EMT Ch 21 Brady Lab Quiz

Which medication is a common cause of an anaphylactoid​ reaction? A. NSAIDs B. Activated charcoal C. Epinephrine D. Penicillin

A. NSAIDs Substances that initiate an anaphylactoid​ reaction, such as radiopaque contrast dye and nonsteroidal​ anti-inflammatory drugs​ (NSAIDs), cause the direct breakdown of the mast cell and basophil membranes. In​ general, medications are the leading etiology for anaphylactoid reactions. Other causes of an anaphylactoid reaction are​ protamine, polysaccharides,​ opiates, ACE​ inhibitors, and thiamine. Penicillin is a commonly injected medication that may cause an allergic reaction. Epinephrine is also an injected medication. Activated charcoal is not associated with anaphylactoid reactions.

How many sensitizing exposures to an antigen are required within the body before an anaphylactoid reaction is​ triggered? A. None B. Two if IgE antibodies have formed C. Three if IgE antibodies have not formed D. One if IgE antibodies are already present

A. None In some​ reactions, the chemical mediators can be released from the mast cells and basophils the first time the antigen is introduced into the body without the patient ever having been sensitized. The antigen itself causes the release of the chemical mediators. The anaphylactoid reaction does not require any sensitization​ exposures; it can happen with the first exposure.

Why is early recognition of an acute allergic reaction so important to the​ EMT? A. So that the use of airway skills and an EpiPen can be administered before the patient arrests B. So that you can provide appropriate​ compassion, as an allergic reaction is very frightening C. So that ALS can be called while you are en route to the hospital D. So that you place the patient in the high​ Fowler's position as soon as possible

A. So that the use of airway skills and an EpiPen can be administered before the patient arrests An acute allergic reaction will require the​ EMT's skills as well as ALS​ support, patient​ positioning, and emotional support.​ However, because an anaphylactic reaction can be life​ threatening, the primary assessment is an extremely important part of the patient contact. Closely assess the airway for signs of obstruction. Stridor or crowing sounds indicate significant swelling to the upper airway. Inserting an airway adjunct may not help to relieve the obstruction if the swelling is at the level of the larynx. It may be necessary to provide positive pressure ventilation to force the air past the swollen upper airway. You may also find a swollen tongue that interferes with the airway. Wheezing may be prominent upon assessment of breathing. If a patient is severely​ disoriented, unresponsive, or breathing​ inadequately, immediately begin positive pressure ventilation with supplemental oxygen. The use of an epinephrine​ auto-injector is also indicated if the patient has one available.

What is the main benefit of an epinephrine​ auto-injector? A. The patient can administer the medication by himself. B. EMTs are able to carry​ auto-injectors for patient use. C. ​Auto-injectors can be reused if there is little or no improvement. D. ​Auto-injectors are available without a prescription.

A. The patient can administer the medication by himself. Epinephrine comes packaged in a disposable delivery system for​ self-administration by the patient. A common device that is prescribed to patients is the EpiPen​ auto-injector. The​ auto-injector has a​ spring-activated, concealed needle that is designed to deliver a precise dose of epinephrine when activated.​ Auto-injectors are typically prescribed by the​ patient's physician or may be available on EMS units in some areas. The​ auto-injector contains a single dose and may be used one time with the exception of a Twinject which has 2 injectors and may be used twice.

In what circumstances should you NOT use epinephrine in the treatment of a severely anaphylactic​ patient? A. There are no such circumstances in the emergency setting. B. If the patient has a history of cerebral vascular accidents​ (CVAs) C. If the patient has a systolic pressure below 90 mmHg D. If the patient has sustained a cervical spine injury

A. There are no such circumstances in the emergency setting. If the​ patient's condition warrants its use and medical direction​ approves, there is no prehospital contraindication for the drug. Although the use of the drug does come with some potential side effects related to the cardiovascular​ system, if it is warranted but not​ used, the patient can die.

