Chapter 20 - Immunologic Emergencies

immune system

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

immune response

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

(T/F) Allergic reactions can occur in response to almost any substance

True

(T/F) An allergic reaction occurs when the body has an immune response to a substance

True

The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the infant-child auto-injector delivers ______ mg. A. 0.03; 0.3 B. 0.1; 0.01 C. 0.01; 0.1 D. 0.3; 0.15

D. 0.3; 0.15

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.

D. All of these answers are correct.

stridor

A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope.

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 and bronchiolitis.

toxin

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

epinephrine

A substance produced by the body (commonly called adrenaline), and a drug produced by pharmaceutical companies that increases pulse rate and blood pressure; the drug of choice for an anaphylactic reaction.

The effects of epinephrine are typically observed within _________ following administration. A. 1 minute B. 1 hour C. 30 seconds D. 30 minutes

A. 1 minute

Which of the following sounds indicates swelling of the upper airway? A. Stridor B. Rhonchi C. Wheezing D. Rales

A. Stridor

Which of the following would MOST likely provide clues regarding the source of a patient's allergic reaction? A. The environment in which the patient is found B. The time of year in which the exposure occurred C. The patient's general physical appearance D. The patient's family history

A. The environment in which the patient is found

Wheezing occurs because excessive _________ and mucus are secreted into the bronchial passages. A. fluid B. carbon dioxide C. blood D. oxygen

A. fluid

The presence of __________ or respiratory distress indicates that the patient is having a severe enough allergic reaction to lead to death. A. hypoperfusion B. hyperfusion C. wheezing D. urticaria

A. hypoperfusion

Anaphylaxis is not always life threatening, but it typically involves: A. multiple organ systems B. wheezing C. urticaria D. wheals

A. multiple organ systems

The stinger from a honeybee should be: A. scraped away from the skin. B. irrigated with copious amounts of water. C. left in place and covered. D. squeezed with tweezers and removed.

A. scraped away from the skin.

You should not use tweezers or forceps to remove an embedded stinger because: A. squeezing may cause the stinger to inject more venom into the wound B. the stinger may break off in the wound C. the tweezers are not sterile and may cause infection D. removing the stinger may cause bleeding

A. squeezing may cause the stinger to inject more venom into the wound

Steps for assisting a patient with administering of an EpiPen include: A. taking body substance isolation precautions. B. placing the tip of the auto-injector against the medial part of the patient's thigh. C. recapping the injector before placing it in the trash. D. Holding the injector in place for 30 seconds

A. taking body substance isolation precautions

anaphylaxis

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

Which of the following is NOT one of the five common allergen categories? A. Food B. Insect bites C. Plants D. Environments

D. Environments

Signs and symptoms of insect stings or bites include all of the following EXCEPT: A. swelling B. ecchymosis C. localized heat D. wheals

B. ecchymosis

When a foreign substance invades the body, the body will __________. A. protect itself B. go on alert C. attempt to inactivate the foreign substance D. All of these answers are correct.

D. All of these answers are correct.

The dosage of epinephrine in an adult EpiPen is: A. 0.10 mg B. 0.15 mg C. 0.30 mg D. 0.50 mg

C. 0.30 mg

Because the stinger of the honeybee is barbed and remains in the wound, it can continue to inject venom for up to: A. 1 minute B. 15 minutes C. 20 minutes D. several hours

C. 20 minutes

Care for a victim of an immunologic emergency who is severely hypotensive should include which of the following? A. Position the patient's airway and initiate positive-pressure ventilations. B. Initiate basic life support measures, including the use of an automated external defibrillator, if necessary. C. Apply high-flow oxygen therapy, place the patient in a shock position, and help maintain the patient's body temperature. D. Routine spinal immobilization due to the potential for traumatic injury

C. Apply high-flow oxygen therapy, place the patient in a shock position, and help maintain the patient's body temperature.

Which of the following medications blocks the release of histamines? A. Acetaminophen (Tylenol) B. Albuterol (Ventolin) C. Diphenhydramine (Benadryl) D. Epinephrine (Adrenalin)

C. Diphenhydramine (Benadryl)

Which of the following signs/symptoms are indicative of respiratory involvement of an allergic reaction? A. Flushed, itching, or burning skin B. A sense of impending doom C. Tightness in the chest or throat D. All of these answers are correct.

