Transcript Chap 18 - Revsworld

Introduction to Emergency
Medical Care
1
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Chapter 18
Immunologic Emergencies
Emergency Care, Twelfth Edition
Limmer • O’Keefe • Dickinson
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National EMS Education
Standard Competencies (1 of 2)
Medicine
Applies fundamental knowledge to provide
basic emergency care and transportation
based on assessment findings for an
acutely ill patient.
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National EMS Education
Standard Competencies (2 of 2)
Immunology
• Recognition and management of shock
and difficulty breathing related to:
– Anaphylactic reactions
• Anatomy, physiology, pathophysiology,
assessment, and management of:
– Hypersensitivity disorders and/or
emergencies
– Anaphylactic reactions
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OBJECTIVES
22.1
22.2
22.3
Define key terms introduced in this chapter. Slides
10, 14, 19, 37, 39
Differentiate between the signs and symptoms of an
allergic reaction and an anaphylactic reaction.
Slides 18–24
Describe the relationship between allergens and
antibodies necessary for an allergic reaction to
occur. Slides 11–13
continued
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OBJECTIVES
22.4
22.5
22.6
Describe the effects of histamine and other
chemicals in producing the signs and symptoms of
anaphylaxis. Slides 13–14
List common allergens. Slides 15–16
Prioritize the steps in assessment and management
of patients with allergic and anaphylactic reactions.
Slides 25–28
continued
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OBJECTIVES
22.7
22.8
Recognize the indications for administering and
assisting a patient in the use of an epinephrine autoinjector. Slides 29, 31
Describe the desired effects and side effects
associated with the administration of epinephrine.
Slides 37–38
continued
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OBJECTIVES
22.9
22.10
Demonstrate administration of epinephrine by autoinjector. Slides 39–41
Describe the considerations in reassessment of
patients with allergic and anaphylactic reactions.
Slides 30–31
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MULTIMEDIA
• Slide 34
• Slide 35
Allergic Reaction—Anaphylaxis Video
Information About Allergic Rhinitis Video
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CORE CONCEPTS
• How to identify a patient experiencing an
allergic reaction
• Differences between a mild allergic
reaction and anaphylaxis
• How to treat a patient experiencing an
allergic reaction
• Who should be assisted with an
epinephrine auto-injector
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Topics
• Allergic Reactions
• Self-Administered Epinephrine
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Allergic Reactions
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Introduction (1 of 2)
• At least 1,000 Americans per year die of
allergic reactions.
• Allergy-related emergencies may involve:
– Acute airway obstruction
– Cardiovascular collapse
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Introduction (2 of 2)
• You must be able to treat these lifethreatening complications.
• Immunology is the study of the body’s
immune system.
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Anatomy and Physiology
• Immune system protects the body from
foreign substances and organisms.
• When a foreign substance invades the
body:
– Body goes on alert.
– Body initiates a series of responses to
inactivate the invader.
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Pathophysiology: Allergic
Reaction (1 of 2)
• An allergic reaction is an exaggerated
immune response to any substance.
• Not caused directly by an outside
stimulus
• Caused by the body’s immune system
– Releases chemicals to combat stimulus
– Include histamines and leukotrienes
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Pathophysiology: Allergic
Reaction (2 of 2)
• Caused by the body’s immune system
– Releases chemicals to combat stimulus
– Include histamines and leukotrienes
• Allergic reaction may be mild and local, or
severe and systemic.
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Pathophysiology:
Anaphylaxis (1 of 3)
• Anaphylaxis is an
extreme, lifethreatening
allergic reaction.
– Involves multiple
organ systems
– Wheezing is one
of the most
common signs.
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Pathophysiology:
Anaphylaxis (2 of 3)
• Urticaria (hives)
is also present.
Source: © Chuck Stewart, MD
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– Consists of small
areas of
generalized
itching or burning
that appear as
multiple, small,
raised areas on
the skin
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Pathophysiology:
Anaphylaxis (3 of 3)
• You may also note hypotension as a
result of hypovolemic shock.
