Anaphylaxis

Question 1

What are the common triggers for allergic reactions?

Answer 1

Foods, medications, seasonal/environmental factors, insect stings, latex.

Question 2

What conditions can mimic an allergic reaction?

Answer 2

Asthma, anxiety/panic attack, vasovagal response, sepsis, angioedema, and gastrointestinal infections.

Question 3

How can asthma mimic an allergic reaction?

Answer 3

Presents with wheezing, dyspnea—differentiated by lack of urticaria or flushing.

Question 4

How is anxiety/panic attack differentiated from allergic reaction?

Answer 4

Panic attacks can cause hyperventilation, chest tightness, and tingling—no urticaria, hypotension, or swelling.

Question 5

What GI condition can mimic allergic reactions due to vomiting and cramps?

Answer 5

Gastroenteritis.

Question 6

What is a key differentiating feature of sepsis vs anaphylaxis?

Answer 6

Sepsis presents with fever and possible infection source, unlike anaphylaxis.

Question 7

What is angioedema and how is it different from allergic swelling?

Answer 7

Angioedema can be hereditary or drug-induced and may not include urticaria or itching.

Question 8

What vital signs are commonly altered in anaphylaxis?

Answer 8

Hypotension, tachycardia, tachypnea, low SpO₂.

Question 9

What condition presents with flushing, hypotension, and wheezing but is not allergic in nature?

Answer 9

Anaphylactoid reaction (non-IgE mediated but similar symptoms).

Question 10

What initial assessment must be done in a suspected allergic reaction?

Answer 10

Scene safety, primary survey, ABCs, and identification of allergen exposure.

Question 11

What are key secondary survey components for allergic reactions (BLS)?

Answer 11

Assess:
a. Site of reaction
b. Lungs (adventitious sounds)
c. Skin (erythema, urticaria, edema)

Question 12

What are the 5 body systems assessed for anaphylaxis criteria?

Answer 12

Respiratory, cardiovascular, neurological, gastrointestinal, dermatologic/mucosal.

Question 13

What historical clues support anaphylaxis diagnosis?

Answer 13

Known allergen exposure, tight throat, fear/doom, generalized itching, prior similar reaction.

Question 14

What respiratory findings support a severe allergic reaction?

Answer 14

Wheezing, stridor, dyspnea, hoarse voice.

Question 15

What cardiovascular findings indicate anaphylaxis?

Answer 15

Hypotension and tachycardia.

Question 16

What neurological findings may accompany anaphylaxis?

Answer 16

Dizziness, confusion, decreased LOC.

Question 17

What GI symptoms are common in moderate-severe allergic reactions?

Answer 17

Nausea, vomiting, cramps, diarrhea.

Question 18

What derm signs are classic in allergic reactions?

Answer 18

Flushing, urticaria, orolingual/facial swelling.

Question 19

What conditions require continuous monitoring for deterioration in allergic reactions?

Answer 19

Airway obstruction, cardiac arrest, bronchospasm.

Question 20

What is the BLS guideline for treating a suspected allergic reaction?

Answer 20

Identify triggers, monitor vitals, perform full secondary survey, prepare for deterioration.

Question 21

When is epinephrine indicated per ALS Moderate to Severe Allergic Reaction directive?

Answer 21

Signs of anaphylaxis or involvement of ≥2 body systems.

Question 22

What is the IM epinephrine dose per ALS protocol?

Answer 22

0.5 mg IM (repeat every 5 min, max 3 doses depending on protocol and response).

Question 23

What medication can be given for persistent GI symptoms post-anaphylaxis (ALS)?

Answer 23

Ondansetron per Nausea/Vomiting Medical Directive.

Question 24

What is the dose of diphenhydramine (if administered by ACP or under BHP)?

Answer 24

25–50 mg IV/IM.

Question 25

When should BVM be used in allergic reactions?

Answer 25

For altered LOC or severe respiratory distress with poor oxygenation.

Question 26

What should be done if airway obstruction is suspected?

Answer 26

Prepare for advanced airway management and rapid transport.

Question 27

If a patient becomes VSA after allergic reaction, what is your protocol?

Answer 27

Initiate cardiac arrest protocol; consider reversible cause (anaphylaxis).

Question 28

Can you TOR anaphylaxis cardiac arrest in field if no ROSC after epinephrine?

Answer 28

Generally no—early transport is critical due to reversibility of cause.

Question 29

What ALS directive allows for epinephrine use without IV access?

Answer 29

Moderate to Severe Allergic Reaction Directive (IM injection is first-line).

Question 30

What other preparations must you make in severe allergic reactions?

Answer 30

Prepare for cardiac arrest, airway obstruction, BHP patch if needed.

Question 31

What is the minimum required equipment for allergic reaction cases?

Answer 31

SpO₂ monitor, auscultation device, airway management tools, epinephrine, suction.

Question 32

What are important bystander or family questions to ask in suspected allergic reaction?

Answer 32

Time of exposure, known allergens, prior reactions, meds taken, EpiPen administered?

Question 33

What’s the significance of rapid onset of symptoms in anaphylaxis?

Answer 33

Faster onset = higher severity and worse outcomes—treat immediately.

