Chapter 21 Flashcards
Abdominal cramping
A common gastrointestinal symptom associated with food-induced anaphylaxis.
Actions of epinephrine
Epinephrine mimics the responses of the sympathetic nervous system, constricting blood vessels to improve blood pressure and reducing leakage from capillaries, while relaxing smooth muscle in bronchioles to improve breathing.
Activation of auto-injector
Activated by pressing it against the patient’s thigh, releasing a spring-activated plunger.
Acute circulatory compromise
A reaction with edema of the bronchiole and/or edema of the upper airway, including falling blood pressure, weak pulse, and poor tissue perfusion.
Acute respiratory compromise
A reaction with normal bronchiole and normal airway resulting in an occluded upper airway and labored respirations.
Administration of epinephrine
To administer the epinephrine by auto-injector, obtain an order from medical direction, obtain the auto-injector, check the medication, remove the safety cap(s), place the tip against the lateral aspect of the patient’s thigh, push the injector firmly, hold in place until all medication is injected, dispose of the injector in a biohazard container, and record the administration.
Adult dose of epinephrine
The dosage for adults is typically 0.3 mg or greater.
Advanced life support (ALS)
May be needed for advanced airway control and further medication administration in severe cases.
Agitation
A state of anxiety or restlessness that may be observed in patients experiencing anaphylaxis.
Airway compromise
Swelling of the tissues lining the larynx that can obstruct airflow.
Airway obstruction signs
Indicators such as stridor, hoarseness, or crowing sounds that suggest significant swelling of the airway.
Allergens
A specific type of antigen that causes an abnormal response by the immune system.
Allergic Reaction
A misdirected and excessive response by the immune system to an allergen.
Allergic reaction vs. side effect
A side effect of a medication is not the same as an allergic reaction, such as nausea after codeine.
Alpha properties of epinephrine
Causes the vessels to constrict and regulates the amount of vasoconstriction.
Altered mental status (AMS)
Changes in mental function that may occur during severe allergic reactions.
Anaphylactic reaction
A severe allergic reaction that can cause weak and rapid pulse, edema, and respiratory distress.
Anaphylactic Reaction Criteria for Epinephrine Administration
Criteria that require aggressive emergency care and administration of epinephrine when specific conditions are met.
Anaphylactic Shock
A life-threatening response characterized by cardiovascular collapse and hypotension.
Anaphylactic Shock
A condition characterized by hypoperfusion or shock in conjunction with other signs and symptoms of anaphylaxis. (AKA Anaphylactic Reaction, Anaphylaxis
Anaphylactoid reaction
A non-IgE mediated reaction that can occur the first time an antigen is introduced into the body.
Anaphylactoid reaction
A reaction where chemical mediators are released from mast cells and basophils the first time the antigen is introduced into the body without prior sensitization.
Angioedema
Swelling of the skin and other tissues such as the lips and tongue, often associated with allergic reactions, can be drug induced.
Antibodies
Proteins that search for the antigen, combine with it, and help to destroy it.
Antigen
A foreign substance that induces an immune response, including the production of IgE antibodies.
Antihistamine
A medication, such as diphenhydramine (Benadryl), used to treat mild allergic reactions.
Assessment for Anaphylaxis
1 Evaluate for patent airway and presence of oropharyngeal edema. 2 Auscultate for wheezing and assess level of respiratory effort. 3 Assess for adequacy of perfusion. 4 Assess for presence of signs and symptoms of anaphylaxis.
Asthma
A chronic respiratory condition that increases the risk of severe allergic reactions.
Auvi-Q
An auto-injector for epinephrine that is about the size of a credit card and has audio instructions for the injection process.
Bag-valve-mask device
A device used to deliver positive pressure ventilation, which may be harder to compress in obstructed airways.
Basophils
White blood cells that circulate in the blood and are involved in the immune response, particularly in allergic reactions.
Bees
Includes honeybees and bumblebees, which are part of the Hymenoptera family.
Beta properties of epinephrine
Increases the heart rate, force of contraction of the heart, and the speed at which the electrical impulses are carried through the heart; causes bronchiole smooth muscle to dilate.
