Module 20-Immunologic Emergencies

Anaphylaxis caused by stinging insects is typically an allergic reaction to ____________ rather than the bite or sting itself.

injected, poison, irritating toxin, deadly venom

Which of the following is an action of epinephrine on the human body?

It causes increased cardiac contractility

Why is epinephrine used for anaphylaxis?

It reverses bronchoconstriction and vasodilation.

angioedema

Localized areas of swelling beneath the skin, often around the eyes and lips, but it can also involve other body areas as well.

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 labored breathing, and has hives over his entire trunk. You should:

Maintain his airway and assist his ventilations

Which of the following are late signs of an allergic reaction?

hypotension, cyanotic/cool skin

Which questions would be most appropriate for the EMT to ask a conscious victim of an allergic reaction?

"Have you taken any medications for this episode and have they worked?"

What is the common dose of epinephrine contained in an adult EpiPen?

0.3 mg

anaphylaxis

An extreme, life-threatening, systemic allergic reaction that may include shock and respiratory failure.

Which of the following categories of allergens is the most common?

Food

The most common allergens:

Food Medication Plants Chemicals Insect bites and stings

The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the infant-child auto-injector delivers ______ mg.

0.3; 0.15

The effects of epinephrine are typically observed within _________ following administration.

1 minute

Specific hx taking info for allergic reactions:

1) Have any interventions already been completed? 2) Has the patient experienced a severe allergic reaction in the past? 3) Be alert for any statements regarding the ingestion of food that commonly cause allergic reactions.

Most patients who die of anaphylaxis do so within the first ____ minutes following exposure.

30

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

wheezing

A high-pitched, whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of the lower airways; occurs in asthma, bronchiolitis, and chronic obstructive pulmonary disease.

toxin

A poison or harmful substance produced by bacteria, animals, or plants.

wheal

A raised, swollen, well-defined area on the skin resulting from an insect bite or allergic reaction.

Which of the following patients has the most significant chance of having a contraindication to epinephrine?

An 80-year-old male with a history of acute coronary syndrome

Epinephrine

A substance produced by the body (commonly called adrenaline) that has a vital role in the function of the sympathetic nervous system; also, a drug produced by pharmaceutical companies, that increases pulse rate and blood pressure; the drug of choice for an anaphylactic reaction. It also eases breathing problems by decreasing muscle tone of the bronchiole tree.

allergen

A substance that causes an allergic reaction.

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

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

You respond to the residence of a 55-year-old woman 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

A 38-year-old woman was bitten by fire ants while at the park. Your primary assessment reveals that she is semiconscious; has labored breathing; and has a rapid, thready pulse. She has a red rash on her entire body and her face is swollen. You should:

Assist her ventilation with 100% oxygen

histamines

Chemical substances released by the immune system in allergic reactions that are responsible for many of the symptoms of anaphylaxis, such as vasodilation.

leukotrienes

Chemical substances that contribute to anaphylaxis; released by the immune system in allergic reactions.

Which of the following medications blocks the release of histamines?

Diphenhydramine (Benadryl)

Which of the following statements regarding fire ants is correct?

Fire ants often bite a person repeatedly.

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.

uticaria

Small areas of generalized itching and/or burning that appear as multiple raised areas on the skin; hives.

envenomation

The act of injecting venom.

immune system

The body system that includes all of the structures and processes designed to mount a defense against foreign substances and disease-causing agents.

allergic reaction

The body's exaggerated immune response to an internal or surface agent.

immune response

The body's response to a substance perceived by the body as foreign.

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

Which of the following signs/symptoms are indicative of respiratory involvement of an allergic reaction?

Tightness in the chest or throat

During airway and breathing portions of the primary assessment of a victim of an immunologic emergency, the EMT should __________.

Work quickly to assess the adequacy of the patients ability to move air in and out of their lungs

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

What is an allergen?

a substance that causes an allergic reaction.

Which of the following MOST accurately defines an allergic reaction?

an exaggerated immune system response to any substance

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.

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

anaphylaxis

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.

The assessment of an immunologic emergency is critical because it will help the EMT determine whether the __________.

call is medical or traumatic in nature, or both

Urticaria is the medical term for:

hives

Anaphylaxis is MOST accurately defined as a(n):

extreme allergic reaction that may affect multiple body systems.

Chemicals that are responsible for the signs and symptoms of an allergic reaction to a bee sting include:

histamines and leukotrienes.

When an auto-injector is used to give epinephrine, the primary injection site is the:

lateral portion of the thigh

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

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.

Patients may experience allergic reactions to which of the following substances?

plant material, food and medications, insect or animal bites and stings

When a foreign substance invades the body, the body will __________

protect itself, go on alert, attempt to inactivate the foreign substance

The purpose of the human immune system is to ________.

protect the body from foreign substances and organisms

Allergic reactions to injected medications may occur ___________ and may be quite severe.

quickly (within 30 minutes of the injection)

When an allergic reaction proceeds to life-threatening anaphylaxis, it will usually do so __________.

quickly, within 30 minutes

What is a wheal?

raised, swollen, well-defined area on the skin

It is critical to closely monitor and reassess a victim of an immunologic emergency because the patient may _____________.

rapidly deteriorate.

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, such as a credit card, in order to try to remove the stinger.

The stinger from a honeybee should be:

scraped away from the skin.

Which of the following sounds indicates swelling of the upper airway?

stridor

Epinephrine stimulates the ________ response, increasing blood pressure and relieving bronchospasm.

sympathetic

An immune system is necessary for human life because __________.

the human body is under constant attack by foreign substances the body must absorb and inactivate foreign substances bacteria and viruses will attempt to cause infection

Immunology

the study of the body's immune system.

Two of the MOST common signs of anaphylaxis are:

urticaria and angioedema

The goal of invaders such as bacteria and viruses is to __________.

use a human body as a home

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?

uticaria

The scene size-up step in the assessment of an immunologic emergency is critical because it may indicate __________.

what safety precautions are necessary to protect the EMTs, patient(s) and bystander(s); the cause of the allergic or anaphylactic reaction, what additional resources, including ALS, the EMT should call for.