Chapter 20 Immunologic Emergencies
52.Because the stinger of a honeybee remains in the wound following a sting
it can continue to inject venom for up to 20 minutes.
29.An extreme, life-threatening, systemic reaction that may include shock and respiratory failure is known as what?
Anaphylaxis
27.Why is epinephrine used for anaphylaxis?
It reverses bronchoconstriction and vasodilation. it increased cardiac contractility, bronchodilatio
58.A 40-year-old male was stung by a bee and is having obvious signs of a severe allergic reaction. He tells you that he has an AnaKit in his car, but has never used it before. As your partner applies oxygen to the patient, you contact medical control. The physician will MOST likely advise you to
inject 0.3 mL of epinephrine 1:1,000 SC.
23.You have been called to a park where a local church is holding a potluck dinner. As you exit your ambulance, a woman approaches you holding her 7-year-old son who is wheezing and having difficulty breathing. She informs you that he inadvertently ate a brownie with nuts, and he is allergic to nuts. The child's mother has an EpiPen that contains the appropriate dose of epinephrine for a child. What dose would that be?
0.15 mg
34.What is the common dose of epinephrine contained in an adult EpiPen?
0.3 mg
17.Urticaria is the medical term for
hives.
3.The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the infant-child auto-injector delivers ______ mg.
0.3; 0.15
10.The effects of epinephrine are typically observed within _________ following administration.
1 minute
35.When administering epinephrine via auto-injector, you should hold the injector in place for
10 seconds.
40.Most patients who die of anaphylaxis do so within the first __________ following exposure.
30 minutes
39.Which of the following patients would MOST likely have a delayed onset of an allergic reaction?
A 45-year-old male who ingested penicillin
31.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
32.What is a wheal?
A raised, swollen, well-defined area on the skin
28.What is an allergen?
A substance that causes an allergic reaction
2.Anaphylaxis caused by stinging insects is typically an allergic reaction to ____________ rather than the bite or sting itself.
A. injected poison B. irritating toxin C. deadly venom =D. All of these answers are correct=
20.Epinephrine, whether made by the body or by a drug manufacturer, works rapidly to
A. raise the pulse rate and blood pressure. B. inhibit an allergic reaction. C. relieve bronchospasm. =D. All of these answers are correct.=
5.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?
Administer oxygen, transport at once, and request a paramedic intercept.
33.Which patients has the most significant chance of having a contraindication to epinephrine?
An 80-year-old male with a history of acute coronary syndrome
12.Care for a victim of an immunologic emergency who is severely hypotensive should include which of the following?
Apply high-flow oxygen therapy, place the patient in a shock position, and help maintain the patient's body temperature.
37.Which of the following MOST accurately defines an allergic reaction?
an exaggerated immune system response to any substance
6.Which of the following medications blocks the release of histamines?
Diphenhydramine (Benadryl)
44.Which of the following statements regarding fire ants is correct?
Fire ants often bite a person repeatedly.
30.You are treating a child with a bee sting. The stinger is still embedded in the child's skin. What should you do?
Scrape the skin with the edge of a stiff object.
15.Which of the following sounds indicates swelling of the upper airway?
Stridor
8.Which of the following would MOST likely provide clues regarding the source of a patient's allergic reaction?
The environment in which the patient is found
14.Which of the following signs/symptoms are indicative of respiratory involvement of an allergic reaction?
Tightness in the chest or throat
54.Which of the following negative effects of anaphylaxis will be the MOST rapidly fatal if not treated immediately?
Upper airway swelling
26.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?
Urticaria (hives)
55.Which of the following physiologic actions does epinephrine produce when given for an allergic reaction?
Vasoconstriction and bronchodilation
18.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 raised, well-defined area of the skin
53.A raised, swollen, well-defined area on the skin that is the result of an insect bite or sting is called
a wheal.
19.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
administer oxygen and transport her to the hospital.
45.The foreign substance responsible for causing an allergic reaction is called a(n)
allergen.