Beta-Blocker
A medication that may limit the response to epinephrine in patients experiencing anaphylaxis.
Biphasic Anaphylactic Reaction
Occurs when initial symptoms resolve and a second reaction occurs approximately 1-72 hours later.
Bites and stings
Insect bites or stings that can lead to anaphylaxis, particularly from yellow jackets or wasps.
Breathing assessment
If breathing is inadequate, administer PPV with oxygen.
Bronchial Constriction
Narrowing of the air passages in the lungs, which can be a symptom of anaphylaxis.
Bronchoconstriction
A life-threatening response in anaphylaxis characterized by the tightening of the muscles around the airways, putting pressure on the alveoli.
Capillaries
Small blood vessels that facilitate the exchange of substances between the blood and tissues, including the transport of chemical mediators.
Capillary permeability
The ability of capillaries to allow substances to pass through their walls, which increases during anaphylaxis leading to fluid leakage. Can lead to shock.
Cardiovascular Collapse
Cardiovascular collapse may occur abruptly, without the prior development of skin or respiratory symptoms.
Cardiovascular collapse and poor perfusion
Tachycardia, hypotension, syncope, light-headedness, general weakness, syncope, and chest pain
Cardiovascular System
Tachycardia (increased heart rate), hypotension (decreased blood pressure), irregular pulse, absent radial pulse (severe shock)
Central Nervous System
Another body system that may exhibit signs and symptoms during an anaphylactic reaction. Increased anxiety, light-headedness, unresponsiveness, disorientation, restlessness, seizures, headache
Chemical mediators
Substances released from mast cells and basophils that cause a cascade of events leading to anaphylaxis.
Chemical Substances
Substances released during an anaphylactic reaction that affect the entire body.
Chest Pain
A symptom that may occur in patients experiencing anaphylaxis, sometimes alongside dyspnea.
Chronic obstructive pulmonary disease (COPD)
A group of lung diseases that block airflow and make it difficult to breathe, increasing the risk of severe allergic reactions.
Circulatory compromise
A state where blood circulation is inadequate, which can occur during severe allergic reactions.
Common allergens causing anaphylaxis
Foods like peanuts, nuts, milk, eggs, shellfish, and certain medications.
Common causes of anaphylactic reaction
Medications, idiopathic causes, and various allergens including food and insect stings.
Contact (absorption)
The route where the antigen is absorbed through the skin.
Contraindications for epinephrine
There are no contraindications for the administration of epinephrine in a life-threatening anaphylactic reaction.
Criteria 1 for epinephrine administration
Sudden onset (minutes to several hours) with involvement of skin, mucosal tissue, or both (generalized hives, itching, flushing, redness, edema to face, lips, tongue, and uvula) and at least one of the following: signs or symptoms of respiratory involvement and compromise (e.g., dyspnea, wheezing, cough, stridor, hypoxemia), hypotension—adult SBP, pediatrics; see SBP chart below associated with end-organ dysfunction (syncope, incontinence, hypotonia).
Criteria 2 for epinephrine administration
Two or more of the following occurring rapidly (minutes to several hours) after exposure to a likely allergen or other trigger for a patient: involvement of skin, mucosal tissue, or both (generalized hives, itching, flushing, redness, edema to face, lips, tongue, and uvula), sudden respiratory compromise (dyspnea, wheezing, cough, stridor, hypoxemia), sudden hypotension—adult SBP, pediatrics; see SBP chart below associated with end-organ dysfunction (syncope, incontinence, hypotonia), sudden gastrointestinal symptoms (crampy abdominal pain, vomiting, diarrhea).
Criteria 3 for epinephrine administration
Reduced SBP after exposure to a known allergen for that patient within minutes to several hours: infants and children a low systolic BP age-specific lower limit of normal or decrease in SBP; adults systolic BP or decrease from the person’s baseline systolic BP.
Cutaneous manifestations
Signs such as urticaria or mucocutaneous swelling that are commonly associated with anaphylaxis.
