Ch. 21 Allergy and Anaphylaxis

Pallor

(n.) an extreme or unnatural paleness

You and your partner are dispatched to 1284 NW 152 Avenue for a child experiencing respiratory distress. On arrival, a frantic woman meets you at the door and begs you to hurry. She informs you that her 12-year-old son was playing in the backyard when he felt a sudden pain on the back of his leg. You find the child on the back porch, in obvious distress, leaning forward in a chair with his elbows on his knees, struggling to catch his breath. Due to severe dyspnea, he is unable to answer your questions. You also notice that his left arm is in a cast. Your partner immediately applies a nonrebreathing mask as you complete the primary assessment. The child's respirations are rapid and shallow, and his pulse is rapid and thready. His skin is pale with patches of raised red spots on his hands, arms, and face. Your partner conducts a systematic rapid physical exam as you obtain vital signs and a SAMPLE history from the mother. When you inquire about allergies, the mother tells you the child had a very mild reaction to a bee sting several months ago. His medical history also includes asthma, anxiety, and a recent fracture of his arm. Your partner informs you that he heard wheezes in all lung fields and observed additional raised red spots on the child's chest.

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When administering epinephrine by auto-injector, the EMT should hold the injector in place for: 5 seconds. 10 seconds. 20 seconds. 30 seconds.

10 seconds (When administering epinephrine via auto-injector, push the injector firmly against the thigh until it activates. Hold the injector in place for 10 seconds to ensure that all the medication is injected.)

What possible chemical is being released into this patient's body during this reaction? A. Histamine B. Antihistamine C. Epinephrine D. Glucose

A. Histamine

allergic reaction

An exaggerated immune response to any substance

Which medication should be administered first for this patient? A. Albuterol B. Epinephrine C. Acetaminophen (Tylenol) D. Diphenhydramine (Benadryl)

B. Epinephrine

2. What should you do first? A. Administer albuterol. B. Transport to the hospital. C. Administer epinephrine. D. Coach the patient to slow his breathing.

C. Administer epinephrine.

if a patient has stingers embedded in their skin, ___(DO/DO NOT) leave stinger(s) in place

DO NOT leave stinger(S) in place

Urticaria

Generalized itching or burning that appears as multiple, small, raised areas on the skin

Side effects of epinephrine:

High blood pressure Increased pulse rate Anxiety Cardiac arrhythmias Pallor Dizziness Chest pain Headache Nausea Vomiting

6. Your partner notes the presence of a medical alert bracelet around the patient's wrist. What should be done and why?

Remove the bracelet. As swelling increases, there is a risk that the jewelry will become constrictive and difficult to remove later. This could result in reduced perfusion to the extremity

Besides an allergic reaction, provide an example of another illness or injury you should consider as part of the differential diagnosis

Some examples include: sepsis (a rash may indicate wide-spread infection), or an anxiety attack (the patient is anxious and breathing rapidly). In an adult patient, pulmonary embolus would also be a possibility, though it is not very likely in a child

The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: a. stridor. b. anxiety. c. cyanosis. d. wheezing. rationale

The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: stridor. Rationale: Correct answer anxiety.Rationale: This is typically a symptom of hypoxia or decreased oxygenation to the brain. cyanosis. Rationale: This is a sign of hypoxia and inadequate tissue perfusion. wheezing. Rationale: This is a sign of lower airway constriction or narrowing.

8. Following the administration of epinephrine, the patient reports that his heart is beating "very fast." How should you respond?

