Chapter 21: Allergy and Anaphylaxis - Emergency Care and Transportation of the Sick and Injured, 12e
You and your partner are dispatched to 1284 NW 152 Avenue for a child experiencing respiratory distress. On arrival, a frantic woman meets you at the door and begs you to hurry. She informs you that her 12-year-old son was playing in the backyard when he felt a sudden pain on the back of his leg. You find the child on the back porch, in obvious distress, leaning forward in a chair with his elbows on his knees, struggling to catch his breath. Due to severe dyspnea, he is unable to answer your questions. You also notice that his left arm is in a cast. Your partner immediately applies a nonrebreathing mask as you complete the primary assessment. The child's respirations are rapid and shallow, and his pulse is rapid and thready. His skin is pale with patches of raised red spots on his hands, arms, and face. Your partner conducts a systematic rapid physical exam as you obtain vital signs and a SAMPLE history from the mother. When you inquire about allergies, the mother tells you the child had a very mild reaction to a bee sting several months ago. His medical history also includes asthma, anxiety, and a recent fracture of his arm. Your partner informs you that he heard wheezes in all lung fields and observed additional raised red spots on the child's chest. 1. The raised red spots are most likely: A. angioedema. B. acne. C. urticaria. D. a fungal infection.
1. Answer: C urticaria.
2. What should you do first? A. Administer albuterol. B. Transport to the hospital. C. Administer epinephrine. D. Coach the patient to slow his breathing.
2. Answer: C Administer epinephrine.
3. What possible chemical is being released into this patient's body during this reaction? A. Histamine B. Antihistamine C. Epinephrine D. Glucose
3. Answer: A Histamine
4. Which medication should be administered first for this patient? A. Albuterol B. Epinephrine C. Acetaminophen (Tylenol) D. Diphenhydramine (Benadryl)
4. Answer: B Epinephrine
5. 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
5. Answer: A A high-pitched whistling sound caused by bronchoconstriction
6. Your partner notes the presence of a medical alert bracelet around the patient's wrist. What should be done and why?
6. Answer: Remove the bracelet. As swelling increases, there is a risk that the jewelry will become constrictive and difficult to remove later. This could result in reduced perfusion to the extremity.
7. Your partner suggests that, in addition to epinephrine, the two of you should assist the patient in using his albuterol inhaler. How should you respond? Why?
7. Answer: You should agree to the use of albuterol, as the patient has a history of asthma and exhibits wheezing, which is an indication of lower airway obstruction. Because the primary effect of albuterol is bronchodilation, the inclusion of this treatment could be beneficial.
8. Following the administration of epinephrine, the patient reports that his heart is beating "very fast." How should you respond?
8. Answer: This is a normal side effect of epinephrine. The tachycardia is the result of the drug's stimulation of the body's stress response, and therefore the patient experiences an increased heart rate, increased workload on the heart, and increased demand for oxygen by the heart. Therefore, you should reassure the patient that this effect is normal.
9. Besides an allergic reaction, provide an example of another illness or injury you should consider as part of the differential diagnosis.
9. Answer: Some examples include: sepsis (a rash may indicate wide-spread infection), or an anxiety attack (the patient is anxious and breathing rapidly). In an adult patient, pulmonary embolus would also be a possibility, though it is not very likely in a child
5. Most patients who die of anaphylaxis do so within the first ___ minutes following exposure. Select one: A. 5 B. 60 C. 30 D. 90 See Common Allergens
Answer: 30 minutes
4.What is a wheal? A.A raised, swollen, well-defined area on the skin B.An area of localized swelling involving the lips, tongue, and larynx C.Generalized itching or burning that appears as multiple, small, raised areas on the skin D.An exaggerated immune response to any substance
Answer: A Rationale: Insect stings and bites can cause a wheal, which is a raised, swollen, well-defined area on the skin. There is no specific treatment for these injuries, although applying ice sometimes makes them less irritating.
7.The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: A.stridor. B.anxiety. C.cyanosis. D.wheezing.
Answer: A Rationale: Stridor is a high-pitched sound that is most often heard during inhalation. It indicates swelling of the upper airway. Wheezing, a whistling sound, is caused by narrowed bronchioles; it indicates narrowing or swelling of the lower airway. Anxiety and cyanosis can occur from a variety of causes; they are not exclusive to airway swelling.
5.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: A.leave the stingers in place. B.scrape the stingers from her skin. C.pull the stingers out with tweezers. D.cover the stings with tight dressings.
Answer: B Rationale: Because of the venom left in the sac located at the end of the stinger, you should not grab the stingers in an attempt to remove them. Instead, scrape them off with a rigid object such as a credit card.
9.The adult EpiPen system delivers _____ mg of epinephrine, and the infant-child system delivers _____ mg. A.0.15, 0.3 B.0.3, 0.15 C.0.15, 0.5 D.0.5, 0.2
Answer: B Rationale: The adult EpiPen system delivers 0.3 mg of epinephrine via an automatic needle and syringe system; the infant-child system delivers 0.15 mg
10.When administering epinephrine by auto-injector, the EMT should hold the injector in place for: A.5 seconds. B.10 seconds. C.20 seconds. D.30 seconds.
