I
Detailed Lesson Plan
Chapter 21
Anaphylactic Reactions
50–65 minutes
|Chapter 21 objectives can be found in an accompanying folder. |
|These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. |
|Minutes |Content Outline |Master Teaching Notes |
| |Introduction |Case Study Discussion |
|5 |During this lesson, students will learn about assessment and emergency care for patients suffering from allergic |What is your general impression of the patient? |
| |reaction. |What is the first action you should take? |
| |Case Study | |
| |Present The Dispatch and Upon Arrival information from the chapter. | |
| |Discuss with students how they would proceed. | |
| |Anaphylactic Reaction—Pathophysiology of Anaphylactic Reaction |Weblink |
|15 |The immune system is a defense mechanism to fight off invasion by foreign substances. |Go to |
| |Antigens are foreign substances that are recognized by the cells of the immune system and eventually destroyed. |and click on the mykit link for Prehospital Emergency Care, |
| |When an antigen enters the body, it sets off an immune response, and the immune system produces antibodies, |9th edition to access a web resource on the immune system and |
| |proteins that search for the antigen, combine with it, and help to destroy it. |allergic reactions. |
| |If an allergen, a type of antigen, enters the body, it can cause an abnormal response by the immune system known as| |
| |an allergic reaction. | |
| |An allergic reaction is a misdirected and excessive response by the immune system to an allergen. The response can | |
| |be local or systemic. | |
| |A life-threatening allergic reaction is known as an anaphylactic reaction (also anaphylaxis or anaphylactic shock).| |
| |Swelling in the upper and lower airways can cause breathing difficulties and hypoxia. |Discussion Question |
| |Dilated blood vessels and capillaries can decrease blood pressure and cause shock. |What is the relationship between an allergic reaction and |
| |Sensitization |anaphylaxis? |
| |An allergic reaction usually does not occur the first time the body is exposed to and produces antibodies against a| |
| |particular antigen. | |
| |Hypersensitivity can develop upon first exposure, meaning if the person is again exposed to the antigen, an |Video Clip |
| |allergic reaction will occur. |Go to |
| |The process of developing hypersensitivity on first exposure to an antigen is known as sensitization and primes the|and click on the mykit link for Prehospital Emergency Care, |
| |patient for a possible anaphylactic reaction. |9th edition to access a video on allergic rhinitis. |
| |During sensitization, antibodies attach to mast cells and basophils. When the antigen is reintroduced into the | |
| |body, the cell membranes break down and release chemical mediators (such as histamine) that cause the signs and | |
| |symptoms of anaphylaxis. | |
| |Life-threatening responses from the chemical mediators include bronchoconstriction, increase in capillary | |
| |permeability, and vasodilation. | |
| |Anaphylactoid reaction |Critical Thinking Discussion |
| |Sometimes mast cells and basophils can release chemical mediators the first time the antigen is introduced into the|How does the body’s response to an allergen result in signs |
| |body without the patient ever being sensitized. This is referred to as an anaphylactoid reaction. |and symptoms of anaphylaxis? |
| |Signs, symptoms, and treatment are exactly the same as for anaphylactic reaction. | |
| |See Table 21-1 for substances that commonly cause anaphylactoid reactions. | |
| |Causes of anaphylactic reaction | |
| |Some causes of anaphylactic reaction are idiopathic (cannot be identified). | |
| |How antigens enter the body | |
| |Injection | |
| |Ingestion | |
| |Inhalation | |
| |Contact (absorption) | |
| |Common causes of anaphylactic reaction | |
| |Venom | |
| |Foods |Discussion Question |
| |Pollen |What are some common causes of anaphylaxis? |
| |Medications (penicillin) | |
| |Other substances (glue) | |
| |Exercise |Animation |
| |Latex |Go to |
| | |and click on the mykit link for Prehospital Emergency Care, |
| | |9th edition to access an animation on anaphylactic reaction. |
| |Anaphylactic Reaction—Assessment-Based Approach to Anaphylactic Reaction |Class Activity |
| |Scene size-up |Provide ample opportunity for students to practice skills. |
|20 |Be certain your own safety is not in jeopardy (especially if anaphylactic reaction is the result of a bite or | |
| |sting). | |
| |Look for clues at the scene such as medications. | |
| |Primary assessment | |