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Allergic Reactions
• Immune system naturally responds to
foreign substances in body
• Allergic reaction: exaggerated response to
foreign substance
• Allergen: substance causing exaggerated
effect
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Body’s Reaction to Allergen
• First exposure
– Immune system forms antibodies
– Antibodies identify and attack particular
foreign substance
– Antibodies combine only with allergen they
were formed in response to
continued
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Body’s Reaction to Allergen
• Second (and subsequent) exposures
– Antibodies exist
– Antibody combines with allergen, leading to
release of histamine and other chemicals into
bloodstream
– Chemicals cause harmful effects
continued
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Body’s Reaction to Allergen
• Effects of histamine and other chemicals
– Inflammation (swelling)
– Bronchoconstriction
– Vasodilation
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Anaphylaxis
• Severe, life-threatening allergic reaction
• Can cause:
– Dilation of blood vessels (hypotension)
– Airway swelling (airway obstruction)
– Bronchoconstriction (respiratory failure)
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Common Allergens
•
•
•
•
•
Insects
Foods
Plants
Medications
Others
– Dust, makeup,
soap, etc.
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Common Allergens (1 of 3)
• Insect bites and
stings
– When an insect bites
and injects the bite
with its venom, this is
called envenomation.
– The reaction may be
local (swelling and
itchiness) or systemic
(involving the entire
body).
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Common Allergens (2 of 3)
• Medications
– Penicillin injection may
cause an immediate
and severe reaction.
– Oral penicillin may
take longer.
Source: Courtesy of Carol B. Guerrero
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– A person will typically
experience an allergic
reaction after
becoming sensitized.
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Common Allergens (3 of 3)
• Plants
– Dusts, pollens, other plant materials
• Food
– Reaction can be relatively slow
– Shellfish, nuts
• Chemicals
– Makeup, soap, latex
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Insect Stings (1 of 11)
• Death from stinging insects far outnumber
deaths from snakebites.
– Stinging organ of most insects is a small
hollow spine projecting from the abdomen.
– Venom can be injected directly into skin.
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Insect Stings (2 of 11)
• Honeybees
cannot withdraw
their stinger.
– Fly away and die
• Wasps, hornets,
and fire ants can
sting multiple
times.
Source: A. © manfredxy/ShutterStock, Inc.
Source: B. © Heintje Joseph T. Lee/
ShutterStock, Inc.
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Insect Stings (3 of 11)
• Some ants, especially the fire ant, also
strike repeatedly.
– Often inject a particularly irritating toxin at the
bite sites
Source: A. Courtesy of Scott Bauer/USDA
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Insect Stings (4 of 11)
• Signs and
symptoms
include:
– Sudden pain
– Swelling
– Localized heat
Source: © Simon Krzic/ShutterStock, Inc.
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– Redness in lightskinned
individuals
– Itching and
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Insect Stings (5 of 11)
• There is no specific treatment for these
injuries.
– Applying ice sometimes helps.
– Swelling may be dramatic and frightening.
– Local manifestations are not serious.
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Insect Stings (6 of 11)
• Stinger of the
honeybee can continue
to inject venom for up
to
20 minutes.
• Attempt to remove the
stinger by scraping the
skin with the edge of a
sharp, stiff object such
as a credit card.
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Insect Stings (7 of 11)
• Do not use tweezers or forceps.
• Wash the area with soap and water.
• Remove any jewelry from the area.
• Be alert for vomiting or signs of shock.
• Give oxygen if needed.
• Monitor the patient’s vital signs.
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Insect Stings (8 of 11)
• About 5% of people may have
anaphylactic reactions from:
– Bees
– Hornets
– Yellow jackets
– Wasps
• Account for 200 deaths per year.
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Insect Stings (9 of 11)
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Insect Stings (10 of 11)
• Patients may experience:
– Generalized itching and burning
– Widespread urticaria
– Wheals
– Swelling of the lips and tongue
– Bronchospasm and wheezing
– Chest tightness and coughing
– Dyspnea
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Insect Stings (11 of 11)
• Patients may experience (cont’d):
– Anxiety
– Abdominal cramps
– Hypotension
– Occasionally, respiratory failure
• If untreated, anaphylactic reaction can
proceed rapidly to death.
