CHAPTER 21 QUIZ. Handout Write the letter of the best answer in the space provided.

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1 Handout 21-1 QUIZ Write the letter of the best answer in the space provided. 1. A severe form of allergic reaction is called A. an allergen. C. epinephrine. B. anaphylaxis. D. an immune reaction. 2. Harmless to most individuals, allergens are foreign substances that cause an abnormal immune system response known as A. mitosis. C. an allergic reaction. B. hypotoxemia. D. an immune response. 3. An EMT who notices that his hands are red and itchy after a call may be experiencing an allergic reaction to A. latex gloves. C. exercise. B. talcum powder. D. heat exposure. 4. Signs and symptoms of an allergic reaction include all of the following except A. itching. C. decreased blood pressure. B. increased appetite. D. watery eyes. 5. A sign of a severe allergic reaction is A. runny nose. C. mild edema. B. cyanosis. D. malaise. 6. The dose of epinephrine that should be given to an adult suffering severe allergic reaction is mg. A. 0.3 C B. 0.5 D Epinephrine is most commonly administered as a(n) A. tablet. C. prescribed inhaler. B. gel. D. auto-injector. 8. When administered as a medication, epinephrine will accomplish all of the following except A. constrict blood vessels. C. relax the bronchioles. B. lower blood pressure. D. stimulate the heartbeat. 9. The dose of epinephrine that should be given to infants/children is mg. A. 0.5 C B. 0.3 D If the patient s condition improves following the administration of epinephrine, you should A. perform ongoing assessment. C. initiate CPR. B. administer a second dose. D. connect the AED.

2 Handout 21-2 IN THE FIELD Review the following real-life situations. Then answer the questions that follow. The patient is an 8-year-old boy with a known history of allergies and asthma. His mother tells you that she administered his EpiPen 5 minutes before your arrival. However, you believe that she gave it incorrectly. He pulled away when I tried to give the shot, explains the mother. I saw some of the medicine form a mist in the air. You examine the arm where the mother says that she gave the injection, but find no puncture mark. The child s distress has worsened since your arrival, and he now seems barely conscious. I have three more EpiPens, offers the mother. 1. What action(s) should you take at this time? Your next patient is an unconscious construction worker named Fred. He had barely started to work with some fiberglass insulation when he fainted, explains one of his coworkers. You ask the coworkers more questions and find out that Fred was sneezing and coughing just before he fainted. They also noticed that he was using a handkerchief to wipe his watery eyes and runny nose. He usually wears a respiratory mask on the job site, adds one of the coworkers, but he forgot to bring it today. Upon conducting a physical examination of the patient, you find a Medic Alert tag indicating that Fred has a number of allergies. His vital signs include a blood pressure of 70/42 and a weak pulse of 136. During your initial assessment, the foreman hands you an EpiPen kit. I found this in Fred s lunch box, he says. Will it help? 2. What action(s) should you take at this time?

3 Handout 21-3 REVIEW Write the word or words that best complete each sentence in the space provided. 1. An abnormal or excessive response of the body s immune system to a foreign material is called a(n). 2. Foreign substances recognized by the cells of the immune system and eventually destroyed by the body s response are called. 3. A severe form of an allergic reaction is called. 4. Antibodies are proteins that search for the antigen, combine with it, and then help to destroy it in a process known as. 5. from insect bites or stings, especially of wasps, hornets, yellow jackets, and fire ants, may cause an allergic reaction and anaphylaxis. 6. Red, itchy, possibly raised blotches on the skin are known as. 7. Management of the airway during anaphylaxis may require, the placement of a tube in the trachea to facilitate breathing. 8. When administered as a medication, epinephrine will blood vessels to improve the patient s. 9. A spring-loaded needle and syringe with a single dose of epinephrine is known as a(n) The correct dose of epinephrine for an adult is mg; for a child, it is mg.

