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Question 1
A 40-year-old stung by a wasp has hives, lip swelling, loud inspiratory stridor and a blood pressure of 86/50. A first responder has already started an IV. Which medication should the paramedic give FIRST?
- Epinephrine 5 mg nebulized for the stridor
- Epinephrine 0.3 mg intramuscularly in the lateral thigh
- Diphenhydramine 50 mg intravenously followed by famotidine
- Methylprednisolone 125 mg by slow intravenous push
Why each answer is right or wrong
Answer: B
- A. Nebulized epinephrine can be added for stridor, but it does not replace the intramuscular dose, which also treats the shock.
- B. Correct. Airway swelling with hypotension is anaphylaxis, and intramuscular epinephrine in the anterolateral thigh is first-line.
- C. Antihistamines treat hives and itching but do not reverse airway edema or shock.
- D. The open IV makes this tempting, but steroids act over hours and do not reverse airway swelling now.
When anaphylaxis is suspected, epinephrine is first-line, and time to delivery is the main safety measure. The national guideline gives 0.3 mg of the 1 mg/mL concentration intramuscularly to patients of 25 kg or more, repeated every 5 to 15 minutes if hypoperfusion persists. Nebulized epinephrine is an add-on for stridor, not a substitute. An IV already in place is used for fluid, 20 mL/kg rapidly, rather than for slower adjunct drugs.
Sources: NASEMSO Model EMS Guidelines v3.0 (2022)
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Medic Basics is a free NREMT Paramedic and EMT prep app from Grip Theory LLC, with FP-C and CCP-C critical care transport prep. It has 1,194 Paramedic, 883 EMT and 994 FP-C and CCP-C practice questions, 30 scenario-based item sets, timed rhythm drills and adaptive mock exams. It runs on iPhone, iPad, Android and in any web browser, with no account and no ads. The clinical reviewer is Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P.
Written and reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P with a clinical review teamEvery rationale lists its sourcesBuilt to the current test plans
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Medic Basics
