Chapter 21

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

A panicked and anxious patient tells you that he is allergic to peanuts and thinks he may have accidentally eaten some. He states that the last time he ate peanuts he almost died and needed to have a​ "tube put in his​ throat." When assessing this​ patient, which of these signs or symptoms would provide the best evidence that the patient is having an​ allergic, and possibly an early​ anaphylactic, reaction?

Hives on his chest

During the primary​ assessment, which of these findings would most lead the EMT to suspect an allergic​ reaction?

Hives to the face and neck

A patient has been stung by a bee. Which of these findings would be present in​ anaphylaxis, but not in a local allergic​ reaction?

Hypotension

A patient states that he is allergic to poison ivy and was burning it yesterday while clearing brush off his farm when he accidentally inhaled some of the smoke.​ Today, he awoke and found a red rash to the back of his left hand and called 911. Assessment reveals him to be alert and​ oriented, with easy respirations and a blood pressure of​ 128/70 mmHg. Your next action would be​ to:

Obtain a full SAMPLE and OPQRST history

A patient with an allergy to bees and a prescribed EpiPen was working in the garden when she noted swelling to the right side of her face. Assessment reveals swelling that is red and hot to the right cheek area. Her airway is​ patent, respirations easy and​ adequate, and radial pulse strong. Her vital signs are​ pulse, 76;​ respirations, 16​ breaths/min; blood​ pressure, 156/62​ mmHg; and​ SpO2, 99%. What should be the​ EMT's action at this​ time?

Perform a secondary assessment

You have been called for a male patient experiencing a severe allergic reaction. The patient is very confused and having great difficulty breathing. He has an epinephrine​ auto-injector, but your service does not have protocols related to its use.​ Fortunately, in your EMT​ class, you learned about and passed a test on the use of an epinephrine​ auto-injector for allergic reactions. In this​ case, you​ should:

Provide oxygen and respiratory support as​ needed, followed by immediate transport

A young female​ patient, who is allergic to​ peanuts, was just exposed to peanut butter in a sandwich at a church picnic. Assessment reveals her to be alert and​ oriented, with swollen lips and hives on her face. She is breathing adequately at a rate of 18​ breaths/min and has a heart rate of 82​ beats/min. Your partner advises you that her blood pressure is​ 118/72 mmHg and​ room-air SpO2 is​ 92%. The patient states that she also has​ asthma, for which she uses an inhaler. What should you do​ first?

Provide supplemental oxygen

When reassessing a patient whom you are treating for an anaphylactic​ reaction, which of these findings would be of the greatest​ concern?

Respiratory rate change from 28 to 10​ breaths/min with increasing patient lethargy

In which of these situations would the EMT contact medical direction prior to administering epinephrine to a patient who is experiencing an anaphylactic​ reaction?

The patient is not prescribed an​ auto-injector

If signs and symptoms of anaphylaxis occur rapidly in a​ patient, the EMT must realize​ that:

The reaction will likely be severe

A patient informs you that whenever she is exposed to a particular​ soap, she experiences a mild allergic reaction. As a knowledgeable​ EMT, you should recognize​ that:

The soap contains an antigen

You are staffing an information booth at the county fair when a mother and her​ 15-year-old son approach. The mother informs you that her son is severely allergic to bee stings and had an epinephrine​ auto-injector prescribed to him when he was 5 years old. She hands you the 0.15 mg​ auto-injector and notes that it expired several years ago. Which of these statements would be most appropriate for you to​ make?

​"Call your doctor to get a new injector and ask him if he wants to change the​ dose."

A patient who is severely short of breath and covered with hives states that she is allergic to crab. Despite her​ allergy, she tried some crab dip 10 minutes​ ago, since it had been​ "years and​ years" since she had her last allergic reaction. Which question should the EMT ask​ first?

​"Do you have an epinephrine​ auto-injector?"

The EMT shows he understands the use of an epinephrine​ auto-injector for treating a patient with an anaphylactic reaction when he makes which of these​ statements?

​"Epinephrine administered through an​ auto-injector can be used for all anaphylactic and anaphylactoid​ reactions, regardless of the​ cause."

A​ 39-year-old female​ patient, who is allergic to​ shellfish, thinks that she may have accidentally ingested some that was mixed into her food at a restaurant. When assessing​ her, which of these statements made by the patient would be suggestive that she is in the early stages of an anaphylactic​ reaction?

​"I suddenly feel like a have a lump in my​ throat."

You have just assisted a patient with his epinephrine​ auto-injector. The patient states that he has never taken epinephrine before. What would be the appropriate EMT response about how the drug may make him​ feel?