During an acute allergic​ reaction, what causes the blood pressure to​ decrease? A. Vasodilation and fluid shifting B. Profound vasoconstriction from the chemical mediators that are released C. Development of skin hives D. Fluid shifting out of the gastrointestinal system and into the interstitial spaces

A. Vasodilation and fluid shifting In an anaphylactic​ reaction, the entire body is affected by the release of chemical substances by the immune system. These chemical substances produce​ life-threatening reactions in the​ airway, lungs, blood​ vessels, and heart. Blood vessels​ dilate, and capillaries can begin to​ leak, decreasing the blood pressure and causing shock​ (hypoperfusion). Skin hives cause​ itching, not hypotension. Chemical mediators do not​ vasoconstrict; they vasodilate.

You arrive on scene for a patient in respiratory distress. When you approach the​ patient, you find him lying supine in the​ yard, unresponsive, and covered with​ hives, and you note a​ high-pitched inspiratory shrill sound with every inhalation. One of your immediate field impressions should​ be: A. anaphylactic reaction. B. hypoglycemic episode. C. acute stroke. D. seizure activity.

A. anaphylactic reaction. Because an anaphylactic reaction can be life​ threatening, the primary assessment is an extremely important part of the patient contact. In gathering your general impression of a patient with an anaphylactic​ reaction, you may note signs of obstruction. Stridor or crowing sounds indicate significant swelling to the upper airway. Inserting an airway adjunct may not help to relieve the obstruction if the swelling is at the level of the larynx. It may be necessary to provide positive pressure ventilation to force the air past the swollen upper airway. You may also find a swollen tongue that interferes with the airway. Wheezing may be prominent upon assessment of breathing. If a patient is severely​ disoriented, unresponsive, or breathing​ inadequately, immediately begin positive pressure ventilation with supplemental oxygen. You may also notice​ hives, which are raised red blotches that may occur all over the skin. Hives are usually accompanied by severe itching. Hives​ (urticaria) and itching​ (pruritus) are the hallmark signs and symptoms of an allergic reaction.

While you are caring for a patient who wrecked his​ car, he starts to complain of a rash and itching of his skin. He then tells you that he is allergic to​ latex, and you are wearing a pair of latex exam gloves. What is the entry mechanism of this antigen to the​ patient's body? A. Injection B. Absorption C. Inhalation D. Ingestion

B. Absorption The likely mechanism is absorption from your gloves contacting his skin during your assessment and management. The latex in the gloves gets deposited on his​ skin, and the absorption starts​ (hence the hives and​ itching). Some EMS systems use​ latex-free gloves and equipment to avoid this issue.

Your patient is a​ 26-year-old adult who weighs 85 kilograms and is experiencing an anaphylactic reaction to a bee sting.​ On-line medical direction has instructed you to administer an epinephrine injection. Your patient has a Twinject EpiPen that contains two single​ 0.3-mg doses. What would you​ do? A. Administer half the dose. B. Administer a single​ 0.3-mg dose once and then reassess. C. Do not administer either dose. D. Administer the full dose​ twice, one after the other.

B. Administer a single​ 0.3-mg dose once and then reassess. Although the EMT has the ability to administer the 0.3 mg​ twice, this should be done only if the​ patient's condition warrants it after the first dose. The EMT should reassess the​ airway, breathing, and circulatory components of the patient to determine the response to the dose.

A patient who is displaying clinical findings of both respiratory compromise and hypoperfusion is in need of what​ intervention? A. ​Fowler's positioning B. Epinephrine administration C. Slow and easy transport D. ​Low-flow oxygen

B. Epinephrine administration If the patient is displaying findings that both the​ airway/breathing and perfusion parameters are​ failing, the patient needs​ high-flow oxygen, probable airway​ maintenance, and epinephrine administration if the patient is prescribed an epinephrine​ auto-injector.

What is a primary assessment concern for the EMT in treating a patient who is suspected of having an allergic​ reaction? A. Is the patient​ wheezing? B. Is the airway still​ intact? C. Is hypotension​ present? D. Will there be a risk for​ seizures?

