P

repared By Faiz

SS1
Patient M., 49 years old, unconscious. According to friends, in the park, the patient had a sharp weakness,
pallor, convulsions, and then loss of consciousness a minute after the wasp bite. The patient did not regain
consciousness, blood pressure is 40/0 mmHg, pulse is thready. Collection of anamnesis, including
allergological, is impossible due to the severity of the patient's condition.
On examination, the condition is extremely serious. The patient is unconscious. The skin is pale, lip
cyanosis, acrocyanosis, moist. Breathing is frequent, shallow, BH - 30 in 1 min.
List the plan of necessary therapeutic and diagnostic measures. What is the forecast?

Answer-Plan of necessary therapeutic and diagnostic measures:

1. Immediate resuscitation measures, including airway management, oxygen therapy, and intravenous fl
uids to address the patient's hypotension and respiratory distress.

2. Administration of epinephrine to treat anaphylaxis caused by the wasp bite.

3. Laboratory diagnostic tests, including complete blood count, electrolyte levels, and liver and kidney fu
nction tests to assess the patient's overall health status.

4. Diagnostic imaging, such as CT or MRI, to assess brain function and rule out other potential causes of
unconsciousness.

5. Consideration of rabies prophylaxis if there is a suspicion of exposure to the virus.

Forecast: The patient's prognosis is extremely poor given the severity of their condition and the prolong
ed loss of consciousness. Without prompt and appropriate medical intervention, the patient is at high ris
k of mortality.

SS2
The patient turned to the dentist of the surgical office of the dental clinic for the purpose of tooth
extraction. From the anamnesis, it was established that the patient had an allergic reaction to penicillin
injection. The patient was anesthetized with a 2% solution of novocaine. After 3-5 minutes, the patient's
condition worsened. Objective data: pronounced pallor, cyanosis, profuse sweat, tachycardia, blood
pressure dropped sharply; there was a tingling sensation, itching of the skin of the face, a feeling of fear, a
feeling of heaviness behind the sternum and difficulty breathing.
1. Determine the urgent condition of the patient.
2. Create an algorithm for emergency care

Answers-1. The patient is in an urgent condition, showing signs of anaphylactic shock, which can be life-t
hreatening if not treated immediately.

2. Algorithm for emergency care:

a. Stop the administration of novocaine immediately.

b. Call for emergency medical services (EMS) or transfer the patient to a hospital emergency department
if possible.

c. Administer epinephrine immediately, either through an auto-injector or intramuscular injection, to tre

at the anaphylactic shock.

d. Monitor the patient's vital signs, including blood pressure, heart rate, and oxygen saturation levels.

e. Provide oxygen therapy to improve the patient's breathing.

f. Administer antihistamines and corticosteroids to reduce inflammation and allergic reactions.

g. If the patient's condition does not improve, consider administering additional doses of epinephrine or
other medications as advised by a physician.

h. Once the patient's condition stabilizes, transfer them to a hospital for further evaluation and treatme
nt.

i. Document all interventions and observations in the patient's medical record.

SS3
The patient turned to the dentist of the surgical office in order to sanitize the oral cavity. After tuberal
anesthesia, the patient developed dizziness, nausea, chest tightness, convulsions, blood pressure — 0/40
mm Hg, pulse — 120 beats per minute.
Tasks:
1. Determine the urgent condition of the patient.
2. Create an algorithm for emergency care.

Answer-1. The patient is in an urgent condition, showing signs of anaphylactic shock, which can be life-t
hreatening if not treated immediately.

2. Algorithm for emergency care:

a. Stop the administration of tuberal anesthesia immediately.

b. Call for emergency medical services (EMS) or transfer the patient to a hospital emergency department
if possible.

c. Administer epinephrine immediately, either through an auto-injector or intramuscular injection, to tre

at the anaphylactic shock.

d. Monitor the patient's vital signs, including blood pressure, heart rate, and oxygen saturation levels.

e. Provide oxygen therapy to improve the patient's breathing.

f. Administer antihistamines and corticosteroids to reduce inflammation and allergic reactions.

g. If the patient's condition does not improve, consider administering additional doses of epinephrine or
other medications as advised by a physician.

h. Once the patient's condition stabilizes, transfer them to a hospital for further evaluation and treatme
nt.
i. Document all interventions and observations in the patient's medical record.

SS4
At the surgical reception after the introduction of novocaine, the patient complained of anxiety, chest
tightness, weakness, dizziness, nausea.
Blood pressure 80/40 mm Hg, pulse 120 beats/min, low filling and tension

Answere-These symptoms and vital signs indicate that the patient is experiencing anaphylactic shock, a s
evere and potentially life-threatening allergic reaction. Immediate action is required to treat this emerge
ncy condition. Follow the algorithm for emergency care outlined above, starting with stopping the admi
nistration of tuberal anesthesia and calling for emergency medical services or transferring the patient to
a hospital emergency department if possible. Administer epinephrine immediately to treat the anaphyla
ctic shock, monitor the patient's vital signs, provide oxygen therapy, and administer antihistamines and
corticosteroids as needed. If the patient's condition does not improve, consider administering additional
doses of epinephrine or other medications as advised by a physician. Once the patient's condition stabili
zes, transfer them to a hospital for further evaluation and treatment, and document all interventions an
d observations in the patient's medical record.