Question 34

Pt has facial swelling, dyspnea, urticaria, and hypotension after shellfish. Dx?

Answer 34

Anaphylaxis—treat with epinephrine IM and rapid transport.

Question 35

Pt has vomiting and diarrhea after eating but no rash or airway symptoms. Dx?

Answer 35

Likely gastroenteritis. Monitor, rehydrate, no epinephrine unless allergic signs develop.

Question 36

Pt with wheezing, dyspnea, but no rash or hypotension. Has asthma hx. Dx?

Answer 36

Asthma exacerbation. Treat with bronchodilators per protocol, monitor airway.

Question 37

Pt has facial flushing, tingling, rapid breathing, and fear after peanut ingestion—normal vitals. Dx?

Answer 37

Could be panic or early allergic reaction. Monitor closely for escalation.

Question 38

Pt has confusion, flushing, hypotension, but no rash. Febrile. Dx?

Answer 38

Likely sepsis. Consider IV fluids, BHP patch.

Question 39

Elderly pt with dry cough, wheeze, no rash, on ACE inhibitor. Dx?

Answer 39

Likely angioedema. Monitor airway. No epinephrine unless progression.

Question 40

Compare panic attack vs anaphylaxis.

Answer 40

Panic: hyperventilation, tingling, fear, NO rash/hypotension. Anaphylaxis: rash, hypotension, airway edema, systemic involvement.

Question 41

Compare asthma vs anaphylaxis.

Answer 41

Asthma: wheeze only, often chronic. Anaphylaxis: wheeze + rash/hypotension/swelling after trigger.

Question 42

Compare GI infection vs food allergy.

Answer 42

GI infection: longer onset, fever possible. Allergy: rapid onset, systemic involvement.

Question 43

What is the key differentiating factor between mild/moderate allergic reaction and anaphylaxis?

Answer 43

Anaphylaxis involves two or more body systems or causes life-threatening symptoms (e.g., hypotension, airway compromise); mild/moderate does not.

Question 44

What are the common symptoms of a mild/moderate allergic reaction?

Answer 44

Localized rash Itching Urticaria Mild swelling (face, lips, eyes) GI upset (nausea, vomiting) Tingling in the mouth

Question 45

What symptoms define anaphylaxis?

Answer 45

Shortness of breath (dyspnea) Wheezing/stridor Hypotension/shock Airway swelling Altered LOC Involvement of ≥2 body systems (e.g., respiratory + skin)

Question 46

What respiratory findings suggest mild reaction vs anaphylaxis?

Answer 46

Mild: No respiratory involvement or mild wheeze Anaphylaxis: Dyspnea, wheeze, stridor, hoarseness, airway swelling

Question 47

What are the vital signs typically seen in mild/moderate allergic reactions?

Answer 47

Normal vitals or mild tachycardia. No hypotension.

Question 48

What are the vital signs typically seen in anaphylaxis?

Answer 48

Hypotension Tachycardia Increased respiratory rate Decreased SpO₂

Question 49

What is the neurological difference between mild allergy and anaphylaxis?

Answer 49

Mild: Patient is alert, oriented Anaphylaxis: May have confusion, dizziness, or decreased LOC

Question 50

What GI symptoms appear in both, and how to differentiate?

Answer 50

Mild: Occasional vomiting or abdominal pain Anaphylaxis: Severe vomiting, diarrhea, cramps + other system involvement

Question 51

What skin findings appear in both conditions?

Answer 51

Mild: Local rash or hives, itching Anaphylaxis: Generalized urticaria + facial/orolingual swelling + flushing

Question 52

What subjective symptoms often point toward anaphylaxis?

Answer 52

Feeling of doom Tightness in the throat Difficulty swallowing or breathing Fear, anxiety

Question 53

Can a patient with only skin involvement be in anaphylaxis?

Answer 53

No—anaphylaxis requires at least 2 system involvement, unless there is airway compromise or hypotension from a known allergen.

Question 54

Which directive applies for mild/moderate allergic reaction treatment?

Answer 54

BLS Allergic Reaction (Known or Suspected) Standard—monitor, supportive care, identify allergen.

Question 55

Which directive applies for anaphylaxis?

Answer 55

ALS Moderate to Severe Allergic Reaction Medical Directive—IM epinephrine is first-line.

Question 56

How is treatment different between the two in the prehospital setting?

Answer 56

Mild/Moderate: Antihistamines (if ACP) or monitoring, supportive care Anaphylaxis: Immediate IM epinephrine, oxygen, airway management, BVM, rapid transport

Question 57

What medication is not given for mild allergy but is critical in anaphylaxis?

Answer 57

Epinephrine (0.5 mg IM) — for anaphylaxis only

Question 58

What directive applies if nausea/vomiting is prominent in either scenario?

Answer 58

ALS Nausea/Vomiting Medical Directive – consider ondansetron if available and authorized

Question 59

When should you initiate rapid transport for an allergic reaction?

Answer 59

If signs of anaphylaxis are present If patient worsens during care If airway compromise is suspected

Question 60

Can a mild/moderate allergic reaction escalate to anaphylaxis?

Answer 60

Yes—monitor closely for progression; be prepared to treat if additional systems become involved.