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Latex Allergy
• Common concern in EMS
– Many patients have latex sensitivity
– Providers can develop latex allergy from
prolonged exposure
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Course of Reaction
• No way to predict exact course of an
allergic reaction
• Severe reaction often takes place
immediately, but can be delayed 30
minutes or more
• Mild allergic reaction can rapidly progress
to anaphylaxis
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Signs and
Symptoms: Skin
• Swelling
• Flushing (red skin)
• Warm, tingling feeling
in face, mouth, chest,
feet, or hands
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Signs and Symptoms: Hives
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Signs and
Symptoms: Respiratory
•
•
•
•
•
•
Tightness in throat or chest
Cough
Rapid, labored, and/or noisy breathing
Hoarseness, muffled voice, loss of voice
Stridor
Wheezing
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Signs and
Symptoms: Cardiac
• Increased heart rate
• Decreased blood pressure
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Signs and
Symptoms: Generalized
• Itchy, watery eyes and/or runny nose
• Headache
• Feeling of impending doom
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Signs and Symptoms:
Anaphylactic Shock
• Altered mental status
• Flushed, dry skin or pale, cool, clammy
skin
• Nausea or vomiting
• Changes in vital signs
– Increased pulse, respirations
– Decreased blood pressure
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Distinguishing Anaphylaxis
from Mild Allergic Reaction
• Any of previous signs and symptoms can
be associated with an allergic reaction
• Anaphylaxis: patient has either respiratory
distress or signs and symptoms of shock
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Obtain SAMPLE history.
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Apply high-concentration oxygen.
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Patient Assessment (1 of 3)
• Scene size-up
• Scene safety
– Identify and address environmental hazards.
– Patient’s environment or activity may
indicate source of reaction.
– Never enter a scene where more than one
person is experiencing same symptoms.
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Patient Assessment (2 of 3)
• Scene safety (cont’d)
– Follow standard precautions, with a minimum
of gloves and eye protection.
– Consider the need for additional or
specialized resources.
– Call for additional resources earlier rather
than later.
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Patient Assessment (3 of 3)
• Mechanism of injury/nature of illness
– May not be an allergic reaction
– Trauma may have occurred.
– Determine the MOI/NOI.
– Look for bee stingers or chemicals and other
indications of a reaction.
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Primary Assessment (1 of 5)
• Perform a rapid scan of the patient.
• Form a general impression.
– May present as respiratory or cardiovascular
distress in the form of shock
– Patients will be very anxious.
– Call for ALS backup if available.
– Try to get information on the chief complaint.
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Assessment
• Primary assessment
• Identify and treat life-threatening problems
– Airway
– Breathing
– Circulation
continued
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Primary Assessment (2 of 5)
• Airway and
breathing
– Anaphylaxis can cause
rapid swelling of the
upper airway.
– Only a few minutes to
assess the airway and
provide lifesaving
measures
– Work quickly to
determine the severity
of the symptoms.
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Primary Assessment (3 of 5)
• Airway and breathing (cont’d)
– Position conscious patients in tripod position
and listen to the lungs.
– Do not hesitate to initiate high-flow oxygen.
– In severe situations, the definitive care is an
injection of epinephrine.
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Primary Assessment (4 of 5)
• Circulation
– May present with hypotension
– Palpate for radial pulse.
• If the patient is unresponsive and without a pulse,
begin BLS or use an AED.
• If pulse is present, assess for a rapid pulse, and
check skin condition and capillary refill.
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Primary Assessment (5 of 5)
• Initial treatment
– Oxygen
– Positioning
– Maintaining normal body temperature
• Transport decision
– Always provide prompt transport for any
patient who may be having an allergic
reaction.
– Take along all medications and auto-injectors
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History Taking (1 of 4)
• Identify:
– Chief complaint
– History of present illness
– Associated signs and symptoms
– Pertinent negatives
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History Taking (2 of 4)
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History Taking (3 of 4)
• SAMPLE history
• If the patient is conscious, ask the
following questions:
– Have any interventions already been
completed?
