護理師正在為病人靜脈注射萬古黴素（Vancomycin）。病人突然出現臉部、頸部及上半身嚴重發紅（flushing）。護理師應首先採取哪項行動？
A nurse is administering intravenous vancomycin to a client. The client suddenly develops intense flushing of the face, neck, and upper torso. Which action should the nurse take first?
- AAdminister epinephrine subcutaneously皮下注射腎上腺素
- BStop the infusion immediately立即停止輸注正確答案
- CNotify the rapid response team通知快速反應小組
- DSlow the rate of the infusion減慢輸注速率
- B立即停止輸注
病人出現的是vancomycin輸注反應（紅人症候群），機轉為藥物直接誘發肥大細胞釋放組織胺，屬非IgE媒介的類過敏反應，與過敏性休克不同：通常不伴隨喉頭水腫或喘鳴音。但鑑別機轉並不改變處置原則——依FDA仿單，一旦發生輸注反應即應立即停止輸注（B），這是護理師無須醫囑即可執行的第一步，症狀多半在停止後迅速緩解。緩解後可依醫囑以延長至60分鐘以上、速率≤10 mg/min重新開始給藥；延長輸注時間是再次給藥時的預防手段，而非反應當下的處置，故D減慢滴速並非首要。A皮下注射腎上腺素與C啟動快速反應小組都是針對過敏性休克的處置，本例並無過敏性休克徵象，貿然執行屬不必要的急救程序。護理師必須同時掌握兩件事：能區分輸注反應與真正的過敏反應，也知道兩者都必須先停止輸注。
- A皮下注射腎上腺素
腎上腺素是用於治療真正的過敏性休克。紅人症候群是速率相關反應，除非伴隨支氣管痙攣或循環衰竭，否則不需使用 Epinephrine。
- B · 正確答案立即停止輸注
除非病人血壓大幅下降或極度不適，否則不必完全停藥。大多數情況下，減慢滴速即可讓組織胺釋放趨緩，症狀隨之消失。
- C通知快速反應小組
紅人症候群通常是良性的。除非病人出現意識改變、嚴重低血壓或呼吸窘迫，否則不需要動用到快速反應小組（RRT）。
- D減慢輸注速率
減慢輸注速率是首選，因為紅人症候群直接與滴速呈正相關。將輸注時間延長至 2 小時以上通常能有效緩解並完成給藥。
美國護理指引對 Red Man Syndrome 有明確的分級處理，護理師具備高度判斷力來減慢滴速。台灣部分醫院在萬古黴素醫囑上會直接備註『輸注時間不可低於 60 分鐘』，若發生反應，護理師通常會先暫停、通知醫師，這與美國優先減慢速率的策略略有不同。
English explanation
Option B is correct because the client is experiencing a vancomycin infusion reaction, in which vancomycin directly triggers mast cell histamine release. This is a non-IgE-mediated reaction rather than anaphylactic shock and is usually not accompanied by laryngeal edema or wheezing. FDA labeling directs the nurse to stop the infusion immediately when this reaction occurs, and this first action does not require a prescription. Symptoms usually improve rapidly after the infusion stops. After improvement, vancomycin may be restarted as prescribed over at least 60 minutes at 10 mg/min or less. Option D is incorrect because slowing the infusion is a preventive measure when restarting therapy, not the immediate response to an active reaction. Option A is incorrect because subcutaneous epinephrine is an intervention for anaphylactic shock. Option C is incorrect because activating the rapid response team is also an anaphylactic shock intervention, and this client has no such signs. The nurse must distinguish the reactions while recognizing that either requires stopping the infusion first.