25.What are late signs of an allergic reaction?
hypotension and cyanotic, cool skin
42.You are assessing a young male who was stung on the leg by a scorpion. He is conscious and alert, his breathing is regular and unlabored, and his blood pressure is 122/64 mm Hg. Assessment of his leg reveals a wheal surrounded by an area of redness. He states that he had a "bad reaction" the last time he was stung by a scorpion, and carries his own epinephrine auto-injector. You should
apply oxygen as needed, clean the area with soap and water or a mild antiseptic, and transport him to the hospital.
38.You respond to the residence of a 55-year-old female with a possible allergic reaction to peanuts that she ate approximately 30 minutes ago. The patient is conscious and alert, but has diffuse urticaria and the feeling that she has a lump in her throat. As your partner applies oxygen to the patient, you should
ask her if she has prescribed epinephrine.
57.A 38-year-old female was bitten by fire ants while at the park with her kids. Your initial assessment reveals that she is semiconscious, has profoundly labored breathing with reduced tidal volume, and has a rapid, thready pulse. She has a red rash on her entire body and her face appears swollen. You should
assist her ventilations with 100% oxygen.
59.While auscultating breath sounds of a patient who was stung multiple times by a yellow jacket, you hear bilateral wheezing over all lung fields. This indicates
constriction of the bronchioles in the lungs.
43.Common side effects of epinephrine include all of the following, EXCEPT
drowsiness.
41.Common signs and symptoms of an allergic reaction include all of the following, EXCEPT
drying of the eyes.
13.Anaphylaxis is MOST accurately defined as a(n)
extreme allergic reaction that may affect multiple body systems.
24.Which categories of allergens is the most common?
food
60.You have just administered subcutaneous epinephrine to a 22-year-old male from his AnaKit. After properly disposing of the syringe, you should
have him chew and swallow the antihistamine tablets.
47.Chemicals that are responsible for the signs and symptoms of an allergic reaction to a bee sting include
histamines and leukotrienes.
56.When using an auto-injector to give epinephrine, the primary injection site is the
lateral portion of the thigh.
49.A 48-year-old male is found unconscious in the garden by his wife. When you arrive at the scene and assess the man, you find that he is unresponsive, has severely labored breathing, and has hives over his entire trunk. You should
maintain his airway and assist his ventilations.
16.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
monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.
21.Anaphylaxis is not always life threatening, but it typically involves
multiple organ systems.
36.While auscultating breath sounds of a patient who was stung multiple times by a yellow jacket, you hear bilateral wheezing over all lung fields. This indicates
narrowing of the bronchioles in the lungs.
48.Immediately after giving an epinephrine injection, you should
properly dispose of the syringe.
4.When a foreign substance invades the body, the body will __________.
protect itself, go on alert, and attempt to inactivate the foreign substance
1.When an allergic reaction proceeds to life-threatening anaphylaxis, it will usually do so __________.
quickly, within 30 minutes.
61.A 50-year-old male was stung by a honeybee approximately 15 minutes ago. He presents with respiratory distress, facial swelling, and hypotension. After placing him on oxygen and administering his epinephrine via auto-injector, you note that his breathing has improved. Additionally, his facial swelling is resolving and his blood pressure is stable. Your next action should be to
record the time and dose of the injection on the run form.
50.You have administered one dose of epinephrine to a 40-year-old female to treat an allergic reaction that she developed after being stung by a scorpion. Your reassessment reveals that she is still having difficulty breathing, has a decreasing mental status, and has a blood pressure of 80/50 mm Hg. You should
request permission from medical control to give another dose of epinephrine.
7.The stinger from a honeybee should be
scraped away from the skin.
22.You should not use tweezers or forceps to remove an embedded stinger because
squeezing may cause the stinger to inject more venom into the wound.
11.Epinephrine stimulates the ________ response, increasing blood pressure and relieving bronchospasm.
sympathetic
9.The goal of invaders such as bacteria and viruses is to __________.
use a human body as a home
51.The two MOST common signs of anaphylaxis are
wheezing and diffuse urticaria.
46.Epinephrine is indicated for patients with an allergic reaction when
wheezing and hypotension are present.
