Chapter 23 | Allergic Reaction

Question 1

Define:

allergic reaction

Answer 1

exxagerated response by immune system to foreign substance

Question 2

Answer:

How many doses of epinephrine are in most epinephrine auto-injectors?

Answer 2

1 dose

0.3mg

Question 3

Choose:

Which of the following is most likely to be a complaint of a patient suffering from anaphylaxis?

A: “My legs are numb and I can’t move them.”

B: “I can’t remember what happened.”

C: “My throat feels like it is closing.”

D: “I am having severe muscle pains.”

Answer 3

C

Question 4

Answer:

Your patient has eaten a casserole that may have contained seafood. The patient is worried because he has a seafood allergy. Upon assessment, you find no signs or symptoms of anaphylaxis. The patient’s vital signs are stable and he has an epinephrine auto-injector prescribed to him.

Which of the following actions is most appropriate?

A: Transport the patient rapidly before the onset of anaphylaxis.

B: Assist him with the administration of his epinephrine auto-injector.

C: Try to find out if the casserole contained seafood.

D: Advise the patient that he does not require treatment and transport at this time.

Answer 4

C

Question 5

Answer:

You are transporting a 41-year-old female suffering from severe anaphylaxis. Her respiratory rate is 42 per minute, she is cyanotic, and she has a decreased level of responsiveness.

What next step is the highest priority of care for this patient?

Answer 5

assist ventilations with a BVM

Question 6

Answer:

You are on the scene of a motor vehicle collision in which a car has driven off the roadway and is resting at the bottom of an embankment. The driver is in severe respiratory distress and is unable to speak. His skin is flushed and he has hives. A Medic-Alert bracelet indicates an allergy to peanuts. You notice a candy bar wrapper on the floor of the car.

What should you do first?

Answer 6

immediately administer high-concentration oxygen

the most reasonable assumption (at least while treating patient’s life-threatening condition) is that this patient had an allergic reaction to peanuts in the candy bar

Question 7

Answer:

Your patient has a history of severe anaphylaxis and carries several auto-injectors. You have administered one of the auto-injectors, but the patient’s condition continues to worsen.

What is the next best course of action?

Answer 7

contact medical control to inquire about administering another dose

Question 8

Define:

allergen

Answer 8

foreign substance which causes exxagerated response in body’s immune system

Question 9

Fill in the blank:

On the first exposure to an allergen, the body typically responds with [BLANK].

Answer 9

On the first exposure to an allergen, the body typically responds with no allergic reaction.

(antibodies must be formed first)

Question 10

Fill in the blank:

On the second (and subsequent) exposure to an allergen, the body typically responds by [BLANK].

Answer 10

On the second (and subsequent) exposure to an allergen, the body typically responds by allergic reaction.

(antibodies have been formed)

Question 11

Fill in the blank:

When reacting to an allergen, the body releases the [BLANK] hormone.

Answer 11

the body releases the histamine hormone.

hence why anti-histamines help treat it

Question 12

List:

effects of histamine

3 points

Answer 12

• inflammation (swelling)
• bronchoconstriction
• vasodilation/hypotension

Question 13

Define:

anaphylaxis

Answer 13

severe/life-threatening allergic reaction

Question 14

List:

physiological effects of anaphylaxis

2 points

Answer 14

• vasodilation (vessel expansion causing hypotension)
• bronchoconstriction (airway swelling causing dyspnea)

Question 15

List:

examples of common allergens

6 points

Answer 15

• insects
• foods
• plants
• medications
• dust
• makeup

Question 16

List:

skin-related signs/symptoms of allergic reaction

Answer 16

• swelling
• flushing (redness)
• warm/tingling feeling
• hives/rash

Question 17

Define:

urticaria

Answer 17

hives

Question 18

Identify:

Answer 18

urticaria/hives

Question 19

Define:

angioedema

Answer 19

facial swelling

Question 20

Identify:

Answer 20

angioedema

(facial swelling)

Question 21

List:

respiratory-related signs/symptoms of allergic reaction

5 points (things they feel and things you observe)