C. Tightness in the chest or throat

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. a series of small, raised pustules B. an uncomfortable depression in the skin C. a raised, well-defined area of the skin D. a large area of red, blotchy skin

C. a raised, well-defined area of the skin

In dealing with allergy-related emergencies, you must be aware of the possibility of acute _______ and cardiovascular collapse. A. hypotension B. tachypnea C. airway obstruction D. shock

C. airway obstruction

Speed is essential because it severe cases of anaphylaxis, ________ can occur rapidly. A. urticaria B. compensation C. death D. recovery

C. death

Eating certain foods, such as shellfish or nuts, may result in a relatively __________ reaction that still can be quite severe. A. mild B. fast C. slow D. rapid

C. slow

Prolonged respiratory difficulty can cause ________, shock, and even death. A. tachypnea B. pulmonary edema C. tachycardia D. airway obstruction

C. tachycardia

The goal of invaders such as bacteria and viruses is to __________. A. kill their human host B. spread disease and destruction C. use a human body as a home D. cause an immune response

C. use a human body as a home

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

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: A. position her legs well above the level of her heart. B. request a paramedic unit to administer epinephrine. C. advise her to see her physician as soon as possible. D. administer oxygen and transport her to the hospital.

D. administer oxygen and transport her to the hospital

Anaphylaxis is MOST accurately defined as a(n): A. severe allergic reaction that typically resolves without treatment. B. moderate allergic reaction that primarily affects the vasculature. C. allergic reaction that causes bronchodilation and vasoconstriction. D. extreme allergic reaction that may affect multiple body systems.

D. extreme allergic reaction that may affect multiple body systems.

Urticaria is the medical term for: A. a wheal. B. burning. C. swelling. D. hives.

D. hives

Questions to ask when obtaining a history from a patient appearing to have an allergic reaction include: A. whether the patient has recently traveled B. what the patient ate yesterday C. asking bystanders if anyone else is ill D. how the patient was exposed

D. how the patient was exposed

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: A. contact medical control and obtain authorization to administer another 0.3 mg of epinephrine. B. consider administering 0.15 mg of epinephrine to completely resolve her allergic reaction. C. transport her rapidly, as it is obvious that she is having a severe reaction to the epinephrine. D. monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine

D. monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine

When an allergic reaction proceeds to life-threatening anaphylaxis, it will usually do so __________. A. slowly, over more than 30 minutes. B. quickly, within 30 seconds. C. slowly, over several hours. D. quickly, within 30 minutes

D. quickly, within 30 minutes

Epinephrine, whether made by the body or by a drug manufacturer, works rapidly to: A. decrease the pulse rate and blood pressure B. increase an allergic reaction C. increase wheezing D. relieve bronchospasm

D. relive bronchospasm

Your assessment of the patient experiencing an allergic reaction should include evaluations of all of the following EXCEPT the: A. respiratory system B. circulatory system C. skin D. reproductive system

D. reproductive system

Epinephrine stimulates the ________ response, increasing blood pressure and relieving bronchospasm. A. parasympathetic B. cardiac C. respiratory D. sympathetic

D. sympathetic

(T/F) For a patient appearing to have an allergic reaction, give 100% oxygen via nasal cannula

False

(T/F) Wheezing is a high-pitched breath sound, usually resulting from blockage of the airway, and is heard on expiration

False

urticaria

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

wheal

a raised, swollen, well-defined area on the skin resulting from an insect bite or 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? a. Administer oxygen, transport at once, and request a paramedic intercept b. Ask the patient if he has any diphenhydramine tablets that you can administer c. Quickly determine if there are any bystanders who may carry epinephrine d. Remain at the scene with the patient and request a paramedic ambulance

a. Administer oxygen, transport at once, and request a paramedic intercept

Patients may experience allergic reactions to which of the following substances? a. All of these answers are correct. b. Insect or animal bites and stings c. Food and medications d. Plant material

a. All of these answers are correct.

When an allergic reaction proceeds to life-threatening anaphylaxis, it will usually do so __________. a. slowly, over more than 30 minutes b. quickly, within 30 seconds c. slowly, over several hours d. quickly, within 30 minutes

d. quickly, within 30 minutes

angioedema

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

Allergen

substance that causes an allergic reaction

envenomation

the act of injecting venom

allergic reacion

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

immunology

the study of the body's immune system