​"You may feel a little​ shaky, but that is normal and will​ pass."

Prior to assisting a patient with his epinephrine​ auto-injector, the EMT must ensure​ that:

​On-line or​ off-line medical direction for epinephrine administration exists

You have assisted an adult patient with his epinephrine​ auto-injector. When giving a report to the emergency department​ nurse, you should inform her that which dose of epinephrine was​ administered?

0.3 mg

For the EMT to achieve the best results when assisting a patient with epinephrine​ treatment, the medication should be properly injected​ into:

A muscle

A​ 23-year-old male patient has called EMS for swollen lips and hives. Upon entering the​ scene, which of these observations would make the EMT suspicious that the patient is having an allergic​ reaction?

A new container of penicillin on a table with two pills missing

Within the​ body, the release of histamine causes dilation of​ the:

Blood vessels

After assisting a patient with the use of an epinephrine​ auto-injector, you note that the​ patient's blood pressure has improved. As a knowledgeable​ EMT, you realize that this effect occurred due to​ epinephrine's ability​ to:

Constrict blood vessels

Five minutes after assisting a patient with his epinephrine​ auto-injector, you determine that the patient is getting progressively worse. The patient has a second​ auto-injector available;​ however, written protocols do not address the administration of a second dose. What is the priority action the EMT should take at this​ time?

Contact medical direction for further orders

Why would the patient experiencing an allergic reaction tell you that it is easier to breathe following administration of​ epinephrine?

Dilation of the bronchioles

You have been called to a residence for a female patient who awoke with swollen lips and a rash to her arms and abdomen. In​ addition, she exhibits a mild expiratory wheeze in all lung fields. She called her​ doctor, who advised her to take some Benadryl and call 911 for emergency care. How will the​ Benadryl, acting as an​ antihistamine, benefit this​ patient?

It inhibits the constriction of the​ patient's small airways by blocking histamine

When administering epinephrine to an infant or​ child, the EMT would place the injector at which​ site?

Lateral thigh

An awake but confused patient experiencing an allergic reaction begins to exhibit stridorous respirations. The EMT knows that the underlying condition responsible for this presentation​ is:

Swelling to the upper airway

You are called to an outpatient surgery center for a patient who developed an allergic reaction while receiving an intravenous​ (IV) antibiotic. How would you would document the route of​ exposure?

injection

A patient informs you that he found out he is allergic to certain molds and was prescribed an epinephrine​ auto-injector. He asks you how the epinephrine will help him the next time he is exposed to mold. Your response would​ be:

​"It will cause the blood vessels to constrict and your airway structures to relax so that they​ reopen."

After you assist a patient with his epinephrine​ auto-injector, which of these statements made by the patient best indicates that the epinephrine is working and the patient is​ improving?

​"My breathing feels a lot​ easier."

You are responding to a call for an allergic reaction. Your partner is a new EMT and this is his first call. When prepping him on how the scene and the patient may​ present, which instruction regarding the assessment and treatment of an allergic reaction​ and/or anaphylaxis would be​ correct?

​"Our first priority will not be to determine what caused the allergic​ reaction, but to treat the patient according to his or her​ symptoms."

Five minutes after you assist a patient with her epinephrine​ auto-injector, the patient states that she feels much better and would like to refuse additional care and transport to the hospital. Which of these statements by the EMT would be most appropriate given this​ situation?

​"The epinephrine will start to wear off in 10 or so minutes.​ Let's see how you are doing then before thinking about refusing​ transport."

When assessing a patient with a suspected anaphylactic​ reaction, which of these findings would you​ expect?

​Weak, rapid radial pulse

What is the most severe form of an allergic reaction​ called?

Anaphylaxis

A patient has just taken her first dose of Zocor for high cholesterol. Within​ minutes, she begins to develop​ hives, shortness of​ breath, and low blood pressure. In this​ case, the EMT would recognize that the patient is​ experiencing:

An anaphylactoid reaction

On​ scene, you assisted a patient with his epinephrine​ auto-injector after he was stung multiple times by bees. You are now transporting the patient to the hospital. As you reassess the​ patient, which of these findings would best indicate that the epinephrine is benefiting the​ patient?