Answer 21

• tightness in throat/chest
• cough
• abnormal breathing (rapid/labored/noisy)
• abnormal speaking (hoarseness/muffled/voiceless)
• abnormal breathing sounds (stridor/wheezing)

Question 22

List:

cardiac-related signs/symptoms of allergic reaction

2 points

Answer 22

• increased HR (tachycardia)
• decreased BP (hypotension)

Question 23

List:

head-related signs/symptoms of allergic reaction

4 points (3 physical and 1 mental)

Answer 23

• itchy/watery eyes
• runny nose
• headache
• anxiety or feeling of impending doom

Question 24

List:

signs/symptoms of anaphylactic shock

6 points (assessment findings)

Answer 24

• AMS
• flushed/dry skin or pale/cool/clammy skin
• nausea/vomiting
• increased HR (tachycardia)
• increased RR (tachypnea)
• decreased BP (hypotension)

Question 25

Fill in the blank:

Anaphylaxis can be distinguished from mild allergic reactions because anaphylaxis typically includes either [BLANK] and [BLANK].

Answer 25

Anaphylaxis can be distinguished from mild allergic reactions because anaphylaxis typically includes either respiratory distress or signs/symptoms of shock.

Question 26

Answer:

You respond to a local swim park for a 29-year-old male who was stung by a bee and “passed out.” Upon arrival, you find the patient unresponsive to all stimuli with agonal respirations at 6 per minute. You insert an oral airway and administer oxygen at 15 liters per minute by bag-valve mask. You notice that it is difficult to bag the patient. Your partner listens to lung sounds and states they are very diminished in the upper fields and absent in the lower fields.

What is the best next action?

Answer 26

request orders from medical control to administer epinephrine

bagging is difficult due to bronchoconstriction

Question 27

Choose:

You have responded to a park where you find a 23-year-old female sitting on a bench near a running trail. She states that she has been running for the past 30 minutes and suddenly cannot catch her breath. She states that this has never happened before and she usually runs 5 miles a day. Your assessment reveals that she is flushed, her pulse is fast and weak, her respirations are fast and she is wheezing, and she has hives on her arms and chest.

She is most likely suffering from which of the following?

A. Hyperventilation syndrome

B. Anaphylaxis

C. Heat stroke

D. Allergic reaction

Answer 27

B

Question 28

Choose:

Which of the following is the proper method of disposing of a used epinephrine​ auto-injector?

A. Take it to the hospital for disposal in the emergency department.

B. Bend the needle at an angle to prevent accidental punctures and place it in the trash.

C. Leave it at the scene for the patient or his family to dispose of.

D. Place the device in a rigid biohazardous sharps disposal container.

Answer 28

D

Question 29

Answer:

What happens to blood vessels during an anaphylactic reaction?

Answer 29

dilation

Question 30

Answer:

You are unsure whether a patient’s condition requires the administration of an epinephrine auto-injector.

Which of the following actions is most appropriate?

A. Administer the epinephrine, just in case.

B. Consult with a paramedic on your service for advice.

C. Ask a family member if this is the type of situation when the patient usually takes his​ auto-injector.

D. None of the above

Answer 30

D

they want you to ask Medical Command instead of paramedic or family

but in reality how would A hurt at all??

Question 31

Choose:

You are called to the local park on a hot summer day for an 8-year-old child in respiratory distress. The child can barely speak and appears to be getting sleepy. Vital signs are blood pressure of 90/60, pulse of 120, and respiratory rate of 32. Your physical exam reveals a swollen tongue, inspiratory stridor, wheezing, and hives on the neck and chest.

What condition do you suspect?

A. Asthma

B. Allergic reaction

C. Heat exhaustion

D. Anaphylaxis

Answer 31

D

Question 32

Choose:

Which of the following is not a sign or symptom of an allergic reaction involving the skin?

