NREMT Paramedic Cognitive ExamMedicalEasy
A 28-year-old male presents with sudden onset of difficulty breathing, wheezing, and hives after eating shrimp. He states he has a known shellfish allergy. His blood pressure is 80/40 mmHg, heart rate 120 bpm, respiratory rate 28 bpm, and SpO2 90% on room air. Lung sounds reveal diffuse wheezing. Which of the following is the most appropriate initial intervention?
- AAdminister 500 mL normal saline bolus intravenously
- BAdminister 0.3 mg epinephrine intramuscularly
- CAdminister 10 mg albuterol via nebulizer
- DAdminister 25 mg diphenhydramine orally
Show answer & explanationAnswer & explanation
Correct answer: B. Administer 0.3 mg epinephrine intramuscularly
The patient is experiencing anaphylaxis, characterized by a sudden allergic reaction with respiratory compromise (difficulty breathing, wheezing, SpO2 90%) and circulatory compromise (hypotension). Epinephrine is the primary and most critical medication for anaphylaxis, addressing both bronchoconstriction and vasodilation.
Why the other options are wrong
- A. While supportive, a fluid bolus alone will not reverse the underlying pathophysiological processes of anaphylaxis; epinephrine is paramount.
- C. Albuterol is a bronchodilator that can help with wheezing but does not address the systemic vasodilation and hypotension of anaphylaxis.
- D. Diphenhydramine is an antihistamine that can help with skin symptoms but does not address the life-threatening respiratory or circulatory compromise.
Anaphylaxis Treatment
Immediate and severe systemic allergic reaction requiring prompt administration of epinephrine to counteract widespread vasodilation and bronchoconstriction.
- Epinephrine is the primary treatment.
- Dosage for adults is 0.3-0.5 mg IM.
- Supportive care includes oxygen, IV fluids, and antihistamines/corticosteroids.
Memory trick: EPI-nephrine is your first 'EPI-c' choice for anaphylaxis!