| |Patient may complain of not feeling well or malaise, generalized feeling of weakness or discomfort. | |
| |Closely assess the airway for signs of obstruction (stidor or crowing sounds). | |
| |Positive pressure ventilation may be necessary to force the air past the swollen upper airway. | |
| |If breathing is adequate, place the patient on a nonrebreather mask with an oxygen flow of 15 lpm. | |
| |Management of the airway may require endotracheal intubation, placement of a tube in the trachea to facilitate | |
| |breathing. In most jurisdictions, this is performed by ALS. | |
| |Common signs of allergic reaction | |
| |Rapid and weak pulse (fluid loss) | |
| |Warm, flushed skin (vasodilation) | |
| |Hives (capillary permeability and leaking in the epidermis) | |
| |Edema (capillary permeability and leaking in the dermis) | |
| |Patient with an anaphylactic reaction is considered priority; consider calling ALS. | |
| |Determine if the patient has an epinephrine auto-injector and locate it immediately. | |
| |Secondary assessment | |
| |If the patient is experiencing a severe reaction, conduct the secondary assessment en route to the hospital. | |
| |History | |
| |Use the OPQRST line of questioning, with emphasis on the onset of the reaction. | |
| |The faster the onset of signs and symptoms of an anaphylactic reaction, the more severe and prolonged the reaction | |
| |will probably be. | |
| |Take the patient’s SAMPLE history. | |
| |Signs and symptoms | |
| |Skin | |
| |Warm, tingling feeling in face, mouth, chest, feet, and hands | |
| |Intense itching | |
| |Hives | |
| |Flushed or red skin |Discussion Question |
| |Swelling to the face, lips, neck, hands, feet, and tongue |What are signs and symptoms of anaphylaxis? |
| |Respiratory system | |
| |“Lump in the throat” |Weblink |
| |Tightness in the chest |Go to |
| |High-pitched cough |and click on the mykit link for Prehospital Emergency Care, |
| |Tachypnea |9th edition to access a web resource on urticaria. |
| |Labored breathing | |
| |Noisy breathing | |
| |Impaired ability to talk or hoarseness | |
| |Excessive amounts of coughed-up mucus | |
| |Partially or completely occluded airway | |
| |Difficulty in breathing | |
| |Cardiovascular system | |
| |Tachycardia | |
| |Hypotension | |
| |Irregular pulse | |
| |Absent radial pulse | |
| |Central nervous system | |
| |Increased anxiety | |
| |Lightheadedness | |
| |Unresponsiveness | |
| |Disorientation | |
| |Restlessness | |
| |Seizures | |
| |Headache | |
| |Gastrointestinal system | |
| |Naseau/vomiting | |
| |Abdominal cramping | |
| |Diarrhea | |
| |Difficulty in swallowing | |
| |Loss of bowel control | |
| |Genitourinary system | |
| |Urgent need to urinate | |
| |Cramping of the uterus | |
| |Generalized signs and symptoms | |
| |Itchy, watery eyes | |
| |Runny or stuffy nose | |
| |Sense of impending doom | |
| |Complaints of “not feeling well” | |
| |General weakness or discomfort | |
| |Physical exam | |
| |Baseline vital signs | |
| |Two key categories of signs and symptoms | |
| |Airway and respiratory compromise—Airway occlusion; respiratory distress or respiratory failure with possible | |
| |wheezing or stridor | |
| |Shock (hypoperfusion—Absent or weak pulses; rapid heartbeat; decreased blood pressure; deteriorating mental status | |
| |Physical exam | |
| |Focus the physical exam on the patient’s complains involving the airway, breathing, and circulation. | |
| |The EMT’s major concerns are a compromised airway, inadequate breathing, and shock (hypoperfusion). | |
| |Check the face for swelling and extremities for bites, stings, or injection marks. | |
| |Check pulses and skin temperature, color, and condition for indications of shock. | |
| |Baseline vital signs—Pay particular attention to the breathing, pulse, and blood pressure. | |
| |Remember that what appears to be a mild allergic reaction can progress to a severe, life-threatening reaction | |
| |within minutes. Do not mistake anaphylaxis for other conditions with similar signs and symptoms. | |
| |Emergency medical care | |
| |Distinguish between a mild and a moderate-to-severe reaction. | |
| |The mild reaction typically does not require aggressive intervention or administration of medication. Maintain an | |
| |open airway, provide oxygen, and transport as soon as possible. | |
| |Emergency care for a moderate to severe reaction. | |
| |Maintain a patent airway. | |
| |Suction any secretions. |Discussion Question |
| |Maintain oxygen therapy. |What are the treatment priorities for patients with |
| |Be prepared to assist ventilation. |anaphylaxis? |
| |Administer epinephrine by a prescribed auto-injector (on-line or off-line order). | |
