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Introduction to Emergency Medical Care 1 Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Chapter 18 Immunologic Emergencies Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. National EMS Education Standard Competencies (1 of 2) Medicine Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. National EMS Education Standard Competencies (2 of 2) Immunology • Recognition and management of shock and difficulty breathing related to: – Anaphylactic reactions • Anatomy, physiology, pathophysiology, assessment, and management of: – Hypersensitivity disorders and/or emergencies – Anaphylactic reactions Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. OBJECTIVES 22.1 22.2 22.3 Define key terms introduced in this chapter. Slides 10, 14, 19, 37, 39 Differentiate between the signs and symptoms of an allergic reaction and an anaphylactic reaction. Slides 18–24 Describe the relationship between allergens and antibodies necessary for an allergic reaction to occur. Slides 11–13 continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. OBJECTIVES 22.4 22.5 22.6 Describe the effects of histamine and other chemicals in producing the signs and symptoms of anaphylaxis. Slides 13–14 List common allergens. Slides 15–16 Prioritize the steps in assessment and management of patients with allergic and anaphylactic reactions. Slides 25–28 continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. OBJECTIVES 22.7 22.8 Recognize the indications for administering and assisting a patient in the use of an epinephrine autoinjector. Slides 29, 31 Describe the desired effects and side effects associated with the administration of epinephrine. Slides 37–38 continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. OBJECTIVES 22.9 22.10 Demonstrate administration of epinephrine by autoinjector. Slides 39–41 Describe the considerations in reassessment of patients with allergic and anaphylactic reactions. Slides 30–31 Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. MULTIMEDIA • Slide 34 • Slide 35 Allergic Reaction—Anaphylaxis Video Information About Allergic Rhinitis Video Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. CORE CONCEPTS • How to identify a patient experiencing an allergic reaction • Differences between a mild allergic reaction and anaphylaxis • How to treat a patient experiencing an allergic reaction • Who should be assisted with an epinephrine auto-injector Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Topics • Allergic Reactions • Self-Administered Epinephrine Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Allergic Reactions Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Introduction (1 of 2) • At least 1,000 Americans per year die of allergic reactions. • Allergy-related emergencies may involve: – Acute airway obstruction – Cardiovascular collapse Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Introduction (2 of 2) • You must be able to treat these lifethreatening complications. • Immunology is the study of the body’s immune system. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Anatomy and Physiology • Immune system protects the body from foreign substances and organisms. • When a foreign substance invades the body: – Body goes on alert. – Body initiates a series of responses to inactivate the invader. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Pathophysiology: Allergic Reaction (1 of 2) • An allergic reaction is an exaggerated immune response to any substance. • Not caused directly by an outside stimulus • Caused by the body’s immune system – Releases chemicals to combat stimulus – Include histamines and leukotrienes Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Pathophysiology: Allergic Reaction (2 of 2) • Caused by the body’s immune system – Releases chemicals to combat stimulus – Include histamines and leukotrienes • Allergic reaction may be mild and local, or severe and systemic. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Pathophysiology: Anaphylaxis (1 of 3) • Anaphylaxis is an extreme, lifethreatening allergic reaction. – Involves multiple organ systems – Wheezing is one of the most common signs. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Pathophysiology: Anaphylaxis (2 of 3) • Urticaria (hives) is also present. Source: © Chuck Stewart, MD Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson – Consists of small areas of generalized itching or burning that appear as multiple, small, raised areas on the skin Copyright ©2012 by Pearson Education, Inc. All rights reserved. Pathophysiology: Anaphylaxis (3 of 3) • You may also note hypotension as a result of hypovolemic shock. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Allergic Reactions • Immune system naturally responds to foreign substances in body • Allergic reaction: exaggerated response to foreign substance • Allergen: substance causing exaggerated effect Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Body’s Reaction to Allergen • First exposure – Immune system forms antibodies – Antibodies identify and attack particular foreign substance – Antibodies combine only with allergen they were formed in response to continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Body’s Reaction to Allergen • Second (and subsequent) exposures – Antibodies exist – Antibody combines with allergen, leading to release of histamine and other chemicals into bloodstream – Chemicals cause harmful effects continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Body’s Reaction to Allergen • Effects of histamine and other chemicals – Inflammation (swelling) – Bronchoconstriction – Vasodilation Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Anaphylaxis • Severe, life-threatening allergic reaction • Can cause: – Dilation of blood vessels (hypotension) – Airway swelling (airway obstruction) – Bronchoconstriction (respiratory failure) Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Common Allergens • • • • • Insects Foods Plants Medications Others – Dust, makeup, soap, etc. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Common Allergens (1 of 3) • Insect bites and stings – When an insect bites and injects the bite with its venom, this is called envenomation. – The reaction may be local (swelling and itchiness) or systemic (involving the entire body). Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Common Allergens (2 of 3) • Medications – Penicillin injection may cause an immediate and severe reaction. – Oral penicillin may take longer. Source: Courtesy of Carol B. Guerrero Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson – A person will typically experience an allergic reaction after becoming sensitized. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Common Allergens (3 of 3) • Plants – Dusts, pollens, other plant materials • Food – Reaction can be relatively slow – Shellfish, nuts • Chemicals – Makeup, soap, latex Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (1 of 11) • Death from stinging insects far outnumber deaths from snakebites. – Stinging organ of most insects is a small hollow spine projecting from the abdomen. – Venom can be injected directly into skin. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (2 of 11) • Honeybees cannot withdraw their stinger. – Fly away and die • Wasps, hornets, and fire ants can sting multiple times. Source: A. © manfredxy/ShutterStock, Inc. Source: B. © Heintje Joseph T. Lee/ ShutterStock, Inc. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (3 of 11) • Some ants, especially the fire ant, also strike repeatedly. – Often inject a particularly irritating toxin at the bite sites Source: A. Courtesy of Scott Bauer/USDA Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Source: B. © Chris Harvey/ShutterStock, Inc. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (4 of 11) • Signs and symptoms include: – Sudden pain – Swelling – Localized heat Source: © Simon Krzic/ShutterStock, Inc. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson – Redness in lightskinned individuals – Itching and Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (5 of 11) • There is no specific treatment for these injuries. – Applying ice sometimes helps. – Swelling may be dramatic and frightening. – Local manifestations are not serious. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (6 of 11) • Stinger of the honeybee can continue to inject venom for up to 20 minutes. • Attempt to remove the stinger by scraping the skin with the edge of a sharp, stiff object such as a credit card. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (7 of 11) • Do not use tweezers or forceps. • Wash the area with soap and water. • Remove any jewelry from the area. • Be alert for vomiting or signs of shock. • Give oxygen if needed. • Monitor the patient’s vital signs. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (8 of 11) • About 5% of people may have anaphylactic reactions from: – Bees – Hornets – Yellow jackets – Wasps • Account for 200 deaths per year. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (9 of 11) Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (10 of 11) • Patients may experience: – Generalized itching and burning – Widespread urticaria – Wheals – Swelling of the lips and tongue – Bronchospasm and wheezing – Chest tightness and coughing – Dyspnea Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Insect Stings (11 of 11) • Patients may experience (cont’d): – Anxiety – Abdominal cramps – Hypotension – Occasionally, respiratory failure • If untreated, anaphylactic reaction can proceed rapidly to death. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Latex Allergy • Common concern in EMS – Many patients have latex sensitivity – Providers can develop latex allergy from prolonged exposure Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Course of Reaction • No way to predict exact course of an allergic reaction • Severe reaction often takes place immediately, but can be delayed 30 minutes or more • Mild allergic reaction can rapidly progress to anaphylaxis Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Signs and Symptoms: Skin • Swelling • Flushing (red skin) • Warm, tingling feeling in face, mouth, chest, feet, or hands Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Signs and Symptoms: Hives Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Signs and Symptoms: Respiratory • • • • • • Tightness in throat or chest Cough Rapid, labored, and/or noisy breathing Hoarseness, muffled voice, loss of voice Stridor Wheezing Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Signs and Symptoms: Cardiac • Increased heart rate • Decreased blood pressure Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Signs and Symptoms: Generalized • Itchy, watery eyes and/or runny nose • Headache • Feeling of impending doom Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Signs and Symptoms: Anaphylactic Shock • Altered mental status • Flushed, dry skin or pale, cool, clammy skin • Nausea or vomiting • Changes in vital signs – Increased pulse, respirations – Decreased blood pressure Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Distinguishing Anaphylaxis from Mild Allergic Reaction • Any of previous signs and symptoms can be associated with an allergic reaction • Anaphylaxis: patient has either respiratory distress or signs and symptoms of shock Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Obtain SAMPLE history. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Apply high-concentration oxygen. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Patient Assessment (1 of 3) • Scene size-up • Scene safety – Identify and address environmental hazards. – Patient’s environment or activity may indicate source of reaction. – Never enter a scene where more than one person is experiencing same symptoms. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Patient Assessment (2 of 3) • Scene safety (cont’d) – Follow standard precautions, with a minimum of gloves and eye protection. – Consider the need for additional or specialized resources. – Call for additional resources earlier rather than later. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Patient Assessment (3 of 3) • Mechanism of injury/nature of illness – May not be an allergic reaction – Trauma may have occurred. – Determine the MOI/NOI. – Look for bee stingers or chemicals and other indications of a reaction. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Primary Assessment (1 of 5) • Perform a rapid scan of the patient. • Form a general impression. – May present as respiratory or cardiovascular distress in the form of shock – Patients will be very anxious. – Call for ALS backup if available. – Try to get information on the chief complaint. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Assessment • Primary assessment • Identify and treat life-threatening problems – Airway – Breathing – Circulation continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Primary Assessment (2 of 5) • Airway and breathing – Anaphylaxis can cause rapid swelling of the upper airway. – Only a few minutes to assess the airway and provide lifesaving measures – Work quickly to determine the severity of the symptoms. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Primary Assessment (3 of 5) • Airway and breathing (cont’d) – Position conscious patients in tripod position and listen to the lungs. – Do not hesitate to initiate high-flow oxygen. – In severe situations, the definitive care is an injection of epinephrine. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Primary Assessment (4 of 5) • Circulation – May present with hypotension – Palpate for radial pulse. • If the patient is unresponsive and without a pulse, begin BLS or use an AED. • If pulse is present, assess for a rapid pulse, and check skin condition and capillary refill. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Primary Assessment (5 of 5) • Initial treatment – Oxygen – Positioning – Maintaining normal body temperature • Transport decision – Always provide prompt transport for any patient who may be having an allergic reaction. – Take along all medications and auto-injectors Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. History Taking (1 of 4) • Identify: – Chief complaint – History of present illness – Associated signs and symptoms – Pertinent negatives Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. History Taking (2 of 4) Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. History Taking (3 of 4) • SAMPLE history • If the patient is conscious, ask the following questions: – Have any interventions already been completed? – Do you have any prescribed, preloaded medications for allergic reactions? Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. History Taking (4 of 4) • Ask the following questions (cont’d): – Do you have any respiratory symptoms? – Do you have other symptoms? – Have you had previous allergic reactions, asthma, or hospitalizations? – What were you doing or what were you exposed to before the onset of symptoms? Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Secondary Assessment (1 of 4) • Physical examinations – Includes a systemic head-to-toe or focused assessment – Thoroughly assess breathing, including: • • • • Increased work of breathing Use of accessory muscles Head bobbing, nostril flaring, grunting Tripod positioning Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Secondary Assessment (2 of 4) • Physical examinations (cont’d) – Auscultate both the trachea and the chest. – Wheezing may occur because of narrowing of the air passages. – Assess the circulatory system. – Assess the skin for swelling, rash, hives, or signs of the source of the reaction. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Secondary Assessment (3 of 4) • Vital signs – Assess baseline vitals: • • • • • • Pulse Respirations Blood pressure Skin Pupils Oxygen saturation Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Secondary Assessment (4 of 4) • Vital signs (cont’d) – Rapid respiratory rate indicates airway obstruction. – Rapid respiratory and pulse indicate respiratory distress or systemic shock. – Pulse oximetry is a useful method to assess the patient’s perfusion status. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Reassessment (1 of 3) • Repeat the primary assessment and reassess the patient’s vital signs. – Deterioration of the patient’s condition could be rapid and fatal. – Give special attention to any signs of airway compromise. – Monitor the patient’s anxiety level. – Watch for signs of shock. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Reassessment (2 of 3) • Interventions – Identify how much distress the patient is in. – Severe reactions require epinephrine and ventilatory support. – Milder reactions require supportive care such as oxygen. – Transport to a medical facility. – Recheck your interventions. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Reassessment (3 of 3) • Communication and documentation – When to contact medical control depends on your assessment findings. – Documentation should include: • Signs and symptoms • Reasons for choosing to provide the care you did • Patient’s response to your treatment Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Assessment • History and physical exam – History of allergies – Exposure • What was the patient exposed to? • How (what method/route) was the patient exposed? – Signs and symptoms – Progression – Interventions Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Treatment • Manage patient’s airway and breathing • Apply high-concentration oxygen • Provide artificial ventilations if patient is not breathing adequately • Consider assisting patient with epinephrine auto-injector continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Treatment • If patient is not wheezing or showing signs of respiratory distress or shock – Continue with assessment – Consult medical direction regarding use of auto-injector Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Use of Auto-Injector • When use of auto-injector may be appropriate – If patient has come in contact with substance that caused allergic reaction in the past – If patient also has respiratory distress or exhibits signs and symptoms of shock Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. After Administering Auto-Injector • Record administration of auto-injector • Transport patient • Reassess Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Additional Doses of Epinephrine • Reassessment may show patient condition deteriorating • Additional doses of epinephrine may be necessary • Requires on-line medical control • Requires bringing patient’s additional auto-injectors in ambulance continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Additional Doses of Epinephrine • If no auto-injector available – Request ALS intercept – Treat for shock Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Medical Care (1 of 9) • If patient appears to be having a severe allergic (or anaphylactic) reaction: – Administer BLS, including oxygen. – Provide prompt transport to the hospital. – Reassess vital signs every 5 minutes (unstable patient) or 15 minutes (stable patient). Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Medical Care (2 of 9) – Place hypotensive or shock patients in the appropriate position. – Request ALS backup if you work in a tiered response system. – Be prepared to maintain the airway or administer cardiopulmonary resuscitation. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Medical Care (3 of 9) – If a stinger is present, scrape away with a credit card. – Applying ice may help. – In some areas, you may be allowed to administer epinephrine or assist the patient with epinephrine administration. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Medical Care (4 of 9) • Epinephrine – Mimics the sympathetic (fight-or-flight) response – Causes the blood vessels to constrict – Reverses vasodilation and hypotension – Increases cardiac contractility and relieves bronchospasm – Rapidly reverses the effects of anaphylaxis Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Medical Care (5 of 9) • Indications include: – A severe allergic reaction – Hypersensitivity to an exposed substance • Remember that your EMS service may or may not allow you to assist the patient in the administration of epinephrine. Call medical control! Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Medical Care (6 of 9) Source: Courtesy of Shionogi Pharma, Inc. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson • All kits should contain a prepared, autoinjectable syringe of epinephrine. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Medical Care (7 of 9) • The adult EpiPen delivers 0.3 mg of epinephrine; the infant-child system delivers 0.15 mg. • The Twinject autoinjector contains two doses of epinephrine. • See Skill Drills 18-1 and 18-2. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Medical Care (8 of 9) • Side effects include: – High blood pressure – Increased pulse rate – Anxiety – Cardiac arrhythmias – Pallor – Dizziness Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Medical Care (9 of 9) • Side effects include (cont’d): – Chest pain – Headache – Nausea – Vomiting Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Think About It • Should you administer an auto-injector for a simple allergic reaction? • What assessment findings would indicate the need for epinephrine? Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Allergic Reaction— Anaphylaxis Video Click here to view a video on the subject of anaphylactic shock. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Back to Directory Copyright ©2012 by Pearson Education, Inc. All rights reserved. Information About Allergic Rhinitis Video Click here to view a video on the subject of allergic rhinitis. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Back to Directory Copyright ©2012 by Pearson Education, Inc. All rights reserved. Self-Administered Epinephrine Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Epinephrine • Commonly prescribed to patients with a history of allergy • Auto-injectors are common for people to carry or have at home • Hormone produced by body • Constricts blood vessels • Dilates bronchioles Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Side Effects of Epinephrine • Increased heart rate • Increased cardiac workload Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Auto-Injector • Spring-loaded needle and syringe with a single dose of epinephrine • Upon administration, medication automatically releases and injects Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Administering Auto-Injector • Injection site typically anterior-medial thigh (midway between waist and knee) • Remove clothing from site if possible • Use standard precautions • Remove cap continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Administering Auto-Injector • Press tip of auto-injector firmly against patient’s thigh • Once needle is deployed, allow full injection of medication before removing from injection site • Carefully discard auto-injector into sharps container Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Pediatric Note • Two sizes of auto-injectors – Adult dose: 0.3 mg – Children’s dose (for child less than 66 pounds): 0.15 mg Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Chapter Review Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Chapter Review • Allergic reactions are common. Anaphylaxis, a true life-threatening allergic reaction, is rare. • The most common symptom in these cases is itching. Patients with anaphylaxis will also display life-threatening difficulty breathing and/or signs and symptoms of shock. continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Chapter Review • Patients with anaphylaxis will be extremely anxious. Their bodies are in trouble and are letting them know it. • The signs and symptoms of anaphylaxis result from physiological changes: vasodilation, bronchoconstriction, leaky capillaries, and thick mucus. continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Chapter Review • By quickly recognizing the condition, consulting medical direction, and administering the appropriate treatment, you can literally make the difference between life and death for these patients. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Remember • In an allergic reaction, the body’s immune system overreacts to an allergen and causes potentially harmful side effects. • Anaphylaxis is a severe, systemic form of allergic reaction; it is a life-threatening emergency. continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Remember • EMTs must use assessment to differentiate a localized allergic reaction from a systemic anaphylactic reaction. • Epinephrine is useful in anaphylaxis because it constricts dilated blood vessels and opens bronchial passages. continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Remember • Epinephrine has potentially dangerous side effects and should be used only in the event of anaphylaxis. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Questions to Consider • What are the indications for administration of an epinephrine auto-injector? • List some of the more common causes of allergic reactions. continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Questions to Consider • List signs or symptoms of an anaphylactic reaction associated with each of the following: – Skin – Respiratory system – Cardiovascular system Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Critical Thinking • A 24-year-old male ate a meal that he believes contained shellfish. He is allergic to shrimp. He is sweating and nervous. He appears to be breathing adequately. You do not note any wheezing or stridor. continued Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Critical Thinking • His face is slightly red. His pulse is 88 strong and regular, respirations 24, blood pressure 108/74, and skin warm and moist. Should you administer epinephrine? Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 1. The signs and symptoms of an allergic reaction are caused by the release of: A. histamine. B. adrenalin. C. epinephrine. D. glucagon. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review Answer: A Response: The two chief chemicals released by the body that result in the signs and symptoms of an allergic reaction are histamines and leukotrienes. Epinephrine (adrenalin) is used to treat allergic reactions. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (1 of 2) 1. The signs and symptoms of an allergic reaction are caused by the release of: A. histamine. Rationale: Correct answer B. adrenalin. Rationale: Adrenalin is also called epinephrine and, along with Benadryl, is used to treat anaphylaxis. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (2 of 2) 1. The signs and symptoms of an allergic reaction are caused by the release of: C. epinephrine. Rationale: Epinephrine is used to treat anaphylaxis. D. glucagon. Rationale: Glucagon is a hormone produced by the pancreas that helps in the control of metabolism. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 2. The negative effects associated with anaphylactic shock are the result of: A. severe internal fluid loss. B. inadequate pumping of the heart. C. vasodilation and bronchoconstriction. D. the nervous system’s release of adrenalin. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review Answer: C Rationale: Anaphylaxis is an extreme allergic reaction that is life threatening and involves multiple organ systems. In severe cases, anaphylaxis can rapidly result in death. One of the most common signs of anaphylaxis is wheezing, a high-pitched, whistling breath sound that is typically heard on expiration, usually resulting from bronchospasm/ bronchoconstriction and increased mucus production. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (1 of 2) 2. The negative effects associated with anaphylactic shock are the result of: A. severe internal fluid loss. Rationale: The body does not lose fluid; blood pools in the dilated circulatory system and causes less blood flow back to the heart. B. inadequate pumping of the heart. Rationale: Inadequate pumping is not the problem; the cardiac output is decreased due to poor return to the heart. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (2 of 2) 2. The negative effects associated with anaphylactic shock are the result of: C. vasodilation and bronchoconstriction. Rationale: Correct answer D. the nervous system’s release of adrenalin. Rationale: Adrenalin is the treatment for anaphylaxis. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 3. You are called to a local baseball park for a 23-year-old man with difficulty breathing. He states that he ate a package of peanuts approximately 30 minutes ago and denies any allergies or past medical history. Your assessment reveals widespread urticaria, tachycardia, and a BP of 90/60 mm Hg. You can hear him wheezing, even without a stethoscope. You should be MOST suspicious of a(n): A. acute asthma attack. B. mild allergic reaction. C. severe allergic reaction. D. moderate allergic reaction. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review Answer: C Rationale: The patient’s signs and symptoms indicate a severe allergic reaction, which is rapidly progressing to anaphylactic shock. Signs and symptoms of a severe allergic reaction include difficulty breathing, urticaria (hives) over large parts of the body, and signs of shock (eg, tachycardia, hypotension). Certain foods, such as shellfish and nuts, may result in a relatively slow onset of symptoms, but the symptoms can become just as severe. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (1 of 4) 3. You are called to a local baseball park for a 23-year-old man with difficulty breathing. He states that he ate a package of peanuts approximately 30 minutes ago, and denies any allergies or past medical history. Your assessment reveals widespread urticaria, tachycardia, and a BP of 90/60 mm Hg. You can hear him wheezing, even without a stethoscope. You should be MOST suspicious of a(n): A. acute asthma attack. Rationale: Asthma presents with difficulty breathing, but patients will not have urticaria (hives). Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (2 of 4) 3. You are called to a local baseball park for a 23-year-old man with difficulty breathing. He states that he ate a package of peanuts approximately 30 minutes ago, and denies any allergies or past medical history. Your assessment reveals widespread urticaria, tachycardia, and a BP of 90/60 mm Hg. You can hear him wheezing, even without a stethoscope. You should be MOST suspicious of a(n): B. mild allergic reaction. Rationale: Mild reactions usually appear with urticaria, itching, and some swelling, but not hypotension and breathing difficulties. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (3 of 4) 3. You are called to a local baseball park for a 23-year-old man with difficulty breathing. He states that he ate a package of peanuts approximately 30 minutes ago and denies any allergies or past medical history. Your assessment reveals widespread urticaria, tachycardia, and a BP of 90/60 mm Hg. You can hear him wheezing, even without a stethoscope. You should be MOST suspicious of a(n): C. severe allergic reaction. Rationale: Correct answer Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (4 of 4) 3. You are called to a local baseball park for a 23-year-old man with difficulty breathing. He states that he ate a package of peanuts approximately 30 minutes ago and denies any allergies or past medical history. Your assessment reveals widespread urticaria, tachycardia, and a BP of 90/60 mm Hg. You can hear him wheezing, even without a stethoscope. You should be MOST suspicious of a(n): D. moderate allergic reaction. Rationale: The designation is mild or severe— not moderate. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 4. What is a wheal? A. a raised, swollen, well-defined area on the skin B. a poison C. small areas of generalized itching or burning that appear as multiple, small, raised areas on the skin D. an exaggerated immune response to any substance Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review Answer: A Rationale: Insect stings and bites can cause a wheal, which is a raised, swollen, well-defined area on the skin. There is no specific treatment for these injuries, although applying ice sometimes makes them less irritating. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (1 of 2) 4. What is a wheal? A. a raised, swollen, well-defined area on the skin Rationale: Correct answer B. a poison Rationale: This is the definition of a toxin. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (2 of 2) 4. What is a wheal? C. small areas of generalized itching or burning that appear as multiple, small, raised areas on the skin Rationale: This is the definition of urticaria. D. an exaggerated immune response to any substance Rationale: This is the definition of an allergic reaction. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 5. You are treating a woman who was stung numerous times by hornets. On assessment, you note that some of the stingers are still imbedded in her skin. You should: A. leave the stingers in place. B. scrape the stingers from her skin. C. pull the stingers out with tweezers. D. cover the stings with tight dressings. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review Answer: B Rationale: Because of the venom left in the sac located at the end of the stinger, you should not grab the stingers in an attempt to remove them. Instead, scrape them off with a rigid object such as a credit card. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (1 of 2) 5. You are treating a woman who was stung numerous times by hornets. On assessment, you note that some of the stingers are still imbedded in her skin. You should: A. leave the stingers in place. Rationale: A stinger will continue to inject venom even when the stinger is no longer attached to the insect. B. scrape the stingers from her skin. Rationale: Correct answer Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (2 of 2) 5. You are treating a woman who was stung numerous times by hornets. On assessment, you note that some of the stingers are still imbedded in her skin. You should: C. pull the stingers out with tweezers. Rationale: Using tweezers may squeeze more venom into the patient. D. cover the stings with tight dressings. Rationale: Remove the stingers—do not leave them in place. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 6. A young male is experiencing signs and symptoms of anaphylactic shock after being stung by a scorpion. His level of consciousness is diminished, his breathing is severely labored, you can hear inspiratory stridor, and his face is cyanotic. The patient has a prescribed epinephrine auto-injector. What should you do first? A. Assist him in administering his epinephrine. B. Apply high-flow oxygen via nonrebreathing mask. C. Provide ventilatory assistance with a bag-mask device. D. Elevate his legs and cover him with a warm blanket. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review Answer: C Rationale: The patient is not breathing adequately, as noted by his decreased level of consciousness, severely labored breathing, inspiratory stridor, and cyanosis. Therefore, you should first assist his ventilations with a bag-mask device. He clearly requires epinephrine, but not before restoring adequate breathing first. Regardless of the situation, a patient’s airway must be patent and his or her breathing must remain adequate at all times. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (1 of 2) 6. A young male is experiencing signs and symptoms of anaphylactic shock after being stung by a scorpion. His level of consciousness is diminished, his breathing is severely labored, you can hear inspiratory stridor, and his face is cyanotic. The patient has a prescribed epinephrine auto-injector. What should you do first? A. Assist him in administering his epinephrine. Rationale: This is part of the treatment, but only after the breathing has been addressed. B. Apply high-flow oxygen via nonrebreathing mask. Rationale: Respirations need assistance due to diminished breathing. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (2 of 2) 6. A young male is experiencing signs and symptoms of anaphylactic shock after being stung by a scorpion. His level of consciousness is diminished, his breathing is severely labored, you can hear inspiratory stridor, and his face is cyanotic. The patient has a prescribed epinephrine auto-injector. What should you do first? C. Provide ventilatory assistance with a bag-mask device. Rationale: Correct answer D. Elevate his legs and cover him with a warm blanket. Rationale: You should treat for shock, but breathing is the first priority. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 7. The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: A. stridor. B. anxiety. C. cyanosis. D. wheezing. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review Answer: A Rationale: Stridor is a high-pitched sound that is most often heard during inhalation. It indicates swelling of the upper airway. Wheezing, a whistling sound, is caused by narrowed bronchioles; it indicates narrowing or swelling of the lower airway. Anxiety and cyanosis can occur from a variety of causes; they are not exclusive to airway swelling. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (1 of 2) 7. The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: A. stridor. Rationale: Correct answer B. anxiety. Rationale: This is typically a symptom of hypoxia or decreased oxygenation to the brain. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (2 of 2) 7. The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: C. cyanosis. Rationale: This is a sign of hypoxia and inadequate tissue perfusion. D. wheezing. Rationale: This is a sign of lower airway constriction or narrowing. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 8. What is the best tool or method for assessing a patient’s perfusion status? A. small-volume nebulizer B. bag-mask device C. pulse oximetry D. auto-injector Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review Answer: C Rationale: In a patient experiencing an allergic reaction, pulse oximetry is a useful method that you can use to assess the patient’s perfusion status. By using pulse oximetry, you can determine the percentage of oxygen saturation in the bloodstream, which will assist in identifying the degree of respiratory distress. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (1 of 2) 8. What is the best tool or method for assessing a patient’s perfusion status? A. small-volume nebulizer Rationale: This device holds liquid medicine that is turned into a fine mist. It treats conditions like asthma. B. bag-mask device Rationale: This device delivers supplemental oxygen. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (2 of 2) 8. What is the best tool or method for assessing a patient’s perfusion status? C. pulse oximetry Rationale: Correct answer D. auto-injector Rationale: This device is designed to deliver a single dose of a particular drug, such as epinephrine. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 9. The adult EpiPen system delivers _____ mg of epinephrine, and the infant-child system delivers _____ mg. A. 0.15, 0.3 B. 0.3, 0.15 C. 0.15, 0.5 D. 0.5, 0.2 Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review Answer: B Rationale: The adult EpiPen system delivers 0.3 mg of epinephrine via an automatic needle and syringe system; the infant-child system delivers 0.15 mg. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 9. The adult EpiPen system delivers _____ mg of epinephrine, and the infant-child system delivers _____ mg. A. 0.15, 0.3 Rationale: This is not the correct dosage. B. 0.3, 0.15 Rationale: Correct answer C. 0.15, 0.5 Rationale: This is not the correct dosage. D. 0.5, 0.2 Rationale: This is not the correct dosage. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review 10. When administering epinephrine by auto-injector, the EMT should hold the injector in place for: A. 5 seconds. B. 10 seconds. C. 20 seconds. D. 30 seconds. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review Answer: B Rationale: When administering epinephrine via auto-injector, push the injector firmly against the thigh until it activates. Hold the injector in place for 10 seconds to ensure that all the medication is injected. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (1 of 2) 10. When administering epinephrine by auto-injector, the EMT should hold the injector in place for: A. 5 seconds. Rationale: The injector should be held in place for 10 seconds. B. 10 seconds. Rationale: Correct answer Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Review (2 of 2) 10. When administering epinephrine by auto-injector, the EMT should hold the injector in place for: C. 20 seconds. Rationale: The injector should be held in place for 10 seconds. D. 30 seconds. Rationale: The injector should be held in place for 10 seconds. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved. Please visit Resource Central on www.bradybooks.com to view additional resources for this text. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Copyright ©2012 by Pearson Education, Inc. All rights reserved.