A. Hives

B. Itching

C. Cyanosis

D. Flushing

Answer 32

C

Question 33

Choose:

You are treating a 28-year-old female who is 34 weeks pregnant. She has a history of bee sting anaphylaxis and was stung by a bee while in the garden. She is having severe respiratory distress and her blood pressure is 72/50 mmHg.

Which of the following is the best option for the EMT?

A. Transport rapidly, bypassing the emergency department and taking the patient directly to the obstetrics unit of the hospital.

B. Do not administer the EpiPen under any circumstances.

C. Immediately administer the patient’s EpiPen.

D. Administer the EpiPen only on the advice of medical control.

Answer 33

D

Question 34

Choose:

As you prepare to enter a patient’s room in a nursing home, you see a sign posted on the door indicating that the patient has a latex allergy.

Which of the following is the best way to care for the patient?

A. Put on latex gloves anyway; you must protect yourself with BSI.

B. Ask the nursing facility staff to find synthetic exam gloves to wear for contact with this patient.

C. Ask the nursing staff if the patient has an epinephrine auto-injector available in case of a reaction to your gloves.

D. Only perform a history on this patient, not a physical exam, so you can avoid contacting him with your gloves.

Answer 34

B

Question 35

Answer:

After activating the EpiPen auto-injector, how long should it be held in place before removing it from the patient’s thigh?

Answer 35

10 seconds

Question 36

Choose:

You are on the scene of a 40-year-old male patient who is anaphylactic and still unresponsive following a single epinephrine injection. Prior to giving the injection, you inserted an oral airway and administered oxygen at 15 liters per minute by bag-valve mask and your partner found diminished lung sounds. Following the epinephrine administration, your partner reassesses lung sounds and tells you that the patient is now wheezing loudly in all fields.

What is the next action you should perform?

A. Contact medical control and request to administer another dose of epinephrine.

B. Place the patient on a nonrebreather mask.

C. Discontinue bagging the patient.

D. Hyperventilate the patient.

Answer 36

A

Question 37

Choose:

You are called to a residence for a 50-year-old male complaining of difficulty breathing. He is alert and oriented to time, place, and person. The patient presents with hives over the chest, stridor, a swollen tongue, and wheezing in the upper fields. He is breathing 32 times per minute. He is speaking in two- to three-word sentences.

What is the best treatment for the patient?

(best doesn’t mean first)

A. Oxygen at 15 liters per minute by​ bag-valve mask

B. Administering epinephrine with consent from medical control

C. Rapid transport to the nearest facility

D. Oxygen at 15 liters per minute by nonrebreather mask

Answer 37

B

all the symptoms definitely point toward anaphylaxis as diagnosis

oxygen should be applied immediately to treat ABCs

epinephrine is the only option that has chance to reverse effects of anaphylaxis

Question 38

Choose:

After administering epinephrine per medical control via an auto-injector to an unresponsive anaphylactic adult patient, your partner reassesses the lung sounds. He tells you that the patient is now wheezing loudly in all fields whereas before the injection they were diminished in the upper fields and absent in the lower.

What is your suspicion regarding the patient’s condition?

A. The patient is about to go into cardiac arrest.

B. There is no change in the patient’s condition.

C. The patient’s condition is worsening.

D. The patient’s condition is improving.

Answer 38

D

Question 39

Choose:

Which of the following is not an indication that epinephrine is helping the anaphylaxis patient’s condition?

A. Increased blood pressure

B. Increased heart rate

C. Increased dyspnea

D. Both B and C

Answer 39

C

Question 40

Choose:

Which of the following explains why a patient may experience difficulty breathing during anaphylaxis?

A. Allergens bind to hemoglobin, preventing it from carrying oxygen.

B. Swelling of the airway tissues causes difficulty breathing.

C. Allergens clump together and block blood flow through the lungs.

D. Swelling in the brain decreases the respiratory drive.

Answer 40

B

Question 41

Choose:

You are transporting a 41-year-old female suffering from severe anaphylaxis. Her respiratory rate is 42 per minute, she is cyanotic, and she has a decreased level of responsiveness.

Which of the following is the highest priority of care for this patient?

