PURPOSE. Life-Threatening Allergies & Epinephrine Training. Life-Threatening Allergies & Epinephrine Training
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1 Life-Threatening Allergies & Epinephrine Training Doreen Crowe, MEd, BSN, RN Nurse Leader Wilmington Public Schools Life-Threatening Allergies & Epinephrine Training The speaker has no conflict of interest to declare. This program did not receive commercial support. PURPOSE To provide unlicensed* school personnel with basic knowledge and skills to administer epinephrine by autoinjection in a life-threatening situation. *Refers to Medical license 1
2 OBJECTIVES 1. Identify common causes of allergic emergencies 2. Accurately recognize general and studentspecific warning signs of allergic emergency 3. Accurately identify student for whom the epinephrine is prescribed 4. Accurately read and interpret the emergency medication administration plan 5. Correctly follow directions on the medication administration plan OBJECTIVES (cont.) 6. Accurately read the epinephrine label and follow directions from the label 7. Administer epinephrine by auto-injector 8. Safely handle epinephrine in an auto-injector 9. Accurately describe the school s plan for responding to emergencies 10. Access resources appropriately, including emergency medical services, school nurse, parents and physician THE COMMON CAUSES OF ALLERGIC EMERGENCIES! Food! Insect Stings! Medication! Latex! Exercise (uncommon) 2
3 FOOD Eight Foods account for 90% of all foodallergic reactions INSECT STINGS Bees Wasps Yellow Jackets Hornets Fire Ants MEDICATION Anesthesia Antibiotics 3
4 LATEX Balloons Gloves Band-Aids EXERCISE! Occurs rarely! Typically occurs within a few hours after eating a specific food WHAT IS ANAPHYLAXIS? A potentially life-threatening medical condition occurring in allergic individuals after exposure to an allergen! May occur immediately (seconds) or delayed (hours)! Individuals with Asthma are at an increased risk of a severe reaction 4
5 WHAT ARE SYMPTOMS OF ANAPHYLAXIS? Skin Hives Itchy rash Swelling of face or extremities Stomach Abdominal cramps Nausea Vomiting Diarrhea Mouth Itchy, tingling or swelling of mouth, tongue or lips Lungs** Short of breath Wheezing Repetitive cough Throat** Itchy throat Tight throat Hoarseness Drooling Heart** Faint Weak pulse Low blood pressure Pale or blue **Potentially Life-threatening Other** Anxiety Panic Itchy, watery red eyes HOW MIGHT A CHILD DESCRIBE A REACTION?! My tongue is itching, burning or tingling! My mouth feels funny! There s something stuck in my throat! My lips feel tight! There s a frog in my throat WHAT IS A BIPHASIC REACTION? A second wave of symptoms that may occur two to four hours later 5
6 WHAT IS EPINEPHRINE? Epinephrine is the medicine of choice for treatment of anaphylaxis! Epinephrine is also known as Adrenalin! Works to:! constrict blood vessels, raise blood pressure, relax smooth muscles in lungs to improve breathing *Note: Antihistamines and inhalers/bronchodilators are not to be depended upon to treat a severe reaction such as anaphylaxis, Use Epinephrine. HOW IS EPINEPHRINE DELIVERED?! There are 2 Types of Auto-Injectors:! Auvi-Q! Epipen! There are two strengths:! Adult 0.3mg! Child 0.15mg How do you administer Epinephrine? Using the 6 Rights: 6
7 RIGHT STUDENT 1. Identify the student with a KNOWN allergy 2. Accurately read and interpret student specific Allergy Action Plan 3. Accurately read the prescription label on epinephrine package RIGHT MEDICATION Epipen/Epipen Jr. >> OR <<Auvi-Q RIGHT DOSE! Adult 0.3 mg! Child 0.15mg! Lasts approximately 15 minutes 7
8 RIGHT ROUTE! Large Outer Thigh! May be administered through clothing! Hold in place for 5-10 seconds! Remove carefully! Massage area where administered Note: lie the person down with legs elevated to increase cardiac output RIGHT TIME Student is in Anaphylaxis RIGHT DOCUMENTATION! School district specific! MDPH Report of Epinephrine Administration: 8
