not breathing or if breathing is inadequate, begin rescue breaths.
If the patient is conscious but experiencing respiratory distress, closely monitor their breathing and be prepared to initiate CPR if their condition deteriorates.
I: Implement the Appropriate Emergency Protocol
Immediate implementation of the emergency protocol for anaphylaxis is critical:
- Administer epinephrine: The first-line treatment for anaphylactic shock is epinephrine (adrenaline). Administer 0.3-0.5 mg of epinephrine intramuscularly (IM) in the mid-outer thigh (vastus lateralis muscle) using an auto-injector if available. This can be repeated every 5-15 minutes if necessary and if symptoms persist.
- Administer oxygen: Provide supplemental oxygen to the patient to ensure adequate oxygenation, especially if they are experiencing respiratory distress.
- Administer antihistamines and corticosteroids: These can be given as adjuncts to epinephrine. Antihistamines like diphenhydramine can help reduce some of the symptoms, while corticosteroids may help prevent prolonged or biphasic reactions, although their onset of action is slower.
- Monitor vital signs: Continuously monitor the patient’s vital signs, including heart rate, blood pressure, and respiratory rate.
R: Refer the Patient to Healthcare Professionals
Finally, the patient should be referred to advanced medical care:
- Call 911: Even if the patient responds to initial treatment, anaphylaxis requires further medical evaluation. Call emergency medical services (EMS) immediately.
- Transport: Prepare the patient for transport to a hospital. Ensure they are stabilized and continue monitoring their condition until EMS arrives.
- Provide information: Communicate to EMS personnel the details of the patient’s condition, the treatment administered, and any known allergens or triggers.
- Advise: After stabilization, advise the patient to follow up with an allergist or healthcare provider for further evaluation and management, including the potential prescription of an epinephrine auto-injector for future emergencies.
Conclusion
The R.E.P.A.I.R. protocol is a comprehensive and systematic approach for managing anaphylactic shock, particularly in emergency settings like a dental clinic. It ensures that the healthcare provider can quickly recognize, evaluate, and manage the situation effectively, ultimately referring the patient to the appropriate care to prevent fatal outcomes.