SS5
The patient, 18 years old, complains of deterioration in the form of darkening in the eyes, dizziness,
nausea, vomiting. The condition occurred after a bee sting after 15 minutes. This condition is observed
for the first time.
Objectively: The condition is of moderate severity, urticaria rashes are not abundant around the bite and
on the trunk. Blood pressure is 90/50 (working – 120/80)., pulse - 100 beats per minute. Heart tones are
muted, vesicular breathing in the lungs, there are no wheezing
Questions:
1. Formulate a preliminary diagnosis.
2. Make an algorithm for emergency care.
3. Differential diagnosis.
4. Identify preventive measures.

Answer-1. Preliminary diagnosis: Anaphylactic shock due to a bee sting.

2. Algorithm for emergency care:

- Stop the administration of tuberal anesthesia (if applicable)

- Call for emergency medical services or transfer the patient to a hospital emergency department

- Administer epinephrine immediately

- Monitor vital signs and provide oxygen therapy

- Administer antihistamines and corticosteroids as needed

- Consider administering additional doses of epinephrine or other medications as advised by a physician

- Transfer the patient to a hospital for further evaluation and treatment

- Document all interventions and observations in the patient's medical record.

3. Differential diagnosis:

- Vasovagal syncope

- Acute anxiety or panic attack

- Hypoglycemia

- Seizure disorder

4. Preventive measures:

- Avoidance of bee stings through protective clothing and avoidance of bee-attractive areas

- Carrying an epinephrine auto-injector for individuals with known bee sting allergies

- Education on recognizing and managing anaphylactic reactions.

SS6
When removing a tooth in the dental office after the introduction of ultracaine, symptoms such as a sharp
pallor of the skin, anxiety, cold sweat, difficulty breathing, dizziness, palpitations appeared. A/D - 60/20
mmHg, .Ps – 90 v min
Questions:
1. Formulate a preliminary diagnosis.
2. Determine the treatment tactics.

Answer-1. Preliminary diagnosis: Anaphylactic shock due to the administration of ultracaine.

2. Treatment tactics:

- Stop the administration of ultracaine

- Call for emergency medical services or transfer the patient to a hospital emergency department

- Administer epinephrine immediately

- Monitor vital signs and provide oxygen therapy

- Administer antihistamines and corticosteroids as needed

- Consider administering additional doses of epinephrine or other medications as advised by a physician

- Transfer the patient to a hospital for further evaluation and treatment

- Document all interventions and observations in the patient's medical record.

SS7
The patient, 15 years old, was taken to the emergency room of the hospital by ambulance in a serious
condition: consciousness is lost, the skin and mucous membranes are cyanotic, shallow breathing with
predominant difficulty of exhalation. After several convulsive movements, the patient died with asphyxia.
During the investigation, it turned out that the patient underwent penicillin treatment for focal pneumonia
1.5 months ago. Two days ago, the patient had throbbing pains in her left ear, the next day - suppuration
from the ear. Was
the diagnosis was made: purulent otitis media and treatment was prescribed, including intramuscular
administration of novocaine salt of penicillin. 10 minutes after the injection of 600,000 units of penicillin,
the patient felt ill. There was weakness, there was a sharp shortness of breath. Death occurred after
1 hour after penicillin injection.
Questions:
1. What allergic process has developed in the patient?
2. What antibodies are involved in it?
3. Pathogenetic principles of treatment and prevention?

Answer-1. The patient has developed an anaphylactic shock, which is a severe allergic reaction that can
be life-threatening.

2. The antibodies involved in anaphylactic shock are immunoglobulin E (IgE) antibodies, which are produ
ced by the immune system in response to an allergen.

3. The pathogenetic principles of treatment and prevention of anaphylactic shock include stopping the a
dministration of the allergen, administering epinephrine to counteract the allergic reaction, monitoring
vital signs and providing oxygen therapy, administering antihistamines and corticosteroids as needed, an
d transferring the patient to a hospital for further evaluation and treatment. Prevention involves identify
ing and avoiding known allergens, carrying an epinephrine auto-injector if prescribed, and seeking medic
al attention promptly if symptoms of an allergic reaction occur. In this case, it is important to note that p
enicillin should not be administered to patients with a history of penicillin allergy.

SS8
A worker of an industrial enterprise is vaccinated against influenza. 10 minutes after the subcutaneous
injection, a dry cough, weakness, dizziness, tinnitus, abdominal pain, itching of the skin, rashes like
urticaria appeared. Objectively: The patient is conscious. The skin is pale. Heart tones are sonorous,
rhythmic, heart rate is 105 per minute. Blood pressure is 90/60 mmHg. Breathing is vesicular, dry
wheezing is heard over the entire surface of the lungs. BH 25 per minute.
Questions:
1. Your diagnosis?
2. The sequence of therapeutic measures.

