1. Chapter 20
Allergies

2. Case History
You have arrived at the scene of an adult male having difficulty breathing. You find a 50-year-old male complaining of shortness of breath and tightness in his throat. He tells you that this began about 10 minutes ago after he was stung by a bee while mowing the lawn. You notice that he begins to wheeze as he tells you that his chest and hands feel itchy.

3. Allergic Reactions and Anaphylaxis
Antibody-antigen reaction
Results in release of substances (e.g., histamine)
Affects the respiratory, circulatory, GI systems, and skin
Anaphylaxis
Antibody-antigen reaction gone haywire
Detrimental rather than protective

4. Allergic Reaction Possible causes
Insect bites/stings (bees, wasps, etc.)
Food (nuts, crustaceans, peanuts, etc.)
Plants
Medications
Others

5. Assessment Findings Skin Warm, tingling feeling Itching Hives
Face, mouth, chest, feet, and hands
Itching
Hives

6. Respiratory System Tightness in throat/chest Cough Rapid breathing
Labored breathing
Retractions
Use of accessory muscles

7. Respiratory System Swelling of the airway Noisy breathing
Inability to speak or cough
Hoarseness
Stridor
Wheezing (audible without stethoscope)

8. Respiratory System
Respiratory failure
Respiratory arrest

9. Cardiovascular System
Increased heart rate
Decreased blood pressure
Decreased perfusion (shock) due to vasodilation

10. Generalized Findings Itchy, watery eyes Headache
Sense of impending doom
Runny nose

11. Other Signs and Symptoms
Decreasing mental status
Signs of shock (hypoperfusion)
Respiratory distress

12. Emergency Medical Care – Allergic Reaction
Initial assessment
Focused history and physical examination
Vital signs
Treatment

13. Emergency Medical Care - Focused History/Physical Examination
History of allergies?
What was patient exposed to?
How was he or she exposed?
What effects?
Progression?
Interventions?

14. Emergency Medical Care
Vital signs
SAMPLE history
Oxygen administration

15. Emergency Medical Care
Patient has prescribed epinephrine?
Facilitate administration of preloaded epinephrine.
Reassess every 2 minutes.
Record reassessment findings.
No auto-injector
Transport

16. Patient Without Respiratory Distress or Shock
Continue with focused assessment.
Patient should not receive epinephrine.

17. Relationship to Airway Management
Airway/respiratory compromise may develop over time.
Ensure a patent airway.
Provide ventilation.

18. Indications
Patient exhibits the assessment findings of an allergic reaction.
Medication is prescribed for this patient by a physician.
Medical direction authorizes use for this patient.

19. Form of Medication and Contraindications
Medication form
Liquid
Automatic needle and syringe system
No contraindications, when used in a life-threatening situation

20. Dosage Adult: one adult auto-injector (0.3 mg)
Infant and child: one infant/child auto-injector (0.15 mg)

21. Actions Dilates bronchioles Constricts blood vessels
Blocks histamine effects

22. Side Effects Increased heart rate Pallor Dizziness Chest pain Headache
Nausea
Vomiting
Excitability, anxiety

23. Reassessment Strategies
Transport.
Continue focused assessment.
Airway
Breathing
Circulatory status

24. Reassessment Strategies – Patient Condition Worsens
Signs/symptoms
Decreasing mental status
Increasing breathing difficulty
Decreasing blood pressure
Actions
Obtain medical direction.
Give additional dose of epinephrine.
Treat for shock (hypoperfusion).
Administer CPR and AED, as needed.

25. Reassessment Strategies – Patient Condition Improves
Provide supportive care.
Oxygen
Treatment for shock (hypoperfusion)

26. Summary Management of severe allergic reactions requires
Rapid identification of signs and symptoms
Administration of epinephrine
Management of airway and ventilation
Key signs and symptoms
Hives, itching, coughing, sneezing, etc.
Signs of respiratory distress, airway obstruction, or shock