Chapter 20 - Immunologic Emergencies

Urticaria is the medical term for: - burning. - a wheal. - hives. - swelling.

Urticaria is the medical term for: - burning. - a wheal. *- hives.* - swelling.

What is a wheal? - Widespread areas of generalized itching and/or burning that appear as multiple raised areas on the skin - A poison or harmful substance - A raised, swollen, well-defined area on the skin - Swelling of the tongue

What is a wheal? - Widespread areas of generalized itching and/or burning that appear as multiple raised areas on the skin - A poison or harmful substance *- A raised, swollen, well-defined area on the skin* - Swelling of the tongue

Which of the following patients has the most significant chance of having a contraindication to epinephrine? - A 6-year-old with significant peanut allergies - An 80-year-old male with a history of acute coronary syndrome - A 47-year-old female with bronchospasms - A teenager with no history of allergies

Which of the following patients has the most significant chance of having a contraindication to epinephrine? - A 6-year-old with significant peanut allergies *- An 80-year-old male with a history of acute coronary syndrome* - A 47-year-old female with bronchospasms - A teenager with no history of allergies

Which of the following signs/symptoms are indicative of respiratory involvement of an allergic reaction? - Flushed, itching, or burning skin - A sense of impending doom - Tightness in the chest or throat - All of these answers are correct.

Which of the following signs/symptoms are indicative of respiratory involvement of an allergic reaction? - Flushed, itching, or burning skin - A sense of impending doom *- Tightness in the chest or throat* - All of these answers are correct.

Which of the following sounds indicates swelling of the upper airway? - Rales - Rhonchi - Wheezing - Stridor

Which of the following sounds indicates swelling of the upper airway? - Rales - Rhonchi - Wheezing *- Stridor*

Which of the following would MOST likely provide clues regarding the source of a patient's allergic reaction? - The patient's family history - The environment in which the patient is found - The patient's general physical appearance - The time of year in which the exposure occurred

Which of the following would MOST likely provide clues regarding the source of a patient's allergic reaction? - The patient's family history *- The environment in which the patient is found* - The patient's general physical appearance - The time of year in which the exposure occurred

Why is epinephrine used for anaphylaxis? - It stops the allergic reaction from progressing. - It reverses bronchoconstriction and vasodilation. - It slows tachycardia. - It decreases blood flow.

Why is epinephrine used for anaphylaxis? - It stops the allergic reaction from progressing. *- It reverses bronchoconstriction and vasodilation.* - It slows tachycardia. - It decreases blood flow.

You are responding to a call where an 8-year-old has been stung by a wasp. His skin is pale with patches of raised red spots on his hands, arms, and face. These spots are most likely what? - Angioedema - Acne - Urticaria - A fungal infection

You are responding to a call where an 8-year-old has been stung by a wasp. His skin is pale with patches of raised red spots on his hands, arms, and face. These spots are most likely what? - Angioedema - Acne *- Urticaria* - A fungal infection

You are treating a child with a bee sting. The stinger is still embedded in the child's skin. What should you do? - Remove the stinger with tweezers. - Leave the stinger in place. - Scrape the skin with the edge of a stiff object. - Squeeze the area around the stinger.

You are treating a child with a bee sting. The stinger is still embedded in the child's skin. What should you do? - Remove the stinger with tweezers. - Leave the stinger in place. *- Scrape the skin with the edge of a stiff object.* - Squeeze the area around the stinger.

You have responded to a scene where the 33-year-old male patient is in obvious respiratory distress, breathing rapidly with audible wheezing. The patient's skin is flushed, red, and covered in hives. When you attempt to question the patient, you find he can speak in only two- to three-word sentences. Respirations are 28 breaths/min and labored. Pulse is 120 beats/min. Skin is pale and cool with widespread urticaria and angioedema of the lips. Blood pressure is 88/60 mm Hg, and SpO2 is 88%. Which of the following interventions should you administer first? - Provide high-concentration oxygen. - Administer epinephrine. - Give the patient a nonsteroidal anti-inflammatory drug (NSAID). - Give the patient an antihistamine.

You have responded to a scene where the 33-year-old male patient is in obvious respiratory distress, breathing rapidly with audible wheezing. The patient's skin is flushed, red, and covered in hives. When you attempt to question the patient, you find he can speak in only two- to three-word sentences. Respirations are 28 breaths/min and labored. Pulse is 120 beats/min. Skin is pale and cool with widespread urticaria and angioedema of the lips. Blood pressure is 88/60 mm Hg, and SpO2 is 88%. Which of the following interventions should you administer first? *- Provide high-concentration oxygen.* - Administer epinephrine. - Give the patient a nonsteroidal anti-inflammatory drug (NSAID). - Give the patient an antihistamine.

Anaphylaxis caused by stinging insects is typically an allergic reaction to ____________ rather than the bite or sting itself. - injected poison - irritating toxin - deadly venom - All of these answers are correct.

