Urgent Care Urgent Care for Allergic Reactions and Anaphylaxis 1 — Questions and Answers
Question 1: What is the first-line treatment for anaphylaxis in an urgent care setting?
- Diphenhydramine 50mg IV
- Epinephrine 0.3mg IM (1:1000) (Correct answer)
- Hydrocortisone 200mg IV
- Cetirizine 10mg oral
Correct answer: Epinephrine 0.3mg IM (1:1000)
Epinephrine IM is the only first-line treatment for anaphylaxis; antihistamines and corticosteroids are adjuncts and must never replace it.
Question 2: At which anatomical site should epinephrine be injected for anaphylaxis in adults?
- Deltoid muscle of the upper arm
- Gluteus maximus
- Anterolateral aspect of the mid-thigh (Correct answer)
- Forearm subcutaneous tissue
Correct answer: Anterolateral aspect of the mid-thigh
The anterolateral thigh provides faster absorption and higher peak plasma concentrations than other IM sites, making it the preferred injection location.
Question 3: Which combination of symptoms is classic for anaphylaxis?
- Fever, joint pain, and macular rash
- Urticaria, angioedema, and bronchospasm (Correct answer)
- Hypertension, bradycardia, and confusion
- Isolated nausea and vomiting without skin findings
Correct answer: Urticaria, angioedema, and bronchospasm
Anaphylaxis classically involves cutaneous (urticaria/angioedema), respiratory (bronchospasm), and/or cardiovascular manifestations occurring rapidly after allergen exposure.
Question 4: What is the minimum recommended observation period after treating anaphylaxis in urgent care?
- 30 minutes
- 1-2 hours
- 4-6 hours (Correct answer)
- 24 hours
Correct answer: 4-6 hours
A minimum 4-6 hour observation period is recommended after anaphylaxis treatment to monitor for biphasic reactions, which can recur without re-exposure to the allergen.
Question 5: What is a biphasic anaphylactic reaction?
- Anaphylaxis affecting two organ systems simultaneously
- Recurrence of anaphylaxis symptoms after apparent resolution without re-exposure to allergen (Correct answer)
- Anaphylaxis requiring two sequential doses of epinephrine
- An allergic reaction involving both IgE and IgG pathways
Correct answer: Recurrence of anaphylaxis symptoms after apparent resolution without re-exposure to allergen
Biphasic anaphylaxis is the recurrence of symptoms 1-72 hours after the initial reaction has resolved, without additional allergen exposure.
Question 6: Which of the following medications is considered a second-line adjunct — NOT a replacement for epinephrine — in anaphylaxis management?
- Diphenhydramine alone
- Albuterol alone
- Ranitidine alone
- All of the above are second-line adjuncts only (Correct answer)
Correct answer: All of the above are second-line adjuncts only
Antihistamines (H1 and H2 blockers) and albuterol are all adjunctive therapies that treat specific symptoms but do not address the systemic vascular and airway collapse that epinephrine reverses.
Question 7: A patient with anaphylaxis is not responding after two doses of IM epinephrine. What is the most appropriate next step in urgent care?
- Increase the dose of diphenhydramine to 100mg
- Initiate IV epinephrine infusion and arrange immediate transfer to the ED (Correct answer)
- Administer oral prednisone 60mg
- Give a second antihistamine such as ranitidine
Correct answer: Initiate IV epinephrine infusion and arrange immediate transfer to the ED
Refractory anaphylaxis unresponsive to two IM epinephrine doses requires IV epinephrine infusion and emergency department transfer for advanced monitoring and management.
Urgent Care Urgent Care for Allergic Reactions and Anaphylaxis 1
What is the first-line treatment for anaphylaxis in an urgent care setting?