Decreasing wheezing

A football player in full uniform has been stung by a bee. Your assessment reveals him to be confused with stridorous respirations and weak radial pulses. His skin is warm and flushed and covered with hives. Vital signs are​ pulse, 164;​ respirations, 28​ breaths/min; blood​ pressure, 74/58​ mmHg; and​ SpO2, 87%. The coach notifies you that the patient is allergic to bees and hands you the​ patient's epinephrine pen. Your next action would be​ to:

Administer the epinephrine through a​ pad-less area of the​ patient's pants over the side of his thigh

What is the primary difference between an anaphylactic reaction and an anaphylactoid​ reaction?

An anaphylactoid reaction may occur without prior sensitization to the​ antigen; anaphylaxis requires prior sensitization

A patient develops an allergic reaction after taking penicillin. In this​ case, the penicillin would be recognized by the body​ as:

An antigen

A patient is covered with hives. He is responsive to painful stimuli but has labored respirations with an inspiratory stridor​ sound, bilateral​ wheezing, and a weak and rapid pulse. His vital signs are​ pulse, 128;​ respirations, 24​ breaths/min; and blood​ pressure, 80/50 mmHg. Given this​ presentation, the EMT should suspect that the patient​ has:

Anaphylaxis

Which of these statements is true regarding both anaphylactic and anaphylactoid​ reactions?

Both anaphylactoid and anaphylactic reactions are treated in the same way

You have been summoned to an apartment for a​ 58-year-old female who complains of hives on her chest and abdomen. When​ asked, she states that she has had several episodes of the hives over the past six​ months, but allergy testing has not been able to pinpoint a cause. Based on this​ information, how would you best classify the cause of the​ patient's reaction?

Idiopathic

Regarding the pathophysiology underlying​ anaphylaxis, which of these statements is​ true?

Histamine causes the capillaries to become leaky and bronchioles to constrict

You have been called to a kindergarten class for a​ 5-year-old boy who is allergic to peanuts. He ate some peanuts in the form of a birthday treat brought to school by a classmate who is celebrating a birthday. From the door of the​ classroom, you note the patient to have swollen lips and hives to his face and arms. The patient also looks unresponsive. As you begin the primary​ assessment, what should be a priority​ action?

Inspect the inside of the​ patient's mouth and assure an open airway

What is the most common cause of an allergic reaction in which the antigen was​ ingested?

Medications

You have arrived by the side of a lethargic patient who is allergic to latex and was exposed to it when she spilled a​ latex-containing powder on her right hand. She is able to speak only a few words with each​ breath, and a quick glance at the pulse oximeter reveals the saturation is in the​ 80-90% range.​ Additionally, the​ patient's tongue is swollen and her respirations are​ rapid, labored, and noisy. Which action is your immediate​ priority?

Start positive pressure ventilation

Which of these assessment findings would indicate that the patient is experiencing an anaphylactic reaction after a bee sting and requires immediate​ intervention?

Swollen lips and oral​ mucosa, with a blood pressure of​ 84/50 mmHg

A mother has called you for her​ 9-year-old daughter, who was stung in the right hand by a bee. She states that her older daughter is allergic to bees and she is scared that the patient may also be​ allergic, although she has never been stung before. Assessment of the patient reveals a​ red, painful, and swollen area on the back of the​ girl's right hand. The primary assessment is unremarkable and her vital signs are normal. The mother hands you her older​ daughter's epinephrine​ auto-injector. You​ would:

Wash the​ patient's hand with soap and water

How should an EMT assist a patient in taking his epinephrine​ auto-injector?

Press the injector onto the lateral​ thigh, and wait for it to automatically inject

You are providing​ bag-valve-mask ventilations to a patient in anaphylactic shock. There is increasing resistance to​ ventilation, despite your use of proper ventilation technique. What is the best way to address this​ situation?

Occlude the​ pop-off valve on the​ bag-valve mask and continue ventilations

What is the best explanation of why patients experiencing an anaphylactic reaction have difficulty​ breathing?

Histamine constricts the bronchioles

You are providing a continuing education session for your EMS department regarding​ anaphylaxis, as you have just returned from a national conference at which current issues related to this pathology were discussed. During your​ session, one of your fellow EMS providers asks you how the body can​ "suddenly" become allergic to something. What is your best​ response?

​"After exposure to a new​ antigen, the body will create antibodies to fight​ it; these antibodies can be the root cause of the anaphylactic response​ later."

The EMT exhibits an understanding of allergic reactions and anaphylaxis when she makes which of these​ statements?

​"Anaphylaxis is a severe allergic reaction that will lead to death without emergency​ care."

Which of these statements indicates that the EMT understands airway management in a patient suffering from​ anaphylaxis?

​"When providing positive pressure​ ventilation, it may be difficult to pass air through the swollen​ tissues."


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