Answer: B Rationale: When administering epinephrine via auto-injector, push the injector firmly against the thigh until it activates. Hold the injector in place for 10 seconds to ensure that all the medication is injected.
2.The negative effects associated with anaphylactic shock are the result of: A.severe internal fluid loss. B.inadequate pumping of the heart. C.vasodilation and bronchoconstriction. D.the nervous system's release of adrenaline.
Answer: C Rationale: Anaphylaxis is an extreme allergic reaction that is life threatening and involves multiple organ systems. In severe cases, anaphylaxis can rapidly result in death. One of the most common signs of anaphylaxis is wheezing, a high-pitched, whistling breath sound that is typically heard on expiration, usually resulting from bronchospasm/bronchoconstriction and increased mucus production.
6.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? A.Assist him in administering his epinephrine. B.Apply high-flow oxygen via nonrebreathing mask. C.Provide ventilatory assistance with a bag-mask device. D.Elevate his legs and cover him with a warm blanket.
Answer: C Rationale: The patient is not breathing adequately, as noted by his decreased level of consciousness, severely labored breathing, inspiratory stridor, and cyanosis. Therefore, you should first assist his ventilations with a bag-mask device. He clearly requires epinephrine, but not before restoring adequate breathing first. Regardless of the situation, a patient's airway must be patent and his or her breathing must remain adequate at all times.
3.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): A.acute asthma attack. B.mild allergic reaction. C.anaphylactic reaction. D.moderate allergic reaction.
Answer: C Rationale: The patient's signs and symptoms indicate an anaphylactic reaction. Signs and symptoms of an anaphylactic reaction include difficulty breathing, urticaria (hives) over large parts of the body, and signs of shock (eg, tachycardia, hypotension). Certain foods, such as shellfish and nuts, may result in a relatively slow onset of symptoms, but the symptoms can become just as severe.
8.The most common trigger of anaphylaxis is: A.plants. B.chemicals. C.medications. D.food.
Answer: D Rationale: Foods such as shellfish and peanuts are the most common triggers of anaphylaxis. These foods account for 30% of deaths from anaphylaxis, especially in adolescents and young adults.
The signs and symptoms of an allergic reaction are caused by the release of: A.histamine. B.epinephrine. C.leukotrienes. D.both histamine and leukotrienes.
Answer: D Response: The two chief chemicals released by the body that result in the signs and symptoms of an allergic reaction are histamines and leukotrienes. Epinephrine (adrenaline) is used to treat allergic reactions. Glucagon is a hormone secreted by the pancreas that helps control metabolism.
6. Which of the following statements regarding epinephrine administration via the intramuscular (IM) route is correct? Select one: A. The 1:1000 concentration should be used. B. The maximum single adult dose is 0.15 mg. C. The IM route should not be used in children. D. The preferred injection site is the upper arm. See Emergency Medical Care of Immunologic Emergencies
Answer: The 1:1000 concentration should be used.
1. 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: Select one: A. position her legs well above the level of her heart. B. advise her to see her physician as soon as possible. C. administer oxygen and transport her to the hospital. D. request a paramedic unit to administer epinephrine. See Emergency Medical Care of Immunologic Emergencies
Answer: administer oxygen and transport her to the hospital.
2. 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: Select one: A. administer oxygen if needed, transport the patient, and monitor him for signs of deterioration. B. ask him if he has epinephrine and request approval from medical control to administer it to the patient. C. begin transport and request to administer epinephrine if his systolic blood pressure falls below 110 mm Hg. D. avoid the use of epinephrine because of his cardiac history, even if his symptoms become severe. See Emergency Medical Care of Immunologic Emergencies
Answer: administer oxygen if needed, transport the patient, and monitor him for signs of deterioration. epinephrine.
7. 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: Select one: A. ask her when her last allergic reaction occurred. B. ask her if she has prescribed epinephrine. C. obtain a complete set of baseline vital signs. D. ascertain if she has a family history of allergies. See Patient Assessment of an Immunologic Emergency
Answer: ask her if she has prescribed epinephrine
4. Common side effects of epinephrine include all of the following, EXCEPT: Select one: A. drowsiness. B. dizziness. C. headache. D. tachycardia. See Emergency Medical Care of Immunologic Emergencies
Answer: drowsiness
3. Anaphylaxis is MOST accurately defined as a(n): Select one: A. extreme allergic reaction that may affect multiple body systems. B. moderate allergic reaction that primarily affects the vasculature. C. severe allergic reaction that typically resolves without treatment. D. allergic reaction that causes bronchodilation and vasoconstriction. See Pathophysiology
Answer: extreme allergic reaction that may affect multiple body systems.