– Do you have any prescribed, preloaded
medications for allergic reactions?
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History Taking (4 of 4)
• Ask the following questions (cont’d):
– Do you have any respiratory symptoms?
– Do you have other symptoms?
– Have you had previous allergic reactions,
asthma, or hospitalizations?
– What were you doing or what were you
exposed to before the onset of symptoms?
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Secondary Assessment (1 of 4)
• Physical examinations
– Includes a systemic head-to-toe or focused
assessment
– Thoroughly assess breathing, including:
•
•
•
•
Increased work of breathing
Use of accessory muscles
Head bobbing, nostril flaring, grunting
Tripod positioning
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Secondary Assessment (2 of 4)
• Physical examinations (cont’d)
– Auscultate both the trachea and the chest.
– Wheezing may occur because of narrowing
of the air passages.
– Assess the circulatory system.
– Assess the skin for swelling, rash, hives, or
signs of the source of the reaction.
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Secondary Assessment (3 of 4)
• Vital signs
– Assess baseline vitals:
•
•
•
•
•
•
Pulse
Respirations
Blood pressure
Skin
Pupils
Oxygen saturation
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Secondary Assessment (4 of 4)
• Vital signs (cont’d)
– Rapid respiratory rate indicates airway
obstruction.
– Rapid respiratory and pulse indicate
respiratory distress or systemic shock.
– Pulse oximetry is a useful method to assess
the patient’s perfusion status.
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Reassessment (1 of 3)
• Repeat the primary assessment and
reassess the patient’s vital signs.
– Deterioration of the patient’s condition could
be rapid and fatal.
– Give special attention to any signs of airway
compromise.
– Monitor the patient’s anxiety level.
– Watch for signs of shock.
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Reassessment (2 of 3)
• Interventions
– Identify how much distress the patient is in.
– Severe reactions require epinephrine and
ventilatory support.
– Milder reactions require supportive care such
as oxygen.
– Transport to a medical facility.
– Recheck your interventions.
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Reassessment (3 of 3)
• Communication and documentation
– When to contact medical control depends on
your assessment findings.
– Documentation should include:
• Signs and symptoms
• Reasons for choosing to provide the care you did
• Patient’s response to your treatment
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Assessment
• History and physical exam
– History of allergies
– Exposure
• What was the patient exposed to?
• How (what method/route) was the patient
exposed?
– Signs and symptoms
– Progression
– Interventions
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Treatment
• Manage patient’s airway and breathing
• Apply high-concentration oxygen
• Provide artificial ventilations if patient is
not breathing adequately
• Consider assisting patient with
epinephrine auto-injector
continued
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Treatment
• If patient is not wheezing or showing signs
of respiratory distress or shock
– Continue with assessment
– Consult medical direction regarding use of
auto-injector
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Use of Auto-Injector
• When use of auto-injector may be
appropriate
– If patient has come in contact with substance
that caused allergic reaction in the past
– If patient also has respiratory distress or
exhibits signs and symptoms of shock
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After Administering
Auto-Injector
• Record administration
of auto-injector
• Transport patient
• Reassess
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Additional Doses
of Epinephrine
• Reassessment may show patient condition
deteriorating
• Additional doses of epinephrine may be
necessary
• Requires on-line medical control
• Requires bringing patient’s additional
auto-injectors in ambulance
continued
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Additional Doses of
Epinephrine
• If no auto-injector available
– Request ALS intercept
– Treat for shock
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Emergency Medical Care (1 of 9)
• If patient appears to be having a severe
allergic (or anaphylactic) reaction:
– Administer BLS, including oxygen.
– Provide prompt transport to the hospital.
– Reassess vital signs every 5 minutes
(unstable patient) or 15 minutes (stable
patient).
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Emergency Medical Care (2 of 9)
– Place hypotensive or shock patients in the
appropriate position.
– Request ALS backup if you work in a tiered
response system.
– Be prepared to maintain the airway or
administer cardiopulmonary resuscitation.
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Emergency Medical Care (3 of 9)
– If a stinger is present, scrape away with a
credit card.