B. Is the airway still​ intact? The first concern for any anaphylactic patient is the airway. This is not because it is the first part of the primary survey but because the airway can easily and rapidly swell shut during an acute anaphylactic reaction. Without a patent​ airway, all other interventions will be doomed to fail. The patient may die from severe bronchoconstriction and​ hypoperfusion, but the most rapid cause of death is typically airway closure.

Itchy​ skin, a runny​ nose, and watery eyes could be signs​ of: A. pneumonia. B. an allergic reaction. C. an anxiety attack. D. respiratory compromise.

B. an allergic reaction. An allergen itself is usually harmless to the​ patient, and most allergic reactions are​ mild, producing nothing more than​ discomfort, such as​ itching, a runny​ nose, and watery​ eyes, results of the​ body's attempts to eliminate the allergen or antigen. These symptoms are not normally associated with​ pneumonia, an anxiety​ attack, or respiratory compromise.

The body system whose function is MOST involved during an allergic reaction is​ the: A. nervous system. B. immune system. C. gastrointestinal system. D. endocrine system.

B. immune system. The body has a defense​ mechanism, known as the immune​ system, to fight off invasion by foreign substances. Foreign​ substances, called​ antigens, including a specific type of antigen called​ allergens, are recognized by the cells of the immune system and are eventually destroyed. In most​ cases, this immune response takes place with no allergic reaction or with just a mild allergic reaction. Although allergens are often quite common and harmless to most​ individuals, they can cause an abnormal response by the immune​ system; this response is known as an allergic reaction. The endocrine system is the collection of glands that produce hormones that regulate​ metabolism, growth, and other things. The nervous system is the​ body's sensory and motor system that is responsible for transmitting signals throughout the body. The gastrointestinal system is responsible for digestion and absorption of nutrients into the body.

Hives​ are: A. always accompanied by severe itching. B. raised red blotches over the skin. C. ​red, itchy flat blotches on the skin. D. caused by a lack of histamine.

B. raised red blotches over the skin. A patient who is suffering from anaphylaxis may have​ hives, which are raised red blotches that may occur all over the skin. Hives are usually​ (but not​ always) accompanied by severe itching. Hives​ (urticaria) and itching​ (pruritus) are the hallmark signs and symptoms of an allergic reaction. Histamine is the primary chemical mediator released by the body during anaphylaxis which is responsible for​ bronchoconstriction, vasodilation, and an increase in capillary permeability​ (leakage).

You arrive on scene for a patient who was reportedly stung by a wasp. The patient presents unresponsive with inspiratory​ stridor, hypotension, and wheezing upon​ auscultation, and his skin is covered with hives. Given these​ findings, what type of allergic reaction is the patient​ experiencing? A. Pulmonary B. Cutaneous C. Anaphylactic D. Mild allergic

C. Anaphylactic An acute anaphylactic reaction is hallmarked by three important​ findings: airway closure​ (which causes​ stridor), bronchoconstriction​ (which causes​ wheezing), and vasodilation​ (which causes​ hypotension). This is a patient who is near death and requires immediate and aggressive basic life support and ALS resuscitation. Just cutaneous reactions are considered​ mild, and findings that involve just the skin and some bronchiole wheezing are considered to be signs of a moderate reaction. A severe reaction as described here is full anaphylaxis.

You arrive on scene to back up another EMT unit for a patient with an allergic reaction. As you approach the​ scene, you see one EMT preparing to administer the​ patient's EpiPen. Which the clinical finding would support the use of the​ EpiPen? A. Low pulse oximeter reading B. Tachypnea C. Hypoperfusion D. Tachycardia

C. Hypoperfusion The​ patient's blood pressure​ (or other evidence of​ hypoperfusion) is one of the key findings that will alert the EMT to the presence of a severe allergic reaction that will probably need the administration of the​ patient's epinephrine​ auto-injector if one is available. Tachycardia and tachypnea are both​ non-descriptive for an acute versus a mild​ reaction, and a dropping pulse ox reading can result from many different conditions other than anaphylaxis.

