Frequently Asked Questions About Shock & **Understanding Allergic Reactions:** & **Body System Involvement:** & **Common Triggers:** & **For Anaphylaxis WITH EpiPen Available:** & **For Anaphylaxis WITHOUT EpiPen:** & **Critical Mistakes:** & **DO vs. DON'T Comparison List:** & **Call 911 Immediately For:** & **Can Treat at Home (With Monitoring):** & **Children with Allergies:** & **Pregnant Women:** & **Biphasic Reactions:** & 8. Direct someone to meet EMS

Q: Can someone go into shock from emotional trauma?

A: Emotional distress doesn't cause medical shock, though someone might faint. Medical shock involves inadequate oxygen delivery to organs. However, severe emotional stress can trigger heart problems that lead to cardiogenic shock.

Q: Why can't I give water to someone in shock?

A: Shock often requires surgery, which needs an empty stomach. Also, shock can cause vomiting, and an unconscious person could aspirate. IV fluids are needed, not oral fluids.

Q: How quickly does shock develop?

A: Depends on the cause. Severe bleeding or anaphylaxis causes shock in minutes. Internal bleeding may take hours. Septic shock develops over hours to days. Always monitor anyone with significant injury.

Q: Should I keep checking blood pressure?

A: If trained and equipped, blood pressure monitoring helps, but don't delay other treatment to check it. Pulse rate and quality, mental status, and skin signs are equally important and easier to assess.

Q: Why elevate the legs?

A: Elevating legs 8-12 inches helps blood return to vital organs. Don't elevate if you suspect head injury, heart attack, stroke, or breathing problems. Never elevate more than 12 inches.

Q: Can shock be reversed?

A: Early shock is reversible with prompt treatment. Once organs begin failing (late shock), survival decreases dramatically. This is why early recognition and treatment are critical.

Q: What if the person feels better after lying down?

A: Improvement doesn't mean they're okay. Continue treatment and transport. Shock can worsen suddenly. Only medical professionals can determine if shock is resolved.

Q: Is shock always obvious?

A: No. Early shock can be subtle—slight anxiety, mild vital sign changes. Compensated shock may show minimal symptoms. Always suspect shock with significant injuries regardless of how the person looks.

Q: Why do shock patients feel cold?

A: Blood flow is redirected from skin to vital organs, making skin cold and clammy. The person feels cold even in warm environments. This is why preventing heat loss is crucial.

Q: Can children hide shock symptoms longer?

A: Yes. Children compensate remarkably well until suddenly decompensating. A child may appear stable then rapidly deteriorate. Never be falsely reassured by a child who "looks okay" after significant injury.

> Final Quick Reference Box: > Remember: S.H.O.C.K. > - Supine position (flat, legs up) > - Heat conservation (blankets) > - Oxygen to organs (positioning) > - Call 911 immediately > - Keep monitoring vital signs > > Time-Critical Actions: > - 0-30 seconds: Position and call 911 > - Every 5 minutes: Check vitals > - Continuous: Reassurance and monitoring > - Document: All changes

Final Critical Message:

Shock is a silent killer that can develop from almost any serious injury or illness. Early recognition and treatment save lives, while delays can be fatal. Don't wait for obvious symptoms—treat based on mechanism of injury and maintain a high index of suspicion. Remember that shock treatment is about buying time until definitive medical care arrives. Your quick actions in recognizing shock, calling 911, properly positioning the patient, and preventing heat loss create the window of opportunity for survival. When in doubt, treat for shock—you cannot harm someone by providing shock treatment, but failing to treat shock can be deadly.# Chapter 11: Allergic Reactions and Anaphylaxis: Emergency Response with and Without EpiPen

The birthday party was in full swing when 8-year-old Emma took a bite of what she thought was a chocolate chip cookie. Within seconds, she felt her tongue tingling. Her mother, always vigilant about Emma's peanut allergy, immediately recognized the signs. The "chocolate chips" were actually peanut butter chips. As Emma's lips began to swell and she started wheezing, her mother grabbed the EpiPen from her purse, administered it to Emma's thigh, and called 911. By the time paramedics arrived, Emma's breathing had improved, though she still needed hospital observation. Her mother's quick recognition and response prevented a potentially fatal outcome. Every 3 minutes, a food allergy reaction sends someone to the emergency room in the United States. While most allergic reactions are mild, anaphylaxis—a severe, life-threatening allergic reaction—kills approximately 200 Americans annually and can progress from first symptom to death in as little as 15 minutes. The number of people with severe allergies has increased dramatically, with food allergies alone affecting 32 million Americans. Understanding how to recognize and respond to allergic reactions, especially anaphylaxis, has become an essential life skill that everyone should possess.