– Applying ice may help.
– In some areas, you may be allowed to
administer epinephrine or assist the patient
with epinephrine administration.
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Emergency Medical Care (4 of 9)
• Epinephrine
– Mimics the sympathetic (fight-or-flight)
response
– Causes the blood vessels to constrict
– Reverses vasodilation and hypotension
– Increases cardiac contractility and relieves
bronchospasm
– Rapidly reverses the effects of anaphylaxis
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Emergency Medical Care (5 of 9)
• Indications include:
– A severe allergic reaction
– Hypersensitivity to an exposed substance
• Remember that your EMS service may or
may not allow you to assist the patient in
the administration of epinephrine. Call
medical control!
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Emergency Medical Care (6 of 9)
Source: Courtesy of Shionogi Pharma, Inc.
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• All kits
should
contain a
prepared,
autoinjectable
syringe of
epinephrine.
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Emergency Medical Care (7 of 9)
• The adult EpiPen
delivers 0.3 mg of
epinephrine; the
infant-child system
delivers 0.15 mg.
• The Twinject autoinjector contains two
doses of epinephrine.
• See Skill Drills 18-1
and 18-2.
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Emergency Medical Care (8 of 9)
• Side effects include:
– High blood pressure
– Increased pulse rate
– Anxiety
– Cardiac arrhythmias
– Pallor
– Dizziness
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Emergency Medical Care (9 of 9)
• Side effects include (cont’d):
– Chest pain
– Headache
– Nausea
– Vomiting
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Think About It
• Should you administer an auto-injector for
a simple allergic reaction?
• What assessment findings would indicate
the need for epinephrine?
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Allergic Reaction—
Anaphylaxis Video
Click here to view a video on the subject of anaphylactic shock.
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Information About
Allergic Rhinitis Video
Click here to view a video on the subject of allergic rhinitis.
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Self-Administered
Epinephrine
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Epinephrine
• Commonly prescribed to patients with a
history of allergy
• Auto-injectors are common for people to
carry or have at home
• Hormone produced by body
• Constricts blood vessels
• Dilates bronchioles
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Side Effects of Epinephrine
• Increased heart rate
• Increased cardiac workload
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Auto-Injector
• Spring-loaded needle and syringe with a single
dose of epinephrine
• Upon administration, medication automatically
releases and injects
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Administering Auto-Injector
• Injection site typically anterior-medial thigh
(midway between waist and knee)
• Remove clothing from site if possible
• Use standard precautions
• Remove cap
continued
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Administering Auto-Injector
• Press tip of auto-injector firmly against
patient’s thigh
• Once needle is deployed, allow full
injection of medication before removing
from injection site
• Carefully discard
auto-injector into
sharps container
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Pediatric Note
• Two sizes of auto-injectors
– Adult dose: 0.3 mg
– Children’s dose (for child less than 66
pounds): 0.15 mg
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Chapter Review
Emergency Care, Twelfth Edition
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Chapter Review
• Allergic reactions are common.
Anaphylaxis, a true life-threatening allergic
reaction, is rare.
• The most common symptom in these
cases is itching. Patients with anaphylaxis
will also display life-threatening difficulty
breathing and/or signs and symptoms of
shock.
continued
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Chapter Review
• Patients with anaphylaxis will be extremely
anxious. Their bodies are in trouble and
are letting them know it.
• The signs and symptoms of anaphylaxis
result from physiological changes:
vasodilation, bronchoconstriction, leaky
capillaries, and thick mucus.
continued
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Chapter Review
• By quickly recognizing the condition,
consulting medical direction, and
administering the appropriate treatment,
you can literally make the difference
between life and death for these patients.
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Remember
• In an allergic reaction, the body’s immune
system overreacts to an allergen and
causes potentially harmful side effects.
• Anaphylaxis is a severe, systemic form of
allergic reaction; it is a life-threatening
emergency.
continued
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Remember
• EMTs must use assessment to
differentiate a localized allergic reaction
from a systemic anaphylactic reaction.
