Anaphylaxis and EpiPen

EpiPen ReviewFor Teachers/Staff

CONCORD PUBLIC SCHOOLS

CONCORD-CARLISLE REGIONAL SCHOOL DISTRICT

Objectives: Recognize early signs of an allergic reaction

State immediate and safe response

Administer EpiPen accurately

Activate the Emergency Response System

Legal Implications First aid given in good faith in an emergency situation

protects the provider from civil liability. See Mass General Laws c.71,s.55A

First aid is the immediate and temporary care provided to a victim of an injury or illness until the service of a physician can be obtained. Examples of life saving techniques are listed below: Cardiopulmonary respiration (CPR) Heimlich maneuver Giving epinephrine

By law, the EpiPen is the only “as needed” medication that can be given by trained school personnel. Scheduled meds may be delegated at the discretion of the

school nurse.

Pre-Test

List three causes of an allergic reaction

Give three signs of an allergic reaction

Demonstrate how to administer an EpiPen

Responsibilities of Staff:

Be aware of children at risk

Identify allergic signs and symptoms

Familiarize yourself with the student’s Individual Emergency Plan

Administer EpiPen only to those who have a prescription

Initiate Emergency Response System: Call for help Call the school nurse Call 911

Definition, Causes & Considerations

Anaphylaxis

What is Anaphylaxis? Anaphylaxis or “general body reaction”

Definition: the overwhelming response of the body to exposure to an allergen which is life-threatening.

It is not a minor allergic response or food intolerance.

Anaphylaxis: Common Causes Insect stings:

bees, wasps, hornets, yellow jackets, fire ants (South)

Food: peanuts, tree nuts, shellfish, fish, milk, eggs,

wheat Medications:

antibiotics, aspirin, seizure meds, muscle relaxants

Exercise: not clearly understood, may be a combination of

factors Latex:

inhaled particles, contact

Anaphylaxis: Food Considerations Cross contamination:

occurs when item is in close contact or proximity to offending foods

i.e. located in storage container in bakery Cross reaction:

item is made up of similar structure i.e. mango and cashews

Hidden ingredients: read labels as some items may be listed under

alternate names i.e. milk - whey, casein

Signs & Symptoms

Anaphylaxis

Skin Hives Swelling Itchy red rash Eczema flare

Gastrointestinal Cramps Nausea Vomiting Diarrhea Gas

Respiratory Eyes itchy, watery Runny nose Stuffy nose Sneezing Cough Itching or swelling of lips Change in voice Difficulty swallowing Tightness in chest Wheezing Shortness of breath Repetitive throat clearing

Cardiovascular Decreased blood pressure Increased heart rate Shock

Neurological Impending doom Weakness

Treatment

Anaphylaxis

Treatment: Early recognition of signs and symptoms and

early treatment are important.

EpiPen (epinephrine) is the drug of choice: If student has had a suspected exposure If the student is having any of the above signs or

symptoms If the signs and symptoms are progressive

Anyone who receives epinephrine must be seen in the Emergency Room and evaluated by an MD.

Medication Administration: The Rule of Thumb for administering any

medication is to observe the “Five Rights”: Right person Right medicine Right dose Right route Right time

Checking the EpiPen: note child’s name on package, expiration date and color through the clear window on EpiPen: It should be clear and colorless. If discolored or brown or the presence of a precipitate,

it should be replaced.

Overview: Administration of EpiPen How?

Use child’s own EpiPen with correct dosage. Take out of sleeve, remove the blue top, hold in fist-like manner. Swing and firmly push orange tip against outer thigh AND hold for a count

of ten seconds. Pen “clicks” when activated. Remember to take note of time. Warning: be sure to avoid touching the orange tip where the needle will

eject upon pressure. Where?

Outer (lateral) aspect of upper thigh. Expose skin if possible to avoid pressure from any object that could pre-trigger the EpiPen.

It may be given through clothing. Why?

To reverse the effects of a severe allergic reaction. When?

With known exposure or beginning symptoms of a severe reaction according to the Individual Emergency Plan.

How? Use child’s own

EpiPen with correct dosage.

Take out of sleeve, remove the blue top, hold in fist-like manner.

Warning: be sure to avoid touching the orange tip where the needle will eject upon pressure.

Where? Outer (lateral) aspect of

upper thigh. Expose skin if possible to avoid pressure from any object that could pre-trigger the EpiPen.

It may be given through clothing.

Use swinging motion to push firmly against outer thigh, so it “clicks” AND hold for 10 seconds.

How The EpiPen Works: The design is an auto injector system which is spring

loaded and activated by pressure. Use only once and discard by returning to plastic sleeve or give to EMT. The needle will be covered by the orange sleeve after auto injection.

Epinephrine counters the effects of an allergic reaction in the cardiovascular and respiratory systems: constricts blood vessels relaxes muscles in lungs reverses swelling and hives stimulates the heartbeat

Onset: begins working in seconds Duration: short, between 10-20 minutes

EpiPen Dosage:

EpiPen 0.30 (over 50

lbs)

EpiPen Jr 0.15

(under 50 lbs)

EpiPen Storage: Store in dark places.

Avoid extremes in temperature and light.

Do not keep in car or refrigerator.

EpiPen Side Effects: *palpitations

*increased heart rate

*sweating

*dizziness

*nervousness & anxiety

nausea & vomiting respiratory difficulty pallor weakness tremor headache apprehension cardiac arrhythmias

EpiPen Warning: Self-Injection If you inject yourself inadvertently,

particularly in the extremities, seek medical care in the Emergency Room as Epinephrine will cause blood vessels to constrict resulting in tissue damage.

Epinephrine is usually safe to give and in life saving situations, it is essential.

EpiPen: Calling 911 Always stay with the child.

Call or if possible direct someone to call 911.

Direct someone to meet EMTs at nearest entrance.

Give information: “I have a student with anaphylaxis and have given Epinephrine.”

Stay on the line until further directed by dispatcher.

EpiPen: Development of Reaction Reactions are unpredictable in the way they develop. Some may be mild initially and respond to the

medication. Others may develop quickly to a generalized, serious

anaphylactic reaction within minutes.

It is important to be aware of a Bi-phasic reaction. This can occur after the initial reaction, within minutes

or up to hours. It is often unexpected and could be life threatening.

Anyone who receives an EpiPen (epinephrine) must be seen in the Emergency Room and evaluated by an MD.

EpiPen Procedure: Review Steps

Recognize signs and symptoms

Stay calm

Call for “help” (nurse, 911)

Give EpiPen (take note of time administered)

Stay with child

Post Test List three causes of an allergic reaction

Give three signs of an allergic reaction

Demonstrate how to administer an EpiPen

Post Review: Demonstration (Required)

This training is not complete until you demonstrate EpiPen administration competency to your building School Nurse.

Please go to your building Nurse to demonstrate correct EpiPen administration.

Your building nurse is always available to answer any questions or concerns.

References Credits Anderson et al (1995)

Asthma and Allergy Foundation

The Comprehensive School Health Manual

Food Allergy Network

Massachusetts General Laws

The Bradford Family: William, Robbie, and Sally

Sue Howard, MEd, MA

Nicki Richards, RN, BSN, MS

Kate Bell, RN, MEd

End of Presentation.