9 How do you administer Epinephrine? EPIPEN AUVI-Q Step 1 Remove Cap Pull Red Safety Cover Step 2 Swing & jab into outer thigh Place against outer thigh, then press firmly SCHOOL PROTOCOL 1. Call 911 from a school phone 2. Specify the problem: A student is in Anaphylaxis & was given Epinephrine 3. Specify location at school 4. Note time of Epinephrine administration & hand over to EMS upon arrival 5. Call parent to meet student at closest medical facility EPIPEN STORAGE & HANDLING! Properly store at room temperature*! Color in window will be clear! Avoid accidental injection to yourself or you will require immediate attention at an Emergency Room *Avoid storing in cooler or vehicle 9
10 Label Reading FDA manufactured foods may contain the 8 major food allergens: 1. Peanuts 2. Tree Nuts 3. Eggs 4. Milk 5. Wheat 6. Soy 7. Shellfish 8. Fish Label Reading! Read all labels carefully! Look for product disclaimers, i.e. manufactured in a facility that produces peanuts/tree nuts! Avoid cross-contact or cross-contamination! Strict avoidance of an allergen is the key to preventing a life-threatening reaction Label Reading: Peanut-Free Diet Avoid Peanuts or any of the following ingredients:! Artificial nuts! Mixed nuts! Peanut butter, oil, flour or protein hydrosylate! Baked goods! Candy (including chocolates) Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients 10
11 Label Reading: Tree Nut-Free Diet Avoid Tree Nuts or any of the following ingredients:! Almonds! Artificial nuts! Brazil nuts! Cashew! Chestnut! Coconut! Hazelnut! Macadamia! Marzipan/Almond paste! Mixed nuts! Pecan! Pesto! Pine nut! Pistachio! Praline! Walnut! Baked goods! Candy (including chocolates) Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients Label Reading: Milk-free Diet Avoid Milk or any of the following ingredients:! Butter, Buttermilk! Casein! Cheese! Lactose, Lactulose! Candy (including chocolates)! Sour Cream! Whey! Yogurt! Baked Goods! Chocolate Candy Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients Label Reading: Egg-free Diet Avoid Eggs or any of the following ingredients:! Albumin! Eggnog! Globulin! Lysozyme! Mayonnaise! Baked Goods! Ice cream! Pasta Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients 11
12 Label Reading: Shellfish-free Diet Avoid Shellfish or any of the following Ingredients:! Barnacle! Crab! Crawfish! Krill! Lobster! Mollusks! Prawns! Shrimp Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients Label Reading: Wheat-free Diet Avoid Wheat or any of the following ingredients:! Bread crumbs! Cereal extract! Couscous! Cracker meal! Farina! Flour! Matzoh! Pasta! Wheat bran, oil, grass or protein! Baked Goods Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients LIABILITY! Epipen Trained personnel are protected by the Good Samaritan law! Refresher training is renewable annually 12
13 APPROPRIATE RESOURCES! School Nurse! School Physician! Parent! Emergency Medical Services (EMS) There is no cure for food allergies. Strict avoidance of the offending allergen is the key to preventing a lifethreatening reaction. COURSE COMPLETION 1. Please take the Post Test for this module. 2. See a School Nurse to demonstrate proper Epinephrine administration with a training device Thank You! PPT Compiled by Heather Crowe, SSU Class of
14 CONTACT INFORMATION Doreen Crowe, MEd, BSN, RN Nurse Leader Wilmington Public Schools REFERENCES! AllergyHome - Your Home for All Your Allergy Needs - AllergyHome.org. (n.d.). AllergyHomeorg. Retrieved July 14, 2014, from Anaphylaxis in Schools and Other Child Care Settings. (n.d.). American Academy of Allergy, Asthma and Immunology. Retrieved July 14, 2014, from academy_statements/position_statements/ps34.asp! Food Allergy Research & Education. (n.d.). Food Allergy Research & Education. Retrieved July 4, 2014, from Managing Life-threatening Food Allergies in School. (n.d.). MA Department of Elementary & Secondary Education. Retrieved July 14, 2014, from REFERENCES! School Health Services. (n.d.). Health and Human Services. Retrieved July 14, 2014, from NASN - National Association of School Nurses - NASN.org. (n.d.). NASN - National Association of School Nurses - NASN.org. Retrieved July 14, 2014, from The official site for Auvi-Q (epinephrine injection, USP). (n.d.). Auvi- Q. Retrieved July 4, 2014, from The official website for EpiPen (epinephrine) and EpiPen Jr (epinephrine) Auto-Injectors. (n.d.).epipen. Retrieved July 4, 2014, from 14
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