• Epinephrine is useful in anaphylaxis
because it constricts dilated blood vessels
and opens bronchial passages.
continued
Emergency Care, Twelfth Edition
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Remember
• Epinephrine has potentially dangerous
side effects and should be used only in the
event of anaphylaxis.
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Questions to Consider
• What are the indications for administration
of an epinephrine auto-injector?
• List some of the more common causes of
allergic reactions.
continued
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Questions to Consider
• List signs or symptoms of an anaphylactic
reaction associated with each of the
following:
– Skin
– Respiratory system
– Cardiovascular system
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Critical Thinking
• A 24-year-old male ate a meal that he
believes contained shellfish. He is allergic
to shrimp. He is sweating and nervous. He
appears to be breathing adequately. You
do not note any wheezing or stridor.
continued
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Critical Thinking
• His face is slightly red. His pulse is 88
strong and regular, respirations 24, blood
pressure 108/74, and skin warm and
moist. Should you administer epinephrine?
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Review
1. The signs and symptoms of an allergic
reaction are caused by the release of:
A. histamine.
B. adrenalin.
C. epinephrine.
D. glucagon.
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Review
Answer: A
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
(adrenalin) is used to treat allergic
reactions.
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Review (1 of 2)
1. The signs and symptoms of an allergic
reaction are caused by the release of:
A. histamine.
Rationale: Correct answer
B. adrenalin.
Rationale: Adrenalin is also called
epinephrine and, along with Benadryl, is
used to treat anaphylaxis.
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Review (2 of 2)
1. The signs and symptoms of an allergic
reaction are caused by the release of:
C. epinephrine.
Rationale: Epinephrine is used to treat
anaphylaxis.
D. glucagon.
Rationale: Glucagon is a hormone
produced by the pancreas that helps in the
control of metabolism.
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Review
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 adrenalin.
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Review
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.
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Review (1 of 2)
2. The negative effects associated with
anaphylactic shock are the result of:
A. severe internal fluid loss.
Rationale: The body does not lose fluid;
blood pools in the dilated circulatory system
and causes less blood flow back to the
heart.
B. inadequate pumping of the heart.
Rationale: Inadequate pumping is not the
problem; the cardiac output is decreased
due to poor return to the heart.
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Review (2 of 2)
2. The negative effects associated with
anaphylactic shock are the result of:
C. vasodilation and bronchoconstriction.
Rationale: Correct answer
D. the nervous system’s release of adrenalin.
Rationale: Adrenalin is the treatment for
anaphylaxis.
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Review
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. severe allergic reaction.
D. moderate allergic reaction.
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Review
Answer: C
Rationale: The patient’s signs and symptoms
indicate a severe allergic reaction, which is rapidly
progressing to anaphylactic shock. Signs and
symptoms of a severe allergic 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.
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Review (1 of 4)
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.
Rationale: Asthma presents with difficulty breathing,
but patients will not have urticaria (hives).
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Review (2 of 4)
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):
B. mild allergic reaction.
Rationale: Mild reactions usually appear with urticaria,
itching, and some swelling, but not hypotension and
breathing difficulties.
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Review (3 of 4)
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):
C. severe allergic reaction.
Rationale: Correct answer
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Review (4 of 4)
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):
D. moderate allergic reaction.
Rationale: The designation is mild or severe—
not moderate.
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Review
4. What is a wheal?
A. a raised, swollen, well-defined area on the
skin
B. a poison
C. small areas of generalized itching or
burning that appear as multiple, small,
raised areas on the skin
D. an exaggerated immune response to any
substance
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Review
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.
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Review (1 of 2)
4. What is a wheal?
A. a raised, swollen, well-defined area on the
skin
Rationale: Correct answer
B. a poison
Rationale: This is the definition of a toxin.
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Review (2 of 2)
4. What is a wheal?
C. small areas of generalized itching or
burning that appear as multiple, small,
raised areas on the skin
Rationale: This is the definition of urticaria.
D. an exaggerated immune response to any
substance
Rationale: This is the definition of an
allergic reaction.
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Review
5. You are treating a woman who was stung
numerous times by hornets. On
assessment, you note that some of the
stingers are still imbedded 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.
