Chapter 21: Allergy and Anaphylaxis:

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?"

when not to use epenephrine

-Patients without signs of respiratory compromise or hypotension -Those who do not meet the criteria for a diagnosis of anaphylaxis

anaphylactic shock

-blood pressure low -repiratory rate high

What is the dose of epinephrine contained in an adult EpiPen? 0.15 mg 0.3 mg 1 mg 3 mg

0.3 mg

The adult EpiPen system delivers _____ mg of epinephrine, and the infant-child system delivers _____ mg. 0.15, 0.3 0.3, 0.15 0.15, 0.5 0.5, 0.2

0.3, 0.15

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

When administering epinephrine by auto-injector, the EMT should hold the injector in place for: 5 seconds. 10 seconds. 20 seconds. 30 seconds.

10 seconds.

When administering epinephrine via auto-injector, you should hold the injector in place for:

10 seconds.

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

30

epenephrine dose depends on weight 66 pounds (40kg)

66 pounds (40kg)

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.

Which of the following negative effects of anaphylaxis will be the MOST rapidly fatal if not treated immediately?

Upper airway swelling

Which of the following physiologic actions does epinephrine produce when given for an allergic reaction?

Vasoconstriction and bronchodilation

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

Which of the following patients would MOST likely have a delayed onset of an allergic reaction?

a 45-year-old male who ingested penicillin

A raised, swollen, well-defined area on the skin that is the result of an insect bite or sting is called:

a wheal.

A 73-year-old man presents with a generalized rash, which he thinks may have been caused by an antibiotic that he recently began taking. He has a history of coronary artery disease, hypertension, and emphysema. He is conscious and alert, his blood pressure is 144/94 mm Hg, and his pulse is 64 beats/min and regular. You auscultate his breath sounds and hear scattered wheezing, although he is not experiencing respiratory distress. You should:

administer oxygen if needed, transport the patient, and monitor him for signs of deterioration.

The foreign substance responsible for causing an allergic reaction is called a(n):

allergen.

Which of the following MOST accurately defines an allergic reaction?

an exaggerated immune system response to any substance

You are called to a local baseball park for a 23-year-old man with difficulty breathing. He states that he ate a package of peanuts approximately 30 minutes ago and denies any allergies or past medical history. Your assessment reveals widespread urticaria, tachycardia, and a BP of 90/60 mm Hg. You can hear him wheezing, even without a stethoscope. You should be MOST suspicious of a(n): acute asthma attack. mild allergic reaction. anaphylactic reaction. moderate allergic reaction.

anaphylactic reaction.

An extreme, life-threatening, systemic reaction that may include shock and respiratory failure is known as: an allergic reaction. anaphylaxis. urticaria. angioedema.

anaphylaxis

results in respiratory distress and/or hypoperfusion (low blood pressure)

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.

angioedema

areas of localized swelling

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.

The signs and symptoms of an allergic reaction are caused by the release of: histamine. epinephrine. leukotrienes. both histamine and leukotrienes.

both histamine and leukotrienes.

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

Common side effects of epinephrine include all of the following, EXCEPT:

drowsiness.

Common signs and symptoms of an allergic reaction include all of the following, EXCEPT:

drying of the eyes

Common signs and symptoms of an allergic reaction include all of the following, EXCEPT:

drying of the eyes.

best treatment for anaphylactic shock

epinephrine

epipen is a trade name for

epinephrine

Anaphylaxis is MOST accurately defined as a(n):

extreme allergic reaction that may affect multiple body systems.

The most common trigger of anaphylaxis is: plants. chemicals. medications. food.

food.

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

histamines and leukotrienes.

Urticaria is the medical term for:

hives.

swelling indicates ___________

inflammation

Because the stinger of a honeybee remains in the wound following a sting:

it can continue to inject venom for up to 20 minutes.

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 female 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.

first treatment for anaphylactic shock

oxygen

Immediately after giving an epinephrine injection, you should:

properly dispose of the syringe.

The purpose of the human immune system is to ________.

protect the body from foreign susbstances and organisms

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

quickly (within 30 minutes of the injection)

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

rapidly deteriorate

A 50-year-old male was stung by a honeybee approximately 15 minutes ago. He presents with respiratory distress, facial swelling, and hypotension. After placing him on oxygen and administering his epinephrine via auto-injector, you note that his breathing has improved. Additionally, his facial swelling is resolving and his blood pressure is stable. Your next action should be to:

record the time and dose of the injection and transport promptly.

You have administered one dose of epinephrine to a 40-year-old female to treat an allergic reaction that she developed after being stung by a scorpion. Your reassessment reveals that she is still having difficulty breathing, has a decreasing mental status, and has a blood pressure of 80/50 mm Hg. You should:

request permission from medical control to give another dose of epinephrine.

