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Recognizing Anaphylaxis in School

Kristin Casey, R.N.

Elizabeth Gartman, R.N.

August, 2012

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Common Causes of Common Causes of Allergic EmergenciesAllergic Emergencies

FoodFoodMedicationMedication

LatexLatexBee stingsBee stings

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What Happens in an Allergic What Happens in an Allergic Response?Response?

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What is Anaphylaxis ?What is Anaphylaxis ?

• Anaphylaxis is the widespread and systemic reaction of chemical mediators affecting the skin, respiratory, GI, and cardiovascular systems.

• This is a life-threatening emergency!!

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Signs of Anaphylaxis

• Itching, swelling of tongue, face, lips

• Tightening of throat, shortness of breath, wheezing, difficulty breathing, coughing

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Signs of Anaphylaxis continued

• Nausea,vomiting• Stomach

cramps, diarrhea

• Hives, rash

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Signs of Anaphylaxis continued

• Thready pulse, low blood pressure, feeling faint,

• pale skin color

• Sense of impending doom

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Treatment of AnaphylaxisTreatment of Anaphylaxis

• Anaphylaxis must be treated with an Epipen. This is injected into the thigh and works to constrict blood vessels and dilate or relax smooth muscles in the lungs to improve breathing, stimulates the heartbeat, and works to reduce the hives and swelling around the face and lips.

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Administration of EpinephrineAdministration of Epinephrine

• Right patient• Right medication• Right dose• Right route• Right time

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Epinephrine DosagesEpinephrine Dosages

• Epinephrine is available in 2 strengths:

• Epipen Jr 0.15 mg (use in children up to 60 pounds).

• Epipen 0.30 mg over 60 pounds.

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How Epinephrine WorksHow Epinephrine Works

• Epinephrine quickly relaxes smooth

muscles in the lungs to improve breathing,

constricts blood vessels, stimulates the

heartbeat, and works to reverse hives and

swelling around the face and lips.

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Effects of EpipenEffects of Epipen

• The effects of the injection wear off in ten to twenty minutes. Therefore immediate activation of the 911 system is essential.

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How is Epinephrine Stored?How is Epinephrine Stored?

• Epinephrine is available in what is called an autoinjector. It is stored at room temperature and should not be subjected to any extremes in temperature. The solution is clear and colorless and should be replaced if it is not.

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How to Administer an EpipenHow to Administer an Epipen

Remove autoinjector from box or cylindrical containerafter making sure the name on the label is for the correct student.

Pull off blue activation cap.

Hold orange tip near outer thigh.

Swing and jab firmly into outer thigh until autoinjector mechanism functions.

Hold in place and count to 10. Remove the Epipen and massage the injection area for 10 seconds.

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Common Side Effects of Epinephrine

• Increase in heart rate• nausea • shakiness• headache • nervousness or anxiety• paleness

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Important Information Important Information

• After injecting the Epipen and removing from the student, the needle is retracted back into the autoinjector lessening the risk of accidental needle stick.

• If an accidental needle stick occurs, medical care should be sought.

• Send Epipen container to the hospital with the student.

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RememberRemember

• If in doubt about the need to administer Epinephrine then go ahead and give it.

”If it’s more than skin, put it in.”

• Most deaths from allergic reactions occur because epinephrine was not administered!!!

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Protocol for Handling Life Protocol for Handling Life Threatening EmergencyThreatening Emergency

• Observe student• Recognize symptoms of anaphylaxis• Administer Epipen• Call 911 and tell dispatcher that patient

has been given Epipen • Call parents• Notify physician

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Field TripsField Trips• All trips out of the school building, even

those to schools within our district, must be reported to school nurse 2 weeks prior to the trip. If there is a student with an Epipen, the nurse will then send home a “permission to delegate form” to the student’s parent to sign. The nurse must be able to delegate to one person whose name will be on that form. The nurse can delegate to staff members only!!!

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Additional Epipen InformationAdditional Epipen Information

• For more information on Epipens and life threatening emergencies visit the following website:

• www.epipen.com