Allergic reactions range from mild discomfort to life-threatening anaphylaxis. Recognizing the progression and severity is crucial for appropriate response.

Mild to Moderate Reactions:

- Localized itching or hives - Sneezing or runny nose - Watery eyes - Mild swelling at contact site - Skin redness or rash - Mild nausea

Severe Reactions (Anaphylaxis):

- Difficulty breathing or swallowing - Swelling of face, lips, tongue, or throat - Rapid pulse - Dizziness or fainting - Widespread hives or rash - Severe nausea, vomiting, or cramping - Sense of impending doom

Skin (80-90% of reactions):

- Hives (raised, itchy welts) - Flushing or redness - Swelling (angioedema) - Itching without rash - Warm sensation

Respiratory (70% of severe reactions):

- Wheezing - Shortness of breath - Throat tightness - Hoarse voice - Persistent cough - Nasal congestion

Cardiovascular (45% of severe reactions):

- Rapid, weak pulse - Low blood pressure - Dizziness or lightheadedness - Fainting - Chest pain - Pale or blue skin color

Gastrointestinal (45% of severe reactions):

- Severe cramping - Vomiting - Diarrhea - Difficulty swallowing - Metallic taste

> Quick Reference Box: > - Anaphylaxis onset: Usually within 5-30 minutes > - Fatal reactions: Most occur within 30 minutes > - Second wave: Can occur 1-72 hours later (biphasic) > - Common triggers: Foods (40%), medications (30%), insects (20%) > - Death causes: Airway obstruction (70%), cardiovascular collapse (30%)

Anaphylaxis is likely when ANY of these occur:

Criteria 1 (Most Common):

Sudden onset involving skin/mucous membranes PLUS: - Respiratory symptoms OR - Low blood pressure OR - End-organ dysfunction

Criteria 2:

Two or more of the following after allergen exposure: - Skin/mucous membrane involvement - Respiratory symptoms - Low blood pressure - Persistent GI symptoms

Criteria 3:

Low blood pressure after exposure to known allergen

Food Allergens (Most Common in Children):

- Peanuts - Tree nuts - Milk - Eggs - Fish/shellfish - Wheat - Soy - Sesame

Other Common Triggers:

- Insect stings (bees, wasps, fire ants) - Medications (antibiotics, NSAIDs) - Latex - Exercise (rare) - Unknown (idiopathic)

Quick, decisive action is crucial when dealing with severe allergic reactions. Every minute counts with anaphylaxis.

Step 1: Recognize Anaphylaxis (10 seconds)

- Assess symptoms quickly - Don't wait for all symptoms - When in doubt, treat as anaphylaxis

Step 2: Call 911 (While Getting EpiPen)

- State "anaphylaxis" or "severe allergic reaction" - Give exact location - Stay on line if possible - Have someone else call if available

Step 3: Position the Person

- Lie flat on back - Elevate legs - If breathing difficulty, allow sitting - If unconscious, recovery position - If pregnant, left side

Step 4: Administer EpiPen

Step 5: Monitor and Prepare for Second Dose

- Watch for improvement - If no improvement in 5-15 minutes, give second dose - Keep person lying down - Monitor breathing and pulse - Be ready for CPR

Step 1: Call 911 Immediately

- Emphasize "anaphylaxis without epinephrine" - Request fastest response - Keep line open - Follow dispatcher instructions

Step 2: Position and Support

- Lie person flat, legs elevated - Loosen tight clothing - Remove allergen if possible - Keep airway open - Prevent falls if standing

Step 3: Give Antihistamine if Available

- Benadryl (diphenhydramine) 25-50mg - Won't stop anaphylaxis but may help - Liquid works faster than pills - Don't delay other treatment

Step 4: Prepare for Deterioration

- Be ready for CPR - Monitor continuously - Keep talking to assess consciousness - Note symptom progression - Gather medical information

> Practice This Now: > - Practice EpiPen technique with trainer > - Time your response (goal: <60 seconds) > - Locate antihistamines in your home > - Practice positioning techniques > - Review CPR skills

Insect Sting Anaphylaxis:

Food-Related Anaphylaxis:

Unknown Trigger:

Continue Care:

- Keep person lying down - Second dose if needed (5-15 min) - Monitor vital signs - Prevent hypothermia - Document everything - Save used EpiPen for EMS

Common After Effects:

- Rapid heartbeat - Shakiness - Headache - Nausea - Anxiety - All normal from epinephrine

Understanding common errors can prevent delayed treatment and improve outcomes.