You are treating a woman who was stung numerous times by hornets. On assessment, you note that some of the stingers are still embedded in her skin. You should: leave the stingers in place. scrape the stingers from her skin. pull the stingers out with tweezers. cover the stings with tight dressings.

scrape the stingers from her skin.

The stinger from a honeybee should be:

scraped away from the skin.

The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: stridor. anxiety. cyanosis. wheezing.

stridor.

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: angioedema. acne. urticaria. a fungal infection.

urticaria

Two of the MOST common signs of anaphylaxis are:

urticaria and angioedema

Two of the MOST common signs of anaphylaxis are:

urticaria and angioedema.

The negative effects associated with anaphylactic shock are the result of: severe internal fluid loss. inadequate pumping of the heart. vasodilation and bronchoconstriction. the nervous system's release of adrenaline.

vasodilation and bronchoconstriction.

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

Epinephrine is indicated for patients with an allergic reaction when:

wheezing and hypotension are present.

raised red spots on the skin are most likely: A. angioedema. B. acne. C. urticaria. D. a fungal infection

C. urticaria.

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.

Which of the following categories of allergens is the most common? Chemical Food Insect bites and stings Medication

Food

Which of the following are late signs of an allergic reaction? Sneezing Hypotension Tachycardia Cyanotic, cool skin

Hypotension and Cyanotic, cool skin

Following the administration of epinephrine, the patient reports that his heart is beating "very fast." How should you respond?

That it's a normal side affect of epinephrine.

Which of the following statements regarding epinephrine administration via the intramuscular (IM) route is correct?

The 1:1000 concentration should be used.

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

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 A coarse, low-pitched breath sound heard in patients with chronic mucus in the upper airways A high-pitched noise heard primarily on inspiration Crackling, moist breath sounds

A high-pitched whistling sound caused by bronchoconstriction

What is a wheal? A raised, swollen, well-defined area on the skin An area of localized swelling involving the lips, tongue, and larynx Generalized itching or burning that appears as multiple, small, raised areas on the skin An exaggerated immune response to any substance

A raised, swollen, well-defined area on the skin

What is a wheal? Widespread areas of generalized itching and/or burning that appear as multiple raised areas on the skin A poison or harmful substance A raised, swollen, well-defined area on the skin Swelling of the tongue

A raised, swollen, well-defined area on the skin

What is an allergen? A chemical substance released by the immune system in allergic reactions that is responsible for many of the symptoms of anaphylaxis, such as vasodilation A poison or harmful substance A raised, swollen, well-defined area on the skin resulting from an insect bite or allergic reaction A substance that causes an allergic reaction

A substance that causes an allergic reaction

Your partner indicates that he heard wheezes in all lung fields. What did he hear? A. A high-pitched whistling sound caused by bronchoconstriction B. A coarse, low-pitched breath sound heard in patients with chronic mucus in the upper airways C. A high-pitched noise heard primarily on inspiration D. Crackling, moist breath sounds

A. A high-pitched whistling sound caused by bronchoconstriction

An immune system is necessary for human life because __________.

All of these answers are correct

Which of the following patients has the most significant chance of having a contraindication to epinephrine? A 6-year-old with significant peanut allergies An 80-year-old male with a history of acute coronary syndrome A 47-year-old female with bronchospasms A teenager with no history of allergies

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

Which of the following MOST accurately defines an allergic reaction?

An exaggerated immune system response to any substance

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

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 stops the allergic reaction from progressing. It reverses bronchoconstriction and vasodilation. It slows tachycardia. It decreases blood flow.

It reverses bronchoconstriction and vasodilation.

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

Lateral portion of the thigh

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

You have responded to a scene where the 33-year-old male patient is in obvious respiratory distress, breathing rapidly with audible wheezing, and with flushed red skin that is 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. Administer epinephrine. Give the patient a nonsteroidal anti-inflammatory drug. Give the patient an antihistamine.

Provide high-concentration oxygen.

A young male is experiencing signs and symptoms of anaphylactic shock after being stung by a scorpion. His level of consciousness is diminished, his breathing is severely labored, you can hear inspiratory stridor, and his face is cyanotic. The patient has a prescribed epinephrine auto-injector. What should you do first? Assist him in administering his epinephrine. Apply high-flow oxygen via nonrebreathing mask. Provide ventilatory assistance with a bag-mask device. Elevate his legs and cover him with a warm blanket.

Provide ventilatory assistance with a bag-mask device.

You are treating a child with a bee sting. The stinger is still embedded in the child's skin. What should you do? Remove the stinger with tweezers. Leave the stinger in place. Scrape the skin with the edge of a stiff object. Squeeze the area around the stinger.

Scrape the skin with the edge of a stiff object.

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

Stridor