CHAPTER 18

You respond to the residence of a 55-year-old female 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:

ask her if she has prescribed epinephrine.

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

stridor

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:

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

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:

administer oxygen and transport her to the hospital.

Anaphylaxis is MOST accurately defined as a(n):

extreme allergic reaction that may affect multiple body systems.

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?

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

Immediately after giving an epinephrine injection, you should:

properly dispose of the syringe.

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 severely labored breathing, and has hives over his entire trunk. You should:

maintain his airway and assist his ventilations.

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. In addition to administering oxygen, you should:

contact medical control if needed, transport the patient, and monitor him for signs of deterioration.

Which of the following statements regarding fire ants is correct?

Fire ants often bite a person repeatedly.

Which of the following patients would MOST likely have a delayed onset of an allergic reaction?

a 45-year-old male who ingested penicillin

When using an auto-injector to give epinephrine, the primary injection site is the:

lateral portion of the thigh.

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

drowsiness.

A 38-year-old female was bitten by fire ants while at the park with her kids. Your primary assessment reveals that she is semiconscious, has profoundly labored breathing, and has a rapid, thready pulse. She has a red rash on her entire body and her face is very swollen. You should:

assist her ventilations with 100% oxygen.

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

30 minutes

A raised, swollen, well-defined area on the skin that is the result of an insect bite or sting is called:

a wheal.

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

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

When administering epinephrine via auto-injector, you should hold the injector in place for:

10 seconds

Which of the following MOST accurately defines an allergic reaction?

an exaggerated immune system response to any substance

Common signs and symptoms of an allergic reaction include all of the following, EXCEPT:

drying of the eyes.

Which of the following medications blocks the release of histamines?

diphenhydramine (Benadryl)

Chemicals that are responsible for the signs and symptoms of an allergic reaction to a bee sting include:

histamines and leukotrienes.

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

upper airway swelling

The two MOST common signs of anaphylaxis are:

wheezing and widespread urticaria.

The stinger from a honeybee should be:

scraped away from the skin.

Urticaria is the medical term for:

hives.

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:

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

The foreign substance responsible for causing an allergic reaction is called a(n):

allergen.

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:

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

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

vasoconstriction and bronchodilation