This is a normal side effect of epinephrine. The tachycardia is the result of the drug's stimulation of the body's stress response, and therefore the patient experiences an increased heart rate, increased workload on the heart, and increased demand for oxygen by the heart. Therefore, you should reassure the patient that this effect is normal.

stridor

a high-pitched sound that is most often heard during inhalation

wheezing

a whistling sound, is caused by narrowed bronchioles; it indicates narrowing or swelling of the lower airway

Your partner indicates that he heard wheezes in all lung fields. What did he hear? A. A high-pitched whistling sound caused by bronchoconstriction B. A coarse, low-pitched breath sound heard in patients with chronic mucus in the upper airways C. A high-pitched noise heard primarily on inspiration D. Crackling, moist breath sounds

a. A high-pitched whistling sound caused by bronchoconstriction

What is a wheal? a. A raised, swollen, well-defined area on the skin b. An area of localized swelling involving the lips, tongue, and larynx c. Generalized itching or burning that appears as multiple, small, raised areas on the skin d. An exaggerated immune response to any substance

a. A raised, swollen, well-defined area on the skin (Insect stings and bites can cause a wheal, which is a raised, swollen, well-defined area on the skin. There is no specific treatment for these injuries, although applying ice sometimes makes them less irritating.)

A young male is experiencing signs and symptoms of anaphylactic shock after being stung by a scorpion. His level of consciousness is diminished, his breathing is severely labored, you can hear inspiratory stridor, and his face is cyanotic. The patient has a prescribed epinephrine auto-injector. What should you do first? a. Assist him in administering his epinephrine. b. Apply high-flow oxygen via nonrebreathing mask. c. Provide ventilatory assistance with a bag-mask device. d. Elevate his legs and cover him with a warm blanket. rationale?

a. Assist him in administering his epinephrine. Rationale: This is part of the treatment, but only after his breathing has been addressed. b. Apply high-flow oxygen via nonrebreathing mask. Rationale: Respirations need assistance due to labored breathing and a diminished level of consciousness. c. Provide ventilatory assistance with a bag-mask device. Rationale: Correct answer d. Elevate his legs and cover him with a warm blanket. Rationale: You should treat for shock, but breathing is the first priority.

You are treating a woman who was stung numerous times by hornets. On assessment, you note that some of the stingers are still embedded in her skin. a. leave the stingers in place. b. scrape the stingers from her skin. c. pull the stingers out with tweezers. d. cover the stings with tight dressings. rationale for answers

a. leave the stingers in place. Rationale: A stinger will continue to inject venom even when the stinger is no longer attached to the insect. b. scrape the stingers from her skin.Rationale: Correct answer c. pull the stingers out with tweezers.Rationale: Using tweezers may squeeze more venom into the patient. d. cover the stings with tight dressings.Rationale: Remove the stingers—do not leave them in place.

The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: stridor. anxiety. cyanosis. wheezing.

a. stridor. (Stridor is a high-pitched sound that is most often heard during inhalation. It indicates swelling of the upper airway. Wheezing, a whistling sound, is caused by narrowed bronchioles; it indicates narrowing or swelling of the lower airway. Anxiety and cyanosis can occur from a variety of causes; they are not exclusive to airway swelling.)

Regardless of the situation, a patient's airway must be patent and his or her breathing must remain adequate at all times.

airway

You are called to a local baseball park for a 23-year-old man with difficulty breathing. He states that he ate a package of peanuts approximately 30 minutes ago and denies any allergies or past medical history. Your assessment reveals widespread urticaria, tachycardia, and a BP of 90/60 mm Hg. You can hear him wheezing, even without a stethoscope. You should be MOST suspicious of a(n): acute asthma attack. mild allergic reaction. anaphylactic reaction. moderate allergic reaction.

anaphylactic reaction. (Rationale: The patient's signs and symptoms indicate an anaphylactic reaction. Signs and symptoms of an anaphylactic reaction include difficulty breathing, urticaria (hives) over large parts of the body, and signs of shock (eg, tachycardia, hypotension). Certain foods, such as shellfish and nuts, may result in a relatively slow onset of symptoms, but the symptoms can become just as severe.)

Leukotrienes

are a chemical that is released, along with histamine, to cause an allergic reaction.

