Anaphylaxis and Auto-injector Training by dfhdhdhdhjr

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									  EMERGENCY
Treatment of Severe
 Allergic Reactions
   Definition and Treatment
                Allergies
• Allergies are the most frequently reported
  chronic condition in children
• Incidence of food, latex, and drug allergies
  appears to be increasing
• Please note: A person can develop a severe
  allergic reaction at any time in their life
   Common Causes for
Life-threatening Allergies

                    Foods

 Insects



   Latex
              Peanuts and Tree Nuts
 Foods That Cause the Majority of
    Severe Allergic Reactions
• Peanuts
• Tree nuts (i.e. walnuts, hazelnuts, pecans,
  almonds, etc)
• Milk and milk products
• Eggs
• Wheat
• Soy
• Shell fish
     Prevention Is the Key

• Know who is at risk
• Limit or avoid exposure to allergens
• Take all complaints from children with
  severe allergies very seriously
• Know what to do if an emergency occurs
  Every student with a
life-threatening allergy
     should have an
  emergency care plan
    developed by the
      school nurse

RCW 28A.210.320, WAC 180-38-045
     An Emergency Care Plan
          Will Include:
•   What the student is allergic to
•   Symptoms
•   Action(s) needed by YOU in an emergency
•   Location of emergency medication(s)
•   Emergency contacts
    What Is Anaphylaxis?
• An excessive reaction by the body to
  combat a substance, considered “foreign”,
  that has been ingested, injected, inhaled or
  absorbed through the skin
• The immune system responds and causes
  cells to release potentially harmful
  chemicals that result in life threatening
  symptoms
  Symptoms of Anaphylaxis

• Symptoms can vary greatly from
  person to person
• A SERIOUS LIFE THREATENING
  REACTION may develop rapidly
  or be slow and gradual
Affected Organs May Include:

•   Skin
•   Mouth
•   Gut
•   Lungs
•   Heart
              Skin
• Widespread hives and flushing

• Widespread swelling
               Mouth


• Swelling or
  itching of the
  tongue, that
  may affect
  speech
                  Gut

• Nausea and/or
  vomiting
• Stomach ache
• Cramps
• Diarrhea
               Lungs

• Repetitive
  coughing
• Wheezing
• Trouble
  breathing
                 Heart

•   Rapid heart rate
•   Lightheadedness
•   Dizziness
•   Loss of
    consciousness
  IF THERE IS
  SUSPECTED
EXPOSURE TO AN
  ALLERGEN
 ALWAYS CALL
    9-1-1
       Why Do People Die From
           Anaphylaxis?

• Student may deny seriousness of their
  condition
• Student may try to avoid the emergency
  injection
• Reluctance on the part of the caregiver/staff
  to administer the emergency injection
  Treatment Response

 The difference in outcome
 appeared to be how quickly
medication was administered
and professional help became
          available
            Treatment

• Epinephrine, by injection, is the
  most effective emergency
  treatment for anaphylaxis
• Additional medications may be
  ordered such as an oral
  antihistamine and/or an inhaler
             Epinephrine
• Epinephrine is a medication ordered by a
  Physician for a specific student
• An Epinephrine Auto-injector is supplied to
  the school by the parent
• Epinephrine is to be administered only to
  the student it was prescribed for
   Epinephrine Auto-injectors

• A disposable epinephrine delivery system,
  with a concealed needle, designed for easy
  administration
• Must be injected promptly
• Effects last 10-20 minutes
• THEREFORE, 9-1-1 must be called
   Two Types of Auto-injectors
         Are Available
The EpiPen®/
EpiPen Jr.® are the
most common and
have been around for
several years and are
designed to give a
single dose of
epinephrine in one
auto-injector
  Two Types of Auto-injectors
    Are Available (cont.)


The Twinject® is newer
and is designed to have
2 doses of epinephrine
in a single auto-
injector.
 Steps To Follow with a Suspected
        Allergic Reaction

• Locate the student‟s prescribed emergency
  medication
• Follow the student‟s emergency care plan
• Make sure 9-1-1 has been called
  Administering the Auto-injector


• Stabilize the leg during the injection as
  there is a natural tendency to pull away
  from the needle
  Administering the Auto-injector
              (cont.)

• Additional assistance may be needed to
  hold the student while the injection is
  being given
• Stay with the student and provide
  reassurance and support while waiting
  for emergency services to arrive
How To Use An             EpiPen ®


1. Pull off the blue
   safety release
2. Place the orange
   tip at a right angle
   to the leg. It is
   designed to give
   through clothing
   (avoid the side
   seam)
How To Use An EpiPen® (cont.)
3. Jab orange tip firmly into outer thigh
   so it „clicks‟
4. Hold against the thigh for TEN full
   seconds
5. Massage injection site


    Confirm that 9-1-1 has been
               called
            After Injection
1. Put EpiPen® back into its plastic sleeve.
   Have available for EMS to dispose of
   properly
2. Note the time you injected the EpiPen®
   and document on the medication log
3. Be prepared to initiate CPR if breathing
   stops
       Important Follow-up
After a severe reaction occurs evaluate the
following:
 1. Was the plan followed?
 2. What signs/symptoms were seen?
 3. Was epinephrine injected early enough?
 4. What could have been done differently?
 5. Any questions? Contact your school nurse.
 IMPORTANT
Additional School
 Considerations
                 Field Trips
1. Take the following on your field trip:
    Emergency Care Plan including medication
      orders
    Emergency medications
    Cell phone with coverage or access to other
      communication methods
2. Avoid storing automatic injector devices in areas
   of extreme temperatures such as ice chests or in a
   hot car or bus
3. Follow district policy for field trips
               Staff Liability
• In Washington State, a school district employee
  would not be held individually liable provided
  they acted in good faith and within the scope of
  their employment with the district according to
  RCW 28A.320.200
• Staff must have participated in proper training of
  administering injectable emergency medication.
• Nursing delegation of the injection of emergency
  medication is addressed by WAC
  246.840.010(10)(b)
   Additional Considerations
1. For additional information, contact
   your school nurse
2. A practice drill could be organized to
   address a serious allergy emergency
3. Epi-pen training devices are available
   through your health room or school
   nurse
              References
http://www.epipen.com/howtouse.aspx
http://www.foodallergy.org
OSPI bulletin No. 34-01 LATS, June 8, 2001
www.twinject.com

								
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