1. Waiting Too Long to Use EpiPen

- "Maybe it will get better" - Waiting for all symptoms - Fear of "wasting" EpiPen - Delayed treatment can be fatal - When in doubt, use it

2. Using Antihistamines Instead of EpiPen

- Benadryl doesn't stop anaphylaxis - Wastes critical time - Creates false security - EpiPen first, antihistamines second - No substitute for epinephrine

3. Sitting or Standing Up

- Reduces blood flow to brain - Can cause sudden death - Even if they feel better - Only sit if can't breathe lying down - Fatal errors documented

4. Not Calling 911 After EpiPen

- Effects wear off in 15-20 minutes - Biphasic reactions common - Need medical observation - May need additional doses - IV medications often required

| DO | DON'T | |---|---| | Use EpiPen at first signs of anaphylaxis | Wait to see if it gets worse | | Call 911 even after EpiPen | Assume one dose is enough | | Keep person lying flat | Let them sit/stand up | | Give second dose if needed (5-15 min) | Hesitate to give second dose | | Remove allergen if possible | Try to make them vomit | | Stay with person constantly | Leave to get supplies | | Use EpiPen through clothing | Waste time removing pants | | Save used EpiPen for EMS | Throw away evidence |

EpiPen Mistakes:

- Wrong end (needle stick to thumb) - Not holding long enough - Injecting into buttocks - Using expired as first choice - Not pressing hard enough

Storage Errors:

- Extreme temperatures - Not carrying everywhere - Expired medications - No backup dose - Inaccessible location

With allergic reactions, the severity determines the response urgency. Understanding the progression helps make critical decisions.

Any Signs of Anaphylaxis:

- Breathing difficulty - Swelling of face/throat - Rapid pulse with symptoms - Widespread hives - Any doubt about severity

After EpiPen Use:

- Always, no exceptions - Even if symptoms improve - For monitoring - Additional treatment needed - Document medical record

High-Risk Situations:

- Known severe allergies - Previous anaphylaxis - Asthma plus allergies - Remote locations - Children or elderly

Mild Reactions Only:

- Localized hives - Minor itching - Sneezing/runny nose - No breathing issues - No facial swelling

Requirements:

- Adult supervision - Antihistamines available - No progression of symptoms - Known mild allergen - Quick access to help

> Important Disclaimer: > Anaphylaxis is unpredictable and can be fatal within minutes. When in doubt, use EpiPen and call 911. Delayed treatment is a leading cause of death. EpiPen is very safe—the risks of not using it far exceed any risks from the medication. This guide cannot replace proper medical training and evaluation.

1. 0-5 minutes: Initial symptoms appear 2. 5-15 minutes: Progression to severe symptoms 3. 15-30 minutes: Life-threatening if untreated 4. 30+ minutes: Fatal outcomes most common 5. 1-72 hours: Possible biphasic reaction

Different populations and situations require modified approaches to allergic reaction management.

Unique Challenges:

- Can't always communicate symptoms - Symptoms may differ from adults - Behavioral changes may be first sign - Need weight-appropriate EpiPen dose - Higher risk of accidental exposure

School/Daycare Considerations:

- Allergy action plan required - Multiple EpiPens needed - Train all caregivers - Practice drills - Clear communication systems

EpiPen Jr. (15-30 kg/33-66 lbs):

- 0.15 mg dose - Shorter needle - Same technique - May need adult dose if larger

Special Risks:

- Cardiovascular disease - Multiple medications - May not recognize symptoms - Higher mortality rate - Delayed treatment common

Modifications:

- Lower threshold to treat - Monitor heart closely - Position carefully - Check all medications - Extended observation needed

Treatment Priorities:

- Mother's life first - Epinephrine safe in pregnancy - Left side positioning - Two lives at risk - Rapid transport essential

Special Considerations:

- May affect fetal heart rate - Don't delay treatment - Inform OB team - Monitor fetal movement - C-section preparedness

Unique Features:

- Occurs during/after exercise - May need food trigger too - Unpredictable occurrence - Mild exercise can trigger - More common in women

Prevention/Treatment:

- Never exercise alone - Carry EpiPen always - Avoid triggers pre-exercise - Stop at first symptoms - Standard treatment protocol

Understanding Second Wave:

- Occurs in 20% of anaphylaxis - 1-72 hours after initial reaction - Usually within 8-10 hours - Can be more severe - Requires hospital observation

Management:

- Minimum 4-6 hour observation - 24 hours for severe reactions - Discharge with EpiPen - Clear return instructions - Oral steroids may help

Regular practice improves response time and effectiveness. Work through these scenarios.

Your dinner companion suddenly says their throat feels weird after eating. You notice their lips look puffy.

Your Actions:

Key Points:

- Don't wait for more symptoms - Act on subtle signs - Time is critical

A child you're watching gets stung by a bee and immediately says "I can't breathe" while clutching their throat.

Your Actions:

Critical Learning:

- Children deteriorate quickly - Don't minimize symptoms - Immediate action required