Anaphylaxis caused by stinging insects is typically an allergic reaction to ____________ rather than the bite or sting itself. - injected poison - irritating toxin - deadly venom *- All of these answers are correct.*

Anaphylaxis is MOST accurately defined as a(n): - allergic reaction that causes bronchodilation and vasoconstriction. - severe allergic reaction that typically resolves without treatment. - extreme allergic reaction that may affect multiple body systems. - moderate allergic reaction that primarily affects the vasculature.

Anaphylaxis is MOST accurately defined as a(n): - allergic reaction that causes bronchodilation and vasoconstriction. - severe allergic reaction that typically resolves without treatment. *- extreme allergic reaction that may affect multiple body systems.* - moderate allergic reaction that primarily affects the vasculature.

Epinephrine stimulates the ________ response, increasing blood pressure and relieving bronchospasm. - respiratory - sympathetic - cardiac - parasympathetic

Epinephrine stimulates the ________ response, increasing blood pressure and relieving bronchospasm. - respiratory *- sympathetic* - cardiac - parasympathetic

The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the infant-child auto-injector delivers ______ mg. - 0.1; 0.01 - 0.03; 0.3 - 0.01; 0.1 - 0.3; 0.15

The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the infant-child auto-injector delivers ______ mg. - 0.1; 0.01 - 0.03; 0.3 - 0.01; 0.1 *- 0.3; 0.15*

The effects of epinephrine are typically observed within _________ following administration. - 30 seconds - 1 minute - 1 hour - 30 minutes

The effects of epinephrine are typically observed within _________ following administration. - 30 seconds *- 1 minute* - 1 hour - 30 minutes

The goal of invaders such as bacteria and viruses is to __________. - cause an immune response - spread disease and destruction - use a human body as a home - kill their human host

The goal of invaders such as bacteria and viruses is to __________. - cause an immune response - spread disease and destruction *- use a human body as a home* - kill their human host

The stinger from a honeybee should be: - left in place and covered. - irrigated with copious amounts of water. - scraped away from the skin. - squeezed with tweezers and removed.

The stinger from a honeybee should be: - left in place and covered. - irrigated with copious amounts of water. *- scraped away from the skin.* - squeezed with tweezers and removed.

A 19-year-old female was stung multiple times on the legs by fire ants. She states that she is allergic to fire ants, but does not carry her own epinephrine. The patient is conscious and alert and complains of pain to the area of the bites. Her blood pressure is 122/70 mm Hg, her pulse is 100 beats/min and strong, and her respirations are 18 breaths/min and unlabored. You should: - advise her to see her physician as soon as possible. - request a paramedic unit to administer epinephrine. - position her legs well above the level of her heart. - administer oxygen and transport her to the hospital.

A 19-year-old female was stung multiple times on the legs by fire ants. She states that she is allergic to fire ants, but does not carry her own epinephrine. The patient is conscious and alert and complains of pain to the area of the bites. Her blood pressure is 122/70 mm Hg, her pulse is 100 beats/min and strong, and her respirations are 18 breaths/min and unlabored. You should: - advise her to see her physician as soon as possible. - request a paramedic unit to administer epinephrine. - position her legs well above the level of her heart. *- administer oxygen and transport her to the hospital.*

A 37-year-old male is having a severe allergic reaction to penicillin. He does not have an epinephrine auto-injector and your protocols do not allow you to carry epinephrine on the ambulance. How should you proceed with the treatment of this patient? - Ask the patient if he has any diphenhydramine tablets that you can administer. - Remain at the scene with the patient and request a paramedic ambulance. - Quickly determine if there are any bystanders who may carry epinephrine. - Administer oxygen, transport at once, and request a paramedic intercept.

A 37-year-old male is having a severe allergic reaction to penicillin. He does not have an epinephrine auto-injector and your protocols do not allow you to carry epinephrine on the ambulance. How should you proceed with the treatment of this patient? - Ask the patient if he has any diphenhydramine tablets that you can administer. - Remain at the scene with the patient and request a paramedic ambulance. - Quickly determine if there are any bystanders who may carry epinephrine. *- Administer oxygen, transport at once, and request a paramedic intercept.*

After administering 0.3 mg of epinephrine via auto-injector to a 22-year-old woman with an allergic reaction, you note improvement in her breathing and dissipation of her hives. However, she is still anxious and tachycardic. You should: - transport her rapidly, as it is obvious that she is having a severe reaction to the epinephrine. - consider administering 0.15 mg of epinephrine to completely resolve her allergic reaction. - monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine. - contact medical control and obtain authorization to administer another 0.3 mg of epinephrine.

After administering 0.3 mg of epinephrine via auto-injector to a 22-year-old woman with an allergic reaction, you note improvement in her breathing and dissipation of her hives. However, she is still anxious and tachycardic. You should: - transport her rapidly, as it is obvious that she is having a severe reaction to the epinephrine. - consider administering 0.15 mg of epinephrine to completely resolve her allergic reaction. *- monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.* - contact medical control and obtain authorization to administer another 0.3 mg of epinephrine.