The adult EpiPen system delivers _____ mg of epinephrine, and the infant-child system delivers _____ mg. a. 0.15, 0.3 b. 0.3, 0.15 c. 0.15, 0.5 d. 0.5, 0.2

b. 0.3, 0.15(The adult EpiPen system delivers 0.3 mg of epinephrine via an automatic needle and syringe system; the infant-child system delivers 0.15 mg.)

When administering epinephrine by auto-injector, the EMT should hold the injector in place for: a. 5 seconds. b. 10 seconds. c. 20 seconds. d. 30 seconds.

b. 10 seconds.

You are treating a woman who was stung numerous times by hornets. On assessment, you note that some of the stingers are still embedded in her skin. You should: a. leave the stingers in place. b. scrape the stingers from her skin. c. pull the stingers out with tweezers. d. cover the stings with tight dressings.

b. scrape the stingers from her skin. (Because of the venom left in the sac located at the end of the stinger, you should not grab the stingers in an attempt to remove them. Instead, scrape them off with a rigid object such as a credit card.)

The signs and symptoms of an allergic reaction are caused by the release of: histamine. epinephrine. leukotrienes. both histamine and leukotrienes.

both histamine and leukotrienes. (The two chief chemicals released by the body that result in the signs and symptoms of an allergic reaction are histamines and leukotrienes. Epinephrine (adrenaline) is used to treat allergic reactions. Glucagon is a hormone secreted by the pancreas that helps control metabolism.)

A young male is experiencing signs and symptoms of anaphylactic shock after being stung by a scorpion. His level of consciousness is diminished, his breathing is severely labored, you can hear inspiratory stridor, and his face is cyanotic. The patient has a prescribed epinephrine auto-injector. What should you do first? a. Assist him in administering his epinephrine. b. Apply high-flow oxygen via nonrebreathing mask. c. Provide ventilatory assistance with a bag-mask device. d. Elevate his legs and cover him with a warm blanket.

c. Provide ventilatory assistance with a bag-mask device. (The patient is not breathing adequately, as noted by his decreased level of consciousness, severely labored breathing, inspiratory stridor, and cyanosis. Therefore, you should first assist his ventilations with a bag-mask device. He clearly requires epinephrine, but not before restoring adequate breathing first. Regardless of the situation, a patient's airway must be patent and his or her breathing must remain adequate at all times.)

The raised red spots are most likely: A. angioedema. B. acne. C. urticaria. D. a fungal infection

c. urticaria

The most common trigger of anaphylaxis is: a. plants. b. chemicals. c. medications. d. food.

d. food(Foods such as shellfish and peanuts are the most common triggers of anaphylaxis. These foods account for 30% of deaths from anaphylaxis, especially in adolescents and young adults.) (c. Rationale: Medications are the second most common source of anaphylactic reactions.)

histamine

is a chemical that, along with leukotrienes, is released to cause an allergic reaction.

epinephrine

is used to treat anaphylaxis.

Anaphalaxis reactions are either ____ or ___

mild or severe

The negative effects associated with anaphylactic shock are the result of: severe internal fluid loss. inadequate pumping of the heart. vasodilation and bronchoconstriction. the nervous system's release of adrenaline.

vasodilation and bronchoconstriction. (Rationale: Anaphylaxis is an extreme allergic reaction that is life threatening and involves multiple organ systems. In severe cases, anaphylaxis can rapidly result in death. One of the most common signs of anaphylaxis is wheezing, a high-pitched, whistling breath sound that is typically heard on expiration, usually resulting from bronchospasm/bronchoconstriction and increased mucus production.)

7. Your partner suggests that, in addition to epinephrine, the two of you should assist the patient in using his albuterol inhaler. How should you respond? Why?

you should agree to the use of albuterol, as the patient has a history of asthma and exhibits wheezing, which is an indication of lower airway obstruction. Because the primary effect of albuterol is bronchodilation, the inclusion of this treatment could be beneficial