Chapter 21 - Anaphylactic Reactions
A patient states that he is allergic to poison ivy and was burning it yesterday and 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. Which one of the following actions should be your next?
Obtain a medical history using the SAMPLE mnemonic
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 has occurred due to epinephrine's ability to:
constrict blood vessels
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; however, your service does not have protocols related its use. In EMT class, you went over 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 followed by immediate transport
A patient informs you that any time 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 allergen.
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. Which one of the following would be the most appropriate response?
"It will cause the blood vessels to constrict and increase your blood pressure."
You are responding to a call for an allergic reaction. Your partner is a new EMT and this is his first call. Which one of the following instructions to him about assessment and treatment of an allergic reaction would be correct?
"Our first priority will not be to determine what caused the allergic reaction, but to treat the patient according to his symptoms."
When administering epinephrine to an infant or child, the EMT would place the injector at what site?
Lateral thigh
What is the most severe form of an allergic reaction called?
anaphylaxis
For the EMT to achieve the best results when assisting with epinephrine, the medication should be placed into:
muscle
You have just assisted a patient with his epinephrine auto-injector. The patient states that he has never taken epinephrine before. You would inform him of which one of the following?
"You may feel a little shaky, but that is normal and will pass."
The EMT's patient has swollen lips and hives. Which one of the following scene size-up observations supports the EMT's suspicion that the patient is having an allergic reaction?
A new container of penicillin is on a table with two pills missing
Five minutes after assisting a patient with his epinephrine auto-injector, you determine the patient to be getting progressively worse. The patient has a second auto-injector available; however, written protocols do not address the administration of a second dose. Which one of the following should be your next best action?
Contact medical direction for further orders
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 states that 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 the patient?
It stops the constriction of the patient's small airways
What should an EMT do to assist a patient in taking his epinephrine auto-injector?
Press the injector onto the lateral thigh, and wait for it to automatically injec
You have arrived by the side of a patient who is allergic to latex and was exposed to it when she spilled a latex-containing powder on her right hand. Assessment reveals her to be lethargic and panicked, and able to speak a few words with each breath. Her tongue is swollen and respirations are rapid, labored, and noisy. Which one of the following actions should be your priority?
Provide positive pressure ventilation
Which one of the following assessment findings would indicate that the patient is suffering from an anaphylactic reaction and requires immediate intervention?
Swollen lips with a blood pressure of 84/50 mmHg
The EMT exhibits an understanding of allergic reactions and anaphylaxis when she makes which one of the following statements?
"Anaphylaxis is a severe allergic reaction that will lead to death without emergency care."
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 five years old. She hands you the 0.15 mg auto-injector and notes that it expired several years ago. Which one of the following 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 but tried some crab dip 10 minutes ago. Which one of the following questions 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 one of the following statements?
"Epinephrine administered through an auto-injector can be used for all severe allergic reactions, regardless of the cause."
Which one of the following statements indicates that the EMT understands airway management in a patient suffering a severe allergic reaction?
"If we have to provide positive pressure ventilation, it may be difficult to pass air through the swollen tissues."
After you assist a patient with his epinephrine auto-injector, which one of the following statements made by the patient best indicates that the epinephrine is working and the patient is improving?
"My breathing feels a lot easier."
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. What statement would be most appropriate given the situation?
"The epinephrine will wear off in 10 to 20 minutes. Let's see how you are doing then before thinking about refusing transport."
Which one of the following 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 who is responsive to painful stimuli is covered with hives. He has labored respirations and a weak pulse that is tachycardic. His vital signs are: pulse 128, respirations 24, and blood pressure 80/50 mmHg. Given this presentation, the EMT should be suspicious of what condition?
Anaphylactic 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 one of the following signs would best indicate that the epinephrine is benefiting the patient?
Decreasing wheezing
Your patient is allergic to peanuts and was just exposed to peanut butter. Assessment reveals her to be alert and oriented, with swollen lips and hives on her face. She is breathing adequately at a rate of 20 breaths per minute and has a heart rate of 82 and blood pressure of 118/72 mmHg. She states that she is nauseated and has a headache. Which one of the following is your immediate treatment for this patient?
Provide oxygen via nonrebreather mask.
A panicked and anxious patient informs 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 needed to have a "tube put in his throat" and almost died. When assessing the patient, which one of the following signs or symptoms would provide the best evidence that the patient is having an allergic reaction?
Hives on his chest
During the primary assessment, which one of the following 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 one of the following findings would be present in anaphylaxis, but not in a mild allergic reaction?
Hypotension
You have been called to a kindergarten class for a five-year-old boy who is allergic to peanuts. He ate some 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. As you begin the primary assessment, which one of the following should you do first?
Inspect the inside of his mouth
What is the most common cause of an allergic reaction?
Medications
A patient with an allergy to bees and a prescribed Epi-pen 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, blood pressure 156/62 mmHg, and SpO2 at 99%. Which one of the following should you do next?
Perform a secondary assessment
When performing the reassessment of a patient having an allergic reaction, which one of the following would be of most concern to the EMT?
Respiratory rate change from 28 to 10 breaths per minute
In which situation would the EMT contact medical direction prior to administering epinephrine to a patient suffering an anaphylactic reaction?
The patient is not prescribed an auto-injector
Which one of the following does the EMT recognize when the onset of signs and symptoms of an allergic reaction is very rapid?
The reaction tends to be more severe
When assessing a patient with an anaphylactic reaction, which one of the following assessment findings should be expected?
Weak radial pulse
You are called to an out-patient surgery center for a patient who developed an allergic reaction while receiving an intravenous (IV) antibiotic. What should the EMT recognize and document as the route of exposure?
injection
Prior to assisting a patient with his epinephrine auto-injector, the EMT must ensure that:
on- or off-line medical direction exists
An alert but confused patient experiencing an allergic reaction begins to exhibit stridorous respirations. The EMT should recognize:
swelling to the upper airway
An alert but confused patient experiencing an allergic reaction begins to exhibit stridorous respirations. The EMT should recognize
swelling to the upper airway.
Which one of the following explains why patients experiencing an allergic reaction have difficulty breathing?
the bronchioles constrict and spasm.
