Transcript Introduction to Emergency Medical Care

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Chapter 20
Allergies
Slide 1
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Case History
You have arrived at the scene of an adult
male having difficulty breathing. You find a
50-year-old male complaining of shortness of
breath and tightness in his throat. He tells you
that this began about 10 minutes ago after he
was stung by a bee while mowing the lawn.
You notice that he begins to wheeze as he
tells you that his chest and hands feel itchy.
Slide 2
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Allergic Reactions and
Anaphylaxis
• Allergic reaction
 Antibody-antigen reaction
 Results in release of substances (e.g., histamine)
 Affects the respiratory, circulatory, GI systems, and
skin
• Anaphylaxis
 Antibody-antigen reaction gone haywire
 Detrimental rather than protective
Slide 3
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Allergic Reaction
• Possible causes
 Insect bites/stings (bees, wasps, etc.)
 Food (nuts, crustaceans, peanuts, etc.)
 Plants
 Medications
 Others
Slide 4
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Assessment Findings
• Skin
 Warm, tingling feeling
» Face, mouth, chest,
feet, and hands
 Itching
 Hives
Slide 5
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Respiratory System
•
•
•
•
•
•
Tightness in throat/chest
Cough
Rapid breathing
Labored breathing
Retractions
Use of accessory muscles
Slide 6
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Respiratory System
•
•
•
•
•
•
Swelling of the airway
Noisy breathing
Inability to speak or cough
Hoarseness
Stridor
Wheezing (audible without
stethoscope)
Slide 7
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Respiratory System
• Respiratory failure
• Respiratory arrest
Slide 8
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Cardiovascular System
• Increased heart rate
• Decreased blood
pressure
• Decreased perfusion
(shock) due to
vasodilation
Slide 9
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Generalized Findings
•
•
•
•
Itchy, watery eyes
Headache
Sense of impending doom
Runny nose
Slide 10
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Other Signs and Symptoms
• Decreasing mental status
• Signs of shock (hypoperfusion)
• Respiratory distress
Slide 11
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Emergency Medical Care –
Allergic Reaction
• Initial assessment
• Focused history and
physical examination
• Vital signs
• Treatment
Slide 12
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Emergency Medical Care Focused History/Physical Examination
• History of allergies?
• What was patient exposed to?
• How was he or she exposed?
• What effects?
• Progression?
• Interventions?
Slide 13
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Emergency Medical Care
• Vital signs
• SAMPLE history
• Oxygen administration
Slide 14
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Emergency Medical Care
• Patient has prescribed epinephrine?
• Facilitate administration of
preloaded epinephrine.
• Reassess every 2 minutes.
• Record reassessment findings.
• No auto-injector
 Transport
Slide 15
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Patient Without Respiratory
Distress or Shock
• Continue with
focused
assessment.
• Patient should
not receive
epinephrine.
Slide 16
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Relationship to Airway
Management
• Airway/respiratory compromise may develop
over time.
• Ensure a patent airway.
• Provide ventilation.
Slide 17
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Indications
• Patient exhibits the assessment findings of an
allergic reaction.
• Medication is prescribed for this patient by a
physician.
• Medical direction authorizes use for this
patient.
Slide 18
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Form of Medication and
Contraindications
• Medication form
 Liquid
 Automatic needle and syringe system
• No contraindications, when used in a life-threatening
situation
Slide 19
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Dosage
• Adult: one adult auto-injector (0.3 mg)
• Infant and child: one infant/child auto-injector (0.15 mg)
Slide 20
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Actions
• Dilates bronchioles
• Constricts blood vessels
• Blocks histamine effects
Slide 21
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Side Effects
• Increased heart rate
• Headache
• Pallor
• Nausea
• Dizziness
• Vomiting
• Chest pain
• Excitability, anxiety
Slide 22
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Reassessment Strategies
• Transport.
• Continue focused
assessment.
 Airway
 Breathing
 Circulatory status
Slide 23
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Reassessment Strategies –
Patient Condition Worsens
• Signs/symptoms
 Decreasing mental status
 Increasing breathing difficulty
 Decreasing blood pressure
• Actions
 Obtain medical direction.
 Give additional dose of epinephrine.
 Treat for shock (hypoperfusion).
 Administer CPR and AED, as needed.
Slide 24
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Reassessment Strategies –
Patient Condition Improves
• Provide supportive
care.
 Oxygen
 Treatment for shock
(hypoperfusion)
Slide 25
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Summary
• Management of severe allergic reactions
requires
 Rapid identification of signs and symptoms
 Administration of epinephrine
 Management of airway and ventilation
• Key signs and symptoms
 Hives, itching, coughing, sneezing, etc.
 Signs of respiratory distress, airway obstruction, or
shock
Slide 26
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