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Guideline for the administration of Epipen ® In anaphylaxis by dpf99262


									     Guideline for the administration of Epipen ® In

    Anaphylactic Reactions: Treatment Algorithm for
     Adults and Children over 6 in the Community
              Consider diagnosis of anaphylaxis when compatible history of
              severe allergic-type reaction with respiratory difficulty and/or
                    hypotension especially if skin changes present

                                    Call Ambulance,
                                  Suggesting diagnosis 1

                                      Stridor, wheeze,
                                   respiratory distress or
                                  clinical signs of shock 2

                              For hypotension, lie patient flat
                                     with legs raised
                          (unless respiratory distress increased)

                           Adrenaline Auto injector (Epipen ®)
                                  Children >6 years:
                                   300 micrograms IM
                                        Adults 3
                                   300 micrograms IM

                     Repeat in 5 minutes if no clinical improvement.
                        Remember urgency of hospital transfer.

1. Ambulance will be equipped with oxygen, salbutamol and fluids which may
be used as adjunctive therapy.
2. If profound shock judged to be immediately life threatening give CPR/ALS if
3. If adults are treated with an adrenaline auto-injector, the 300 micrograms
will usually be sufficient.
A second dose may be required, but this should be considered ONLY if the
patient's condition continues to deteriorate 5 minutes after the first dose.
NB Remember the urgency of hospital transfer.

Adapted from Resuscitation Council (UK) guidelines January 2002 updated
May 2005Introduction
                      Guideline printed overleaf
Approved by HMHTT: October 2007
Review: October 2009
    Guideline for the administration of Epipen ® in
                                                                                  Known cocaine abusers should avoid exposure to adrenaline.
Epipen ® is a prescription only medicine (POM) used for the treatment of          If epipen cannot be used for any reason it is essential to seek medical
anaphylaxis, it may be administered by any person to another who is               assistance immediately by calling an ambulance.
experiencing anaphylaxis.
Epipen ® should be stored at Room temperature. The expiry date should be          Records
checked periodically and before administration.
                                                                                  After administering Epipen, the following should be recorded in the
The dose recommended for use in adults and children over 6 years old is
                                                                                  patient’s nursing record:
300 micrograms to be given intramuscularly (I/M) this is the fixed dose in the
                                                                                  • Name of drug
standard epipen unit. This should be repeated if necessary at 5 minute
intervals according to the patient’s response. The frequency of subsequent        • Dose given
doses depends on the response of the individual. (Please refer to flow            • Date and time given
diagram on the next page). A second injection may be required if the              • Route given
patient’s condition has not improved and medical assistance has not arrived.      • Signature of nurse administering drug
Medical opinion needs to be sought by the patient for dealing with further        For inpatients the above information should be written in the once
possible anaphylaxis.                                                             only/PGD section of the inpatient medicines administration record (MAR)
Standard Epipens should be only be used in Patients (over the age of 6yrs)
                                                                                  In the event of the patient requiring ambulance transport the ambulance
presenting with symptoms of anaphylaxis i.e.
                                                                                  personnel will be informed of all doses given and their times.
    • Cardiovascular collapse
    • Unrecordable blood pressure
                                                                                  Training Requirements
    • Severe bronchospasm or angioedema
    • Audible wheeze, difficulty breathing or stridor                             Any Health Practitioners wishing to use Epipens will ensure that he/she
    • Severe or worsening swelling of lips, face, tongue or neck                  has familiarised themselves with the product and is competent in all
                                                                                  aspects of administration, including cautions and contra-indications. The
    • Diffuse erythema and/or urticaria
                                                                                  Health Practitioner will have due regard for the NMC Code of Conduct,
    • Peripheral oedema
                                                                                  Scope of Professional Practice and Standards for administration of
                                                                                  medications for nurses.
Cautions and contraindications                                                    A comprehensive training video is provided on the manufacturer’s
Epipens should be used more cautiously in:                                        website which can be accessed at the following address
  • Pregnancy                          • Hyperthyroidism                
  • Ischaemic heart disease            • Diabetes mellitus
  • Arrhythmias                        • Angle-closure glaucoma                   References
  • Cerebrovascular disease            • Elderly patients                         • British National Formulary Current Edition
  • Hypertension                                                                  • Standards for the administration of medicines NMC
    In the case of anaphylaxis, benefits will outweigh the risks                  • Resuscitation Council (UK) guidelines January 2002

                                                                Treatment algorithm printed overleaf
Approved by HMHTT: October 2007
Review: October 2009

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