Answer-1. The diagnosis is an allergic reaction to the influenza vaccine, possibly anaphylaxis.

2. The sequence of therapeutic measures should include stopping the administration of the vaccine, ad
ministering epinephrine to counteract the allergic reaction, monitoring vital signs and providing oxygen t
herapy, administering antihistamines and corticosteroids as needed, and transferring the patient to a ho
spital for further evaluation and treatment. It is important to note that the patient should not receive an
y further doses of the influenza vaccine and should avoid any other vaccines that contain similar ingredi
ents. Prevention involves identifying and avoiding known allergens, carrying an epinephrine auto-injecto
r if prescribed, and seeking medical attention promptly if symptoms of an allergic reaction occur.

SS9
An ambulance team was called to the house of a 3-year-old boy. About 20 minutes ago, there were
complaints of anxiety, a sharp headache, difficulty breathing, polymorphic rash all over the body with
itching. It was found that 30 minutes before the arrival of the ambulance team, the patient was given a
single injection of 500 mg of ampicillin intramuscularly for bilateral small-focal pneumonia. At the age of
2 years, when treated with penicillin for acute purulent otitis, there was a reaction in the form of a short-
term allergic rash.
At the time of examination, the child is inhibited. On the skin of the face, trunk, limbs - urticaria rash on a
pale background. Cold, sticky sweat. Exhalation is difficult. The respiratory rate is 56 per 1 minute. A
percussive sound over the lungs with a boxy tinge. Auscultation breathing is carried out evenly on both
sides, scattered small-bubbly and dry whistling wheezes. Blood pressure - 60/20 mmHg, pulse – 160
beats per 1 minute, threadlike. The abdomen is palpable, there is moderate soreness without a certain
localization. There was no urination during the last hour

questions
1. What is your diagnosis?
2. Specify the measures of emergency medical care for the child.
3. What are the further tactics of the child's treatment?

Answer-1. The diagnosis is anaphylactic shock, caused by an allergic reaction to the ampicillin injection.

2. The measures of emergency medical care for the child include:

- Immediate administration of epinephrine (adrenaline) to relieve breathing difficulties and increase blo
od pressure

- Oxygen therapy to improve oxygenation

- Intravenous fluids to maintain blood pressure and prevent dehydration

- Antihistamines and corticosteroids to reduce allergic symptoms

- Monitoring of vital signs and continuous cardiac monitoring

- Transfer to the hospital for further treatment and observation.

3. The further tactics of the child's treatment may include:

- Continued administration of intravenous fluids, oxygen therapy, and medications as needed

- Close monitoring of vital signs, cardiac function, and urine output

- Consultation with an allergist to determine the specific allergen and develop a management plan

- Avoidance of future exposure to the allergen

- Education of the family on recognition and management of anaphylaxis and the use of an epinephrine
auto-injector.

SS10
The call of the ambulance team to the school to a boy of 8 years old in connection with multiple wasp
bites. In the medical center of the school, the child was injected with epinephrine, v / m diphenhydramine.
There were no respiratory disorders. When examined by the doctor of the ambulance crew: the skin is
pale, clean. There are traces of multiple insect bites on the upper limbs and face. Breathing is accelerated
to 22 in 1 minute, breathing noises are evenly carried out on both sides of the chest, there are no
wheezing. There is no violation of the ratio of the duration of inhalation and exhalation. The pulse is more
than 150 in 1 minute, almost not palpable, the heart tones are weakened. Blood pressure is 70/20 mmHg.
There was loose stools. Periodically convulsions. The reaction to the environment is reduced, but it comes
into contact, the answers to the questions are adequate. There are no meningeal signs.
questions
1. What is your diagnosis?
2. Specify the measures of emergency medical care for the child.
3. What are the further tactics of the child's treatment?

Answer-1. The diagnosis is anaphylactic shock, caused by an allergic reaction to the wasp bites.

2. The measures of emergency medical care for the child include:

- Immediate administration of epinephrine (adrenaline) to relieve breathing difficulties and increase blo
od pressure

- Oxygen therapy to improve oxygenation

- Intravenous fluids to maintain blood pressure and prevent dehydration

- Antihistamines and corticosteroids to reduce allergic symptoms

- Monitoring of vital signs and continuous cardiac monitoring

- Treatment of convulsions if necessary

- Transfer to the hospital for further treatment and observation.

3. The further tactics of the child's treatment may include:

- Continued administration of intravenous fluids, oxygen therapy, and medications as needed

- Close monitoring of vital signs, cardiac function, and urine output

- Consultation with an allergist to determine the specific allergen and develop a management plan

- Avoidance of future exposure to the allergen

- Education of the family on recognition and management of anaphylaxis and the use of an epinephrine
auto-injector.