An extreme, life-threatening, systemic reaction that may include shock and respiratory failure is known as what? - Allergic reaction - Anaphylaxis - Urticaria - Angioedema

An extreme, life-threatening, systemic reaction that may include shock and respiratory failure is known as what? - Allergic reaction *- Anaphylaxis* - Urticaria - Angioedema

At the site of the injury, signs and symptoms of an animal or insect bite or sting may include pain, localized heat, and a wheal, which appears as __________. - a series of small, raised pustules - a large area of red, blotchy skin - an uncomfortable depression in the skin - a raised, well-defined area of the skin

At the site of the injury, signs and symptoms of an animal or insect bite or sting may include pain, localized heat, and a wheal, which appears as __________. - a series of small, raised pustules - a large area of red, blotchy skin - an uncomfortable depression in the skin *- a raised, well-defined area of the skin*

Care for a victim of an immunologic emergency who is severely hypotensive should include which of the following? - Position the patient's airway and initiate positive-pressure ventilations. - Apply high-flow oxygen therapy, place the patient in a shock position, and help maintain the patient's body temperature. - Routine spinal immobilization due to the potential for traumatic injury - Initiate basic life support measures, including the use of an automated external defibrillator, if necessary.

Care for a victim of an immunologic emergency who is severely hypotensive should include which of the following? - Position the patient's airway and initiate positive-pressure ventilations. *- Apply high-flow oxygen therapy, place the patient in a shock position, and help maintain the patient's body temperature.* - Routine spinal immobilization due to the potential for traumatic injury - Initiate basic life support measures, including the use of an automated external defibrillator, if necessary.

What is an allergen? - A chemical substance released by the immune system in allergic reactions that is responsible for many of the symptoms of anaphylaxis, such as vasodilation - A poison or harmful substance - A raised, swollen, well-defined area on the skin resulting from an insect bite or allergic reaction - A substance that causes an allergic reaction

What is an allergen? - A chemical substance released by the immune system in allergic reactions that is responsible for many of the symptoms of anaphylaxis, such as vasodilation - A poison or harmful substance - A raised, swollen, well-defined area on the skin resulting from an insect bite or allergic reaction *- A substance that causes an allergic reaction*

What is the common dose of epinephrine contained in an adult EpiPen? - 0.15 mg - 0.3 mg - 1 mg - 3 mg

What is the common dose of epinephrine contained in an adult EpiPen? - 0.15 mg *- 0.3 mg* - 1 mg - 3 mg

When a foreign substance invades the body, the body will __________. - protect itself - go on alert - attempt to inactivate the foreign substance - All of these answers are correct.

When a foreign substance invades the body, the body will __________. - protect itself - go on alert - attempt to inactivate the foreign substance *- All of these answers are correct.*

When an allergic reaction proceeds to life-threatening anaphylaxis, it will usually do so __________. - quickly, within 30 minutes. - slowly, over more than 30 minutes. - quickly, within 30 seconds. - slowly, over several hours.

When an allergic reaction proceeds to life-threatening anaphylaxis, it will usually do so __________. *- quickly, within 30 minutes.* - slowly, over more than 30 minutes. - quickly, within 30 seconds. - slowly, over several hours.

When assessing a patient's breathing, you hear wheezing in all lung fields. What are you hearing? - A high-pitched whistling sound caused by bronchoconstriction - A coarse, low-pitched breath sound heard in patients with chronic mucus in the upper airways - A high-pitched noise heard primarily on inspiration - Crackling, moist breath sounds

When assessing a patient's breathing, you hear wheezing in all lung fields. What are you hearing? *- A high-pitched whistling sound caused by bronchoconstriction* - A coarse, low-pitched breath sound heard in patients with chronic mucus in the upper airways - A high-pitched noise heard primarily on inspiration - Crackling, moist breath sounds

Which of the following are late signs of an allergic reaction? - Sneezing - Hypotension - Tachycardia - Cyanotic, cool skin

Which of the following are late signs of an allergic reaction? - Sneezing *- Hypotension* - Tachycardia *- Cyanotic, cool skin*

Which of the following categories of allergens is the most common? - Chemical - Food - Insect bites/stings - Medication

Which of the following categories of allergens is the most common? - Chemical *- Food* - Insect bites/stings - Medication

Which of the following medications blocks the release of histamines? - Epinephrine (Adrenalin) - Diphenhydramine (Benadryl) - Albuterol (Ventolin) - Acetaminophen (Tylenol)

Which of the following medications blocks the release of histamines? - Epinephrine (Adrenalin) *- Diphenhydramine (Benadryl)* - Albuterol (Ventolin) - Acetaminophen (Tylenol)