4 Handout 21-4 ALLERGIC REACTIONS: TRUE OR FALSE Indicate if the following statements are true or false by writing T or F in the space provided. 1. Generally, an individual must come into contact with an allergen more than once for an anaphylactic reaction to occur. 2. Antibodies are proteins that search for an antigen, combine with it, and destroy it. 3. After 15 to 20 minutes, a patient suffering an allergic reaction has little risk of slipping into anaphylactic shock. 4. During an allergic reaction, you can expect to discover a higher-than-average blood pressure. 5. Epinephrine auto-injectors may not be administered to unconscious patients. 6. Epinephrine has no contraindications when used in a life-threatening situation. 7. A possible side effect of epinephrine use is chest pain. 8. Some anaphylactic reactions require repeated doses of epinephrine before the allergic reaction stops. 9. The two key categories of signs and symptoms that specifically indicate anaphylaxis are respiratory compromise and shock. 10. A patient experiencing an allergic reaction with no signs of respiratory distress or shock should receive epinephrine.

5 Handout 21-5 RECOGNIZING SIGNS AND SYMPTOMS OF ANAPHYLAXIS Place a check mark in front of the signs and symptoms commonly associated with anaphylaxis or anaphylactic shock. increased pulse constipation decreased respirations increased appetite vomiting altered mental status flushed skin absent radial and/or pedal pulses diarrhea decreased pulse increased respirations decreased blood pressure feeling of impending doom stridor

6 Handout 21-6 EPINEPHRINE AUTO-INJECTOR Write in the missing information on the medication flash card below, and save the completed card for future reference. Epinephrine Auto-Injector Medication Names: 1. Generic: 2. Trade: Indications: Contraindications: Medication Form: Dosage: _ Actions: Side Effects:

7 ANSWER KEY HANDOUT 21-1: Chapter 21 Quiz 1. B 4. B 7. D 9. C 2. C 5. B 8. B 10. A 3. A 6. A HANDOUT 21-2: In the Field 1. Sample response: Immediately establish contact with medical direction. Inform them of the situation and request permission to administer a second dose of the medication or to provide additional instructions. All remaining EpiPens should be taken on the ambulance. It may be necessary to request an ALS intercept on this call. 2. Sample response: Complete all steps in the initial assessment. Ensure that a member of the EMT team is managing BVM ventilation or intubation if local protocols allow. Call for an ALS intercept or begin rapid transport as soon as possible. Because the patient is unconscious and in shock, he meets the criteria for use of epinephrine. Contact medical direction if required to do so. Make sure that the medication in the EpiPen kit belongs to the patient, that it is not expired, and that it is clear and colorless. After using the auto-injector, dispose of it in the appropriate biohazard container. Record the time of administration and reassess vital signs. HANDOUT 21-3: Chapter 21 Review 1. allergic reaction 2. allergens 3. anaphylactic shock 4. sensitization 5. Venom 6. hives 7. tracheal intubation 8. constrict, blood pressure 9. auto-injector , 0.15 HANDOUT 21-4: Allergic Reactions: True or False 1. T 4. F 7. T 9. T 2. T 5. F 8. T 10. F 3. F 6. T HANDOUT 21-5: Recognizing Signs and Symptoms of Anaphylaxis Check marks should appear before all of the following conditions: increased pulse; vomiting; altered mental status; flushed skin; absent radial and/or pedal pulses; diarrhea; increased respirations; decreased blood pressure; feeling of impending doom; stridor. HANDOUT 21-6: Epinephrine Auto-Injector (completion) Medication Name: 1. Generic: epinephrine. 2. Trade: Adrenalin (EpiPen and EpiPen Jr. as auto-injectors). Indications: 1. Patient exhibits signs and symptoms of anaphylaxis, including respiratory distress and/or shock. 2. Medication is prescribed to the patient. 3. EMT has received order approving use from medical direction, either on-line or off-line. Contraindications: None in a life-threatening situation. Medication Form: Liquid drug in auto-injector. Dosage: Adult ( 66 lbs.) 0.3 mg. Infant and child ( 66 lbs.) 0.15 mg. Actions: 1. Constricts blood vessels to improve blood pressure. 2. Reduces leakage from blood vessels. 3. Relaxes smooth muscle in the bronchioles to improve breathing; stimulates heartbeat. 4. Works to reverse swelling and hives. Side Effects: 1. Increased heart rate. 2. Pallor. 3. Dizziness. 4. Chest pain. 5. Headache. 6. Nausea and vomiting. 7. Excitability and anxiousness.

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