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Review
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.
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Review (1 of 2)
5. You are treating a woman who was stung
numerous times by hornets. On
assessment, you note that some of the
stingers are still imbedded in her skin.
You should:
A. leave the stingers in place.
Rationale: A stinger will continue to inject
venom even when the stinger is no longer
attached to the insect.
B. scrape the stingers from her skin.
Rationale: Correct answer
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Review (2 of 2)
5. You are treating a woman who was stung
numerous times by hornets. On
assessment, you note that some of the
stingers are still imbedded in her skin.
You should:
C. pull the stingers out with tweezers.
Rationale: Using tweezers may squeeze
more venom into the patient.
D. cover the stings with tight dressings.
Rationale: Remove the stingers—do not
leave them in place.
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Review
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.
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Review
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.
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Review (1 of 2)
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.
Rationale: This is part of the treatment, but only after
the breathing has been addressed.
B. Apply high-flow oxygen via nonrebreathing mask.
Rationale: Respirations need assistance due to
diminished breathing.
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Review (2 of 2)
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?
C. Provide ventilatory assistance with a bag-mask device.
Rationale: Correct answer
D. Elevate his legs and cover him with a warm blanket.
Rationale: You should treat for shock, but breathing is
the first priority.
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Review
7. The MOST reliable indicator of upper
airway swelling during a severe allergic
reaction is:
A. stridor.
B. anxiety.
C. cyanosis.
D. wheezing.
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Review
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.
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Review (1 of 2)
7. The MOST reliable indicator of upper
airway swelling during a severe allergic
reaction is:
A. stridor.
Rationale: Correct answer
B. anxiety.
Rationale: This is typically a symptom of
hypoxia or decreased oxygenation to the
brain.
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Review (2 of 2)
7. The MOST reliable indicator of upper
airway swelling during a severe allergic
reaction is:
C. cyanosis.
Rationale: This is a sign of hypoxia and
inadequate tissue perfusion.
D. wheezing.
Rationale: This is a sign of lower airway
constriction or narrowing.
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Review
8. What is the best tool or method for
assessing a patient’s perfusion status?
A. small-volume nebulizer
B. bag-mask device
C. pulse oximetry
D. auto-injector
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Review
Answer: C
Rationale: In a patient experiencing an
allergic reaction, pulse oximetry is a useful
method that you can use to assess the
patient’s perfusion status. By using pulse
oximetry, you can determine the percentage
of oxygen saturation in the bloodstream,
which will assist in identifying the degree of
respiratory distress.
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Review (1 of 2)
8. What is the best tool or method for
assessing a patient’s perfusion status?
A. small-volume nebulizer
Rationale: This device holds liquid
medicine that is turned into a fine mist. It
treats conditions like asthma.
B. bag-mask device
Rationale: This device delivers
supplemental oxygen.
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Review (2 of 2)
8. What is the best tool or method for
assessing a patient’s perfusion status?
C. pulse oximetry
Rationale: Correct answer
D. auto-injector
Rationale: This device is designed to
deliver a single dose of a particular drug,
such as epinephrine.
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Review
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
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Review
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.
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Review
9. The adult EpiPen system delivers
_____ mg of epinephrine, and the
infant-child system delivers _____ mg.
A. 0.15, 0.3
Rationale: This is not the correct dosage.
B. 0.3, 0.15
Rationale: Correct answer
C. 0.15, 0.5
Rationale: This is not the correct dosage.
D. 0.5, 0.2
Rationale: This is not the correct dosage.
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Review
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.
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Review
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.
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Review (1 of 2)
10. When administering epinephrine by
auto-injector, the EMT should hold the
injector in place for:
A. 5 seconds.
Rationale: The injector should be held in
place for 10 seconds.
B. 10 seconds.
Rationale: Correct answer
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Review (2 of 2)
10. When administering epinephrine by
auto-injector, the EMT should hold the
injector in place for:
C. 20 seconds.
Rationale: The injector should be held in
place for 10 seconds.
D. 30 seconds.
Rationale: The injector should be held in
place for 10 seconds.
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