Anaphylaxis Flashcard 1
Rationale
D. Rationale: After cleaning the wound and applying an antibiotic ointment, the clinician’s next step is to prevent potentially life-threatening infections by inoculating the patient with tetanus toxoid and anti-rabies vaccine. There is a risk of tetanus infection because a bite is a puncture wound that may be dirty. Rabies is a possibility particularly in an animal that has bitten a person.
Question
Which of the following medicines may be necessary for patients with animal bites when the animal can no longer be retrieved and held for observation?
a. Tetanus toxoid
b. Anti-rabies vaccine
c. Antibiotic ointment
d. All of the above
Answer
d. All of the above
Rationale
B. Rationale: The patient is in cardiac arrest. After activating the emergency response system, you should immediately perform high-quality CPR starting with chest compressions. Have someone retrieve an AED, and apply it as soon as possible.
Question
A 10-year-old boy has a severe allergic reaction after eating shellfish. He presents with difficulty breathing and eventually becomes unresponsive. When you arrive on the scene, the patient has no pulse and is not breathing. What is the best intervention in this situation?
a. Give intramuscular epinephrine.
b. Start CPR.
c. Give positive pressure ventilation.
d. Defibrillate.
Answer
b. Start CPR.
Rationale
B. Rationale: Venom from a snake bite or insect bite can cause an anaphylactic reaction, which can lead to anaphylactic shock. In anaphylactic shock, there is extravasation of fluid to the interstitial space, which decreases blood volume within the vessels. This causes marked hypotension and inadequate tissue perfusion of oxygen and nutrients, which is the pathophysiologic effect of shock.
Question
A 24-year-old male who was bitten by a venomous snake suddenly becomes confused, feels faint, and shows signs of cyanosis with a rapid heart rate and shortness of breath. Blood pressure reading is 80/40 mm Hg. What is the likely physiologic process involved?
a. Necrotic effect of the venom
b. Anaphylactic shock
c. Lytic reaction of red blood cells
d. Increased production of white blood cells
Answer
b. Anaphylactic shock
Rationale
A. Rationale: Despite receiving epinephrine, the patient shows signs of respiratory distress. If no intervention is done, the patient may deteriorate into respiratory failure. In this situation, it is recommended that you perform assisted ventilation such as mouth-to-mouth resuscitation or use a barrier device.
Question
A 24-year-old man was stung by a wasp. His face suddenly swells, and he develops hives. He then reports difficulty breathing. You immediately call 911. After injecting the patient with epinephrine, he shows nasal flaring, along with suprasternal and supraclavicular retractions. He seems confused and feels faint. What is your next course of action?
a. Provide assisted ventilation.
b. Give another dose of epinephrine.
c. Start CPR.
d. Monitor the patient and wait for EMS to arrive.
Answer
a. Provide assisted ventilation.
Rationale
B. Rationale: The treatment for severe anaphylactic shock is epinephrine. The correct dosage is supplied by the EpiPen autoinjector, which is injected intramuscularly as an emergency treatment.
Question
A 45-year-old woman suddenly has a severe allergic reaction in the hospital after inadvertently eating peanuts to which she is allergic. She goes into anaphylactic shock. You reach for the crash cart and find the following: defibrillator, EpiPen, adenosine, and digoxin. Which of the following will you use first to treat this patient?
a. Defibrillator
b. EpiPen
c. Adenosine
d. Digoxin
Answer
b. EpiPen
Rationale
A. Rationale: Cetirizine (brand name Zyrtec), together with diphenhydramine and loratadine, are antihistamines that can be used to treat urticaria, which is a mild allergic reaction from the insect bite.
Question
A 5-year-old boy was bitten by a mosquito, which is causing several papular urticaria on the legs. There are no other symptoms. The patient is uncomfortable and keeps scratching the affected areas. Which among the following remedies is a pharmacologic treatment for urticaria from insect bites?
a. Cetirizine
b. Acetaminophen
c. Bacitracin
d. Chewable aspirin
Answer
a. Cetirizine
Rationale
C. Rationale: Patients in anaphylactic shock will have insufficient blood pressure for efficient tissue perfusion. To aid the patient, you can elevate his legs to help keep the blood pressure at above or near-normal levels.
Question
A 58-year-old man went into anaphylactic shock after being injected with an antibiotic. He was treated with the appropriate medications, and you are assigned to monitor the patient. What additional action can you take to help him?
a. Give another dose of epinephrine.
b. Give the patient adenosine.
c. Elevate the patient’s legs above the level of the heart.
d. Place the patient in the recovery position.
Answer
c. Elevate the patient’s legs above the level of the heart.
Rationale
D. Rationale: A bee sting will often have a stinger attached to the skin after a biting episode. The stinger continues to pulsate, injecting more venom into the patient. Thus, it is important to remove the stinger first to keep the affected area from worsening.
Question
A logger was stung by a bee after chopping down a tree. He comes to you for first aid treatment. Which one of the following first-aid interventions should you perform after a bee sting?
a. Apply a cold compress on the sting area.
b. Use calamine lotion on the sting area.
c. Give an oral antihistamine such as loratadine.
d. Remove the stinger.
Answer
d. Remove the stinger.
Rationale
A. Rationale: Dog bites are wounds that can potentially transmit a tetanus infection. It is recommended that dog bite wounds be cleaned and the patient be inoculated with the tetanus vaccine and given the appropriate anti-rabies protocol.
Question
After a dog bite, the first aid provider must bring the patient to the emergency department. This is important so the bite can be treated and the patient can be given protection for dangerous infections. Which of the following is likely to be given in this scenario?
a. Tetanus vaccine
b. Hepatitis B vaccine
c. Influenza vaccine
d. Measles vaccine
Answer
a. Tetanus vaccine
Rationale
D. Rationale: The patient is presenting with signs of anaphylaxis, which is more commonly reported with bee stings.
Question
An unknown insect allegedly bit an 8-year-old boy. The bite has caused the patient to have hives all over his body, swelling of his entire face, difficulty breathing, belly cramps, vomiting, hoarseness, and lightheadedness. Which one of the following insect bites commonly causes this type of reaction?
a. Tick
b. Mosquito
c. Lice
d. Bees
Answer
d. Bees