Cyanotic skin
Skin that appears blue due to inadequate breathing.
Desensitization
A medical process that may reduce the likelihood of an anaphylactic reaction upon subsequent exposures to the same antigen.
Diminished breath sounds
A sign of inadequate respiration, indicating the need for immediate positive pressure ventilation.
Disposal of auto-injector
Dispose of the device in a biohazard puncture-resistant container.
Distinguishing reactions
EMTs must differentiate between systemic anaphylactic reactions and local allergic reactions.
Epinephrine Dosage for adults
0.3 milligram for an adult.
Dosage for children
0.15 milligram for a child.
Duration of epinephrine’s effectiveness
Short, only approximately a few minutes.
Dyspnea
Shortness of breath, which can occur before other signs and symptoms in anaphylaxis.
Early transport
Initiate transport of the patient without unnecessary delay; continued assessment can be done en route.
Edema
Swelling caused by excess fluid trapped in the body’s tissues.
Emergency care algorithm
A systematic approach to managing anaphylactic reactions, including assessing mental status and administering oxygen.
Emergency care for severe anaphylaxis
Requires immediate and aggressive intervention by EMTs, including maintaining a patent airway.
EMS unit protocol for epinephrine
If no epinephrine is prescribed or carried on the EMS unit, transport and reassess.
End organ dysfunction
Symptoms indicating that organs are not receiving enough blood flow, such as syncope or incontinence.
Endotracheal intubation
The placement of a tube in the trachea to facilitate breathing, usually performed by an advanced life support (ALS) team.
Epinephrine
A medication administered in severe systemic anaphylactic reactions, especially when hypotension or respiratory distress is present.
Epinephrine auto-injector
A device typically used to administer epinephrine, though some systems may use an ampule and syringe.
Epinephrine injection
Should be reassessed for effectiveness in reversing life-threatening conditions.
Epinephrine’s antihistamine effect
Reduces the effects of histamine.
Epinephrine’s effect on bronchioles
Causes bronchodilation, reversing bronchoconstriction.
Epinephrine’s effect on capillaries
Causes vasoconstriction and tightens the capillaries, reversing the vasodilation and increased capillary permeability experienced by the anaphylactic patient.
EpiPen
A disposable delivery system for self-administration of epinephrine.
EpiPen auto-injector expense
Because of the excessive expense of the EpiPen auto-injector, some EMS units and patients have begun to carry epinephrine in a vial that requires manual administration.
Exercise-induced anaphylaxis
A condition where physical activity can exacerbate anaphylactic reactions, especially after eating certain foods.
Eye: Conjunctivitis
Red and itchy eyes, increased tears, swelling to eyes
Fire ants
Their bite is similar to that of a bee or hornet and can cause severe allergic reactions.
Flushed or red skin
Swelling to the face, lips, neck, hands, feet, and tongue
Food-induced anaphylaxis
Anaphylaxis triggered by exposure to food allergens, which may not always present with cutaneous symptoms.
Gastrointestinal symptoms
Symptoms such as nausea, vomiting, and diarrhea that can occur during food-induced anaphylaxis.
Generalized Signs and Symptoms
Itchy, watery eyes, runny or stuffy nose, sense of impending doom, complaints of ‘not feeling well’, general weakness or discomfort
Genitourinary System
A body system that can also be involved in the signs and symptoms of anaphylaxis. Urinary incontinence, vaginal bleeding, and pelvic pain
Granules
Small particles within mast cells and basophils that contain chemical mediators and are released during an allergic reaction.
High index of suspicion
The need for thorough assessment in potential allergic reaction patients, considering various factors.
Histamine
The primary chemical mediator released from mast cells and basophils, causing bronchoconstriction, vasodilation, and increased capillary permeability.
History Taking
The process of obtaining information from the patient or bystanders to assess the situation, especially if the patient is unresponsive.
Hives
Raised red blotches on the skin, usually accompanied by severe itching, and are a hallmark sign of an allergic reaction. Most common complaint.
Hymenoptera
The family of insects that account for the majority of severe allergic reactions and anaphylaxis related to insect bites.