Allergic Reactions, Anaphylaxis, and Immunologic Emergencies

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NREMT: Paramedic Level › Allergic Reactions, Anaphylaxis, and Immunologic Emergencies

Questions 1 - 10
1

Bee sting with stridor and facial swelling; how should the paramedic manage the airway in this situation?

Delay airway interventions until antihistamines have been administered

Provide oxygen, prepare suction, and be ready for advanced airway if worsening

Place the patient flat and apply a nonrebreather without further planning

Perform immediate endotracheal intubation before giving epinephrine

Explanation

This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on airway management in potential compromise (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, stridor and facial swelling indicate possible airway involvement, necessitating preparedness for deterioration. The correct answer involves providing oxygen, preparing suction, and readiness for advanced airway intervention. A common distractor might involve immediate intubation without preparation, which is incorrect as it skips supportive measures. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and practice airway management drills. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

2

Shellfish exposure causes hives and mild lip swelling; what additional information would be most helpful in assessment?

History of prior anaphylaxis and whether an epinephrine auto-injector is available

Number of hours slept last night and current caffeine intake

Whether the patient has seasonal allergies to pollen

Whether the patient has ever had a sprained ankle

Explanation

This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on pertinent history in assessment (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, hives and mild lip swelling after shellfish suggest a potential allergic reaction. The correct answer involves inquiring about prior anaphylaxis and epinephrine availability to inform risk and treatment. A common distractor might involve unrelated allergies like pollen, which is incorrect for acute management. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and gather targeted history. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

3

After epinephrine for anaphylaxis, which monitoring action is most appropriate during transport?

Check vital signs only on arrival to avoid stimulating the patient

Continuous ECG and frequent reassessment of airway, BP, and mental status

Remove oxygen after epinephrine to prevent hyperoxia-related bronchospasm

Stop reassessments once rash improves because recurrence is unlikely

Explanation

This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on transport monitoring (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, post-epinephrine care requires vigilance for recurrence or complications. The correct answer involves continuous ECG and frequent reassessment of key parameters. A common distractor might involve stopping monitoring if rash improves, which is incorrect due to biphasic risks. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and maintain monitoring. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

4

After a new medication, urticaria worsens and voice becomes hoarse; what is the primary treatment for anaphylaxis here?

0.3 mg IM epinephrine (1 mg/mL) with airway-focused monitoring

Nebulized albuterol only, then contact medical control for further orders

Diphenhydramine 25–50 mg IV/IM as the sole initial medication

Normal saline bolus only, then reassess for rash resolution

Explanation

This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on treatment escalation with worsening symptoms (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, worsening urticaria and hoarseness suggest progression to anaphylaxis with airway involvement. The correct answer involves prompt IM epinephrine administration with airway monitoring. A common distractor might involve antihistamines alone, which is incorrect for systemic symptoms. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and recognize progression cues. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

5

After bee sting, hypotension and bronchospasm persist; what is the role of epinephrine in managing this condition?

It slows the heart rate and reduces airway tone to prevent tachycardia

It causes bronchodilation and vasoconstriction to improve ventilation and perfusion

It blocks histamine receptors to eliminate rash and itching only

It reduces blood pressure to limit capillary leakage and edema

Explanation

This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on pharmacology and epinephrine's mechanism (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, persistent hypotension and bronchospasm highlight epinephrine's role in reversing these effects. The correct answer involves understanding epinephrine's bronchodilation and vasoconstriction to improve ventilation and perfusion. A common distractor might involve histamine blocking as its primary action, which is incorrect as epinephrine targets adrenergic receptors. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and review medication mechanisms. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

6

Shellfish ingestion causes hives and itching only; which symptom is most indicative of anaphylaxis?

Localized redness confined to the lips and chin

Hypotension with dizziness or syncope after exposure

Isolated pruritus with normal vital signs

Generalized urticaria without respiratory complaints

Explanation

This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on differentiating mild allergies from severe reactions (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, while the patient has hives and itching, the symptom of hypotension with dizziness or syncope indicates systemic involvement and anaphylaxis. The correct answer involves recognizing hypotension as a key indicator of anaphylaxis beyond localized symptoms. A common distractor might involve generalized urticaria without systemic signs, which is incorrect as it does not signify life-threatening progression. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and practice differentiating severity levels. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

7

Bee sting with BP 78/46, tachycardia, and wheezing; which action should the paramedic take first?

Give methylprednisolone IV as initial therapy and monitor for improvement

Administer 0.3 mg IM epinephrine (1 mg/mL) promptly and apply oxygen

Establish IV access before giving any medications to avoid delays

Apply an ice pack to the sting site and reassess blood pressure in 10 minutes

Explanation

This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on priority interventions for shock (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, hypotension, tachycardia, and wheezing indicate anaphylactic shock, requiring immediate action. The correct answer involves administering IM epinephrine promptly along with oxygen. A common distractor might involve delaying for IV access, which is incorrect as epinephrine should not be delayed. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and prioritize treatments. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

8

New antibiotic started; hours later urticaria and crampy abdominal pain occur—what additional information is most helpful?

Last dental visit and recent fluoride exposure

Whether the patient has eaten spicy foods in the last 24 hours

Family history of asthma during childhood

Exact time and dose of the new medication and any prior reactions

Explanation

This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on history-taking and assessment (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, the patient’s urticaria and abdominal pain after a new antibiotic suggest a possible allergic reaction, making details about the medication crucial. The correct answer involves gathering information on the timing, dose, and prior reactions to guide treatment decisions. A common distractor might involve unrelated history like diet or family asthma, which is incorrect as it does not directly inform the allergic response. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and practice targeted questioning. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

9

Bee sting anaphylaxis treated with epinephrine; BP improves but wheezing persists—what action should occur next?

Administer nebulized albuterol and continue close reassessment during transport

Delay transport until all skin findings fully resolve

Give diphenhydramine first and withhold bronchodilators to avoid tachycardia

Discontinue oxygen because blood pressure has normalized

Explanation

This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on ongoing management after initial treatment (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, improved blood pressure but persistent wheezing indicate the need for adjunctive therapy. The correct answer involves administering nebulized albuterol to address residual bronchospasm. A common distractor might involve withholding bronchodilators, which is incorrect as they complement epinephrine. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and practice post-treatment reassessment. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

10

Bee sting: urticaria, wheezing, and GI cramping; which symptom is most indicative of anaphylaxis?

Generalized hives appearing within minutes of exposure

Wheezing with hypotension or signs of poor perfusion

Mild nausea without respiratory complaints

Itching at the sting site only

Explanation

This question tests paramedic-level understanding of allergic reactions and anaphylaxis, focusing on symptom differentiation (NREMT standard). Anaphylaxis is a severe, life-threatening allergic reaction that requires rapid identification and treatment with epinephrine. In this scenario, urticaria, wheezing, and cramping are present, but wheezing with hypotension is most indicative. The correct answer involves recognizing combined respiratory and circulatory compromise. A common distractor might involve generalized hives alone, which is incorrect without systemic effects. Teaching strategies include training paramedics to quickly identify signs of anaphylaxis and prioritize critical symptoms. Encourage familiarity with protocols and emphasize the importance of continuous patient monitoring after intervention.

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