A. Transport rapidly.

B. Search for an epinephrine auto-injector.

C. Elevate the patient’s head.

D. Assist ventilations with a bag-valve mask.

Answer 41

D

Question 42

Choose:

What typically distinguishes a peanut allergy from other food allergies?

A. Linked to many other allergies

B. Slower effect

C. Lesser severity

D. Rapid onset

Answer 42

D

In most cases, the effect of a food allergy is slower than that seen with insect stings. An exception is peanuts. Peanut allergies are frequently very severe and very rapid in onset.

Question 43

Choose:

The release of histamine and other chemicals during an allergic reaction does what to thick mucus in the lungs?

A. Loosens it

B. Promotes its production

C. Depletes it

D. Thins it

Answer 43

B

Question 44

Choose:

Answer 44

A

Question 45

Choose:

Answer 45

B

Question 46

Choose:

Answer 46

B

Question 47

Choose:

Answer 47

B

Question 48

Answer:

You are called to the local park on a hot summer day for an 8-year-old child in respiratory distress. The child can barely speak and appears to be getting sleepy. Vital signs are blood pressure 90/60, pulse 120, and respiratory rate 32. Your physical exam reveals a swollen tongue, inspiratory stridor, wheezing, and hives on the neck and chest.

What condition do you suspect?

Answer 48

anaphylaxis

Question 49

Choose:

When documenting the administration of an epinephrine auto-injector, which of the following should be included?

A: Site of medication administration

B: Time the medication was administered

C: Patient’s response to the medication

D: All of the above

Answer 49

D

Question 50

Choose:

You are on the scene of a 22-year-old female patient who is unresponsive. The patient’s mother states that she is deathly allergic to peanuts and accidentally ate stir fry cooked in peanut oil. The patient is unresponsive with agonal respirations at 6 per minute.

What is your first action?

A: Administer epinephrine with medical control consent.

B: Perform a complete assessment and confirm that the patient is actually in anaphylaxis.

C: Insert an oral airway and apply oxygen at 15 liters per minute by bag-valve mask.

D: Insert an oral airway and apply oxygen at 15 liters per minute by nonrebreather mask.

Answer 50

C

Question 51

Choose:

You are transporting a 41-year-old female suffering from severe anaphylaxis. Her respiratory rate is 42 per minute, she is cyanotic, and she has a decreased level of responsiveness.

Which of the following is the highest priority of care for this patient?

A: Transport rapidly.

B: Search for an epinephrine auto-injector.

C: Elevate the patient’s head.

D: Assist ventilations with a bag-valve mask.

Answer 51

D

Question 52

Choose:

A 23-year-old female complains of being bitten by fire ants multiple times. She says she is allergic to fire ants but has never been prescribed an Epi-pen or any other medication for the allergy. She has several bites on her left foot with redness and some swelling noted. Her breath sounds are clear and equal and her vitals are within normal limits.

What should you do to properly treat this patient while transporting her to the hospital?

A. Administer intramuscular epinephrine and apply oxygen while in transport

B. Continually reassess airway, breathing, and circulation while monitoring vital signs during transport

C. Transport her in the left lateral recumbent position and apply heat packs to the affected area

D. Apply ice to the site and elevate leg while transporting her in position of comfort

Answer 52

B

A lot of patients think they are allergic to certain substances after having a reaction of some type in the past. This does not truly indicate an allergy is present. In this situation, it is best to treat the patient for any signs and symptoms that may present while transporting her to the ER for evaluation. Do not administer epinephrine unless signs of allergic reaction in 2 or more systems are present.

Question 53

Choose:

Epinephrine and norepinephrine are endogenous hormones secreted by the:

A. Pancreas

B. Heart

C. Adrenal medulla

D. Visceral pleura

Answer 53

C

Epinephrine and norepinephrine are endogenous hormones secreted by the adrenal medulla. The adrenal cortex produces the mineralocorticoid, aldosterone; the glucocorticoid, cortisol, and the sex hormones—androgens (e.g., DHEA).