| |Consider calling for advanced life support. | |
| |Initiate early transport. | |
| |Reassessment | |
| |Patient with a mild reaction should be constantly monitored for indications that the reaction is worsening and that| |
| |further intervention may be needed. | |
| |Patient with moderate-to-severe reaction who has received an epinephrine injection should be reassessed to | |
| |determine if the injection has been effective (after two minutes). | |
| |Closely reassess the airway, breathing, and circulation status and looks for signs of deterioration. | |
| |Anaphylactic Reaction—Summary: Assessment and Care |Knowledge Application |
|5 |Review assessment findings that may be associated with allergic reaction and emergency care for allergic reaction. |Given a scenario involving exposure to an allergen, students |
| |See Figures 21-3 and 21-4. |should be able to determine treatment priorities for the |
| | |patient. |
| |Anaphylactic Reaction—Epinephrine Auto-Injector |Teaching Tip |
|15 |Epinephrine is the drug of choice for the emergency treatment of moderate-to-severe allergic reactions. |Pass around examples of epinephrine auto-injectors for |
| |Epinephrine’s alpha1 and alpha2 properties cause vasoconstriction and tighten the capillaries, reversing the |students to see and handle. |
| |increased capillary permeability experienced by the anaphylactic patient. | |
| |The beta2 properties cause bronchodilation, reversing the bronchoconstriction. | |
| |The beta1 properties are responsible for side effects from administration. |Critical Thinking Discussion |
| |Epinephrine also reduces the effects of antihistamine. |What are the actions of epinephrine that are beneficial to the|
| |Body’s response to epinephrine is rapid; however, it only lasts ten to 20 minutse. |patient with anaphylaxis? |
| |Epinephrine comes packaged in a disposable delivery system for self-administration (EpiPen® and Twinject®) | |
| |Autojectors with spring-loaded, concealed needle designed to deliver a precise dose of epinephrine |Weblink |
| |Twinject® is unique because it carries two doses of epinephrine. |Go to |
| |Both epinephrine auto-injectors carry a 0.3 mg dose for patients 66 pounds or greater and 0.15 mg for infants and |and click on the mykit link for Prehospital Emergency Care, |
| |children up to 66 pounds. |9th edition to access a web resource on the epinephrine |
| |Activated by pressing it against the patient’s thigh (lateral portion, midway between the hip and knee preferred); |auto-injector and anaphylaxis. |
| |second dose of Twinject® requires additional steps | |
| |Preferable to move clothing from the injection site but not necessary. |Animation |
| | |Go to |
| | |and click on the mykit link for Prehospital Emergency Care, |
| | |9th edition to access an animation on allergic reactions and |
| | |epinephrine. |
| |Follow-Up |Case Study Follow-Up Discussion |
|5 |Answer student questions. |Why is the immediate application of oxygen an important aspect|
| |Case Study Follow-Up |of Mrs. Stein’s treatment? |
| |Review the case study from the beginning of the chapter. |What is the significance to Mrs. Steins’ treatment and |
| |Remind students of some of the answers that were given to the discussion questions. |recovery of the inability to pinpoint the exact time the |
| |Ask students if they would respond the same way after discussing the chapter material. Follow up with questions to |symptoms began? |
| |determine why students would or would not change their answers. | |
| |Follow-Up Assignments |Class Activity |
| |Review Chapter 21 Summary. |Alternatively, assign each question to a group of students and|
| |Complete Chapter 21 In Review questions. |give them several minutes to generate answers to present to |
| |Complete Chapter 21 Critical Thinking. |the rest of the class for discussion. |
| |Assessments | |
| |Handouts |Teaching Tips |
| |Chapter 21 quiz |Answers to In Review and Critical Thinking questions are in |
| | |the appendix to the Instructor’s Wraparound Edition. Advise |
| | |students to review the questions again as they study the |
| | |chapter. |
| | |The Instructor’s Resource Package contains handouts that |
| | |assess student learning and reinforce important information in|
| | |each chapter. This can be found under mykit at |
| | |. |
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MASTER TEACHING NOTES
• Case Study Discussion
• Teaching Tips
• Discussion Questions
• Class Activities
• Media Links
• Knowledge Application
• Critical Thinking Discussion
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