Chapter 21: Allergy and Anaphylaxis

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 (hives) are small areas of generalized itching/burning that appear as multiple raised areas on the skin.

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.

Epinephrine reverses bronchoconstriction and vasodilation.

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

An allergen is a substance that causes an allergic reaction.

An extreme, life-threatening, systemic reaction that may include shock and respiratory failure is known as:

an allergic reaction.

anaphylaxis.

urticaria.

angioedema.

anaphylaxis.

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.

If a stinger is embedded in a patient’s skin, scrape the skin with the edge of a stiff object.

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.

Because the patient’s respiratory distress is an immediate life threat, providing high-concentration oxygen is the first action you should take.

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

Wheezing is a high-pitched whistling sound caused by bronchoconstriction.

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 wheal is a raised, swollen, well-defined area on the skin, usually as a result of a bug bite.

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 older patient with a history of coronary issues is at greatest risk of having a bad reaction to the administration of epinephrine.

What is the dose of epinephrine contained in an adult EpiPen?

0.15 mg

0.3 mg

1 mg

3 mg

The dose in an adult EpiPen is 0.3 mg of a 1:1,000 concentration.

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

dizziness.

tachycardia.

drowsiness.

headache.

drowsiness.

Immediately after giving an epinephrine injection, you should:

notify medical control of your action.

reassess the patient's vital signs.

record the time and dose given.

properly dispose of the syringe.

properly dispose of the syringe.

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

The IM route should not be used in children.

The preferred injection site is the upper arm.

The maximum single adult dose is 0.15 mg.

The 1:1000 concentration should be used.

The 1:1000 concentration should be used.

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:

assess his ABCs and vital signs in 15 minutes and allow him to drive himself to the hospital if he remains stable.

apply high-flow oxygen, obtain approval from medical control to assist him with his epinephrine, and transport.

apply oxygen as needed, clean the area with soap and water or a mild antiseptic, and transport him to the hospital.

apply high-flow oxygen, apply a chemical cold pack directly to the injection site, and transport at once.

apply oxygen as needed, clean the area with soap and water or a mild antiseptic, and transport him to the hospital.

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 resolution of her hives. However, she is still anxious and tachycardic. You should:

transport her rapidly, because it is obvious that she is having a severe reaction to the epinephrine.

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

contact medical control and obtain authorization to administer another 0.3 mg of epinephrine.

consider administering 0.15 mg of epinephrine to completely resolve her allergic reaction.

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

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

the body's immune system deactivates the bee's venom.

the stinger should quickly be removed with tweezers.

the toxicity of the venom decreases within 10 minutes.

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

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

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

Wheezing

Stridor

Rhonchi

Rales

Stridor

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?

Ask the patient if he has any diphenhydramine tablets that you can administer.

Remain at the scene with the patient and request a paramedic ambulance.

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

Quickly determine if there are any bystanders who may carry epinephrine.

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

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:

notify medical control of the patient's response to your treatment.

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

reassess his breathing and blood pressure in 15 minutes.

visualize his airway to assess for oropharyngeal swelling.

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

Which of the following MOST accurately defines an allergic reaction?

A direct negative effect on the body by an external substance

A release of erythrocytes in response to a foreign substance

Destruction of the immune system by an external substance

An exaggerated immune system response to any substance

An exaggerated immune system response to any substance

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:

position her legs well above the level of her heart.

advise her to see her physician as soon as possible.

administer oxygen and transport her to the hospital.

request a paramedic unit to administer epinephrine.

administer oxygen and transport her to the hospital.

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:

a significant amount of fluid in the alveoli.

rapid swelling of the upper airway tissues.

enlargement of the bronchioles in the lungs.

narrowing of the bronchioles in the lungs.

narrowing of the bronchioles in the lungs.

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

5

60

30

90

30

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

The patient's family history

The patient's general physical appearance

The time of year in which the exposure occurred

The environment in which the patient is found

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:

ascertain if she has a family history of allergies.

obtain a complete set of baseline vital signs.

ask her when her last allergic reaction occurred.

ask her if she has prescribed epinephrine.

ask her if she has prescribed epinephrine.

Two of the MOST common signs of anaphylaxis are:

hypertension and swollen hands.

expiratory stridor and tachycardia.

watery eyes and localized itching.

urticaria and angioedema.

urticaria and angioedema.

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:

ask his wife if he has any known allergies.

perform a detailed secondary assessment.

maintain his airway and assist his ventilations.

administer oxygen and position him on his side.

maintain his airway and assist his ventilations.

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:

monitor her en route to the hospital and call medical control if she worsens.

administer a nebulized bronchodilator to improve the status of her breathing.

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

crush up an antihistamine tablet and place it in between her cheek and gum.

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

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:

begin transport and request to administer epinephrine if his systolic blood pressure falls below 110 mm Hg.

ask him if he has epinephrine and request approval from medical control to administer it to the patient.

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

avoid the use of epinephrine because of his cardiac history, even if his symptoms become severe.

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

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

Severe hypotension

Upper airway swelling

Diffuse urticaria

Systemic vasodilation

Upper airway swelling

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

Vasoconstriction and bronchodilation

Bronchodilation and vasodilation

Blocking of further histamine release

Bronchoconstriction and vasoconstriction

Vasoconstriction and bronchodilation