Chapter 21
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."