Your patient is exhibiting signs and symptoms of an allergic reaction with dyspnea and​ wheezing, and he has itchy hives on his body. His blood pressure is still​ acceptable, and the pulse oximeter reads 97 percent on room air. At this​ time, how severe is the allergic​ reaction? A. Mild B. Severe C. Moderate D. There is not enough information to determine severity.

C. Moderate This patient is still presenting with a moderate reaction. Mild reactions have primarily cutaneous​ (skin) findings and typically do not have a pulmonary component. Moderate reactions include cutaneous findings and a pulmonary component​ (dyspnea, wheezing,​ cough, etc.). Severe reactions typically present with​ hypotension, severe​ wheezing, and airway issues.

Which of the following findings would be a pulmonary manifestation of an acute allergic​ reaction? A. Airway stridor on inhalation B. Low systolic blood pressure with a narrow pulse pressure C. Severe wheezing on inhalation and exhalation D. Feeling of dyspnea by the patient

C. Severe wheezing on inhalation and exhalation Wheezing is caused by the bronchoconstriction resulting from the allergic reaction. If the patient has wheezing on both inhalation and​ exhalation, it makes the reaction more severe. The perception of dyspnea by the patient is also pulmonary in​ nature, but that can occur with mild or severe​ reactions, so it is not a definitive finding in determining patient stability. Stridor is an airway disturbance. Hypotension is a cardiovascular finding.

Which choice would be considered a contraindication for the administration of an EpiPen to a​ 16-year-old male in a​ life-threatening anaphylactic​ situation? A. Respirations that are 24 and shallow B. A pulse rate above 130 C. The EpiPen is prescribed to the​ patient's twin brother. D. A blood pressure reading of​ 90/70

C. The EpiPen is prescribed to the​ patient's twin brother. Despite the seriousness of the​ situation, the EMT may administer an EpiPen only if it is prescribed to the patient to whom it is to be administered. It is not​ "close enough" if the EpiPen was prescribed to the​ patient's twin brother.

Which finding is NOT specific enough to tell you that the patient is having an acute allergic​ reaction? A. Systolic pressure of 78 mmHg with a pulse pressure of 18 mmHg B. Bilateral wheezing with minimal alveolar ventilation C. ​High-pitched inspiratory sound every time the patient breathes D. Presence of hives and redness to the trunk and extremities

D. Presence of hives and redness to the trunk and extremities Hives and redness are skin findings with allergic reactions.​ However, they are typically present on mild reactions as​ well, so their mere presence indicates an allergy has occurred but not the real severity.​ Wheezing, hypotension, and stridor are all findings associated with a more severe reaction.

Which statement is TRUE about the prehospital management of anaphylactoid and anaphylactic​ reactions? A. Oxygen must typically be used more generously in an anaphylactoid reaction. B. Several administrations of an inhaled​ beta-agonist may be required to reach full effectiveness for an anaphylactoid reaction. C. A decreased dosage of epinephrine is required for an anaphylactic reaction. D. The treatment for both conditions is the same.

D. The treatment for both conditions is the same. The two conditions present the same clinically and are treated in the same​ way: with the use of oxygen and an epinephrine​ auto-injector (if one is​ available). Although a bronchodilator might be​ beneficial, the EMT is not allowed to administer a bronchodilator if the prescription calls for its use for ongoing pulmonary disease management.

When administering epinephrine via​ auto-injector, you should place the tip of the device against​ the: A. posterior portion of the​ patient's thigh, inferior to the midaxillary line. B. medial portion of the​ patient's thigh. C. anterior portion of the​ patient's upper arm. D. lateral portion of the​ patient's thigh.

D. lateral portion of the​ patient's thigh. The​ auto-injector is simple to use. It is activated by pressing it against the​ patient's thigh. The pressure releases a​ spring-activated plunger, pushing the concealed needle into the thigh muscle and injecting a dose of the drug. The anterolateral portion of the thigh midway between the hip and knee is preferred because it provides the fastest absorption rate and the highest peak blood concentration of the medication.