Life-Threatening Allergies & Epipen Training

1. Life-Threatening Allergies & Epipen Training Doreen Crowe, RN, BSN, MEd Nurse Leader Wilmington Public Schools

2. PURPOSE • To provide unlicensed* school personnel with basic knowledge and skills to administer epinephrine by auto-injection in a life-threatening situation. *Refers to Medical license

3. OBJECTIVES • Identify common causes of allergic emergencies • Accurately recognize general and student-specific warning signs of allergic emergency • Accurately identify student for whom the epinephrine is prescribed

4. OBJECTIVES (cont.) • Accurately read and interpret the emergency medication administration plan • Correctly follow directions on the medication administration plan • Accurately read the epinephrine label and follow directions from the label

5. OBJECTIVES (cont.) • Administer epinephrine by auto-injector • Safely handle epinephrine in an auto-injector • Accurately describe the school’s plan for responding to emergencies • Access resources appropriately, including emergency medical services, school nurse, parents and physician

6. WHAT ARE COMMON CAUSES OF ALLERGIC EMERGENCIES? • Food • Insect Stings • Medication • Latex • Exercise (uncommon)

7. Peanut Tree Nut (walnuts, cashew, pecan, hazelnut, almond) Milk Egg Fish Shellfish Soy Wheat Eight Foods account for 90% of all food-allergic reactions FOOD

8. INSECT STINGS • Bees • Wasps • Yellow Jackets • Hornets • Fire Ants

9. MEDICATION Anesthesia Antibiotics

10. LATEX Balloons Gloves Band-Aids

11. EXERCISE • Occurs rarely

12. 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

13. WHAT ARE SYMPTOMS OF ANAPHYLAXIS? • Skin • Hives • Itchy rash • Swelling of • face or • extremities • Lungs** • Short of • breath • Wheezing • Repetitive • cough • Throat** • Itchy throat • Tight throat • Hoarseness • Drooling • Stomach • Abdominal cramps • Nausea • Vomiting • Diarrhea • Mouth • Itchy, tingling or swelling of mouth, tongue or lips • Heart** • Faint • Weak pulse • Low blood • pressure • Pale or blue • Other** • Anxiety • Panic • Itchy, • watery • red eyes * *Potentially Life-threatening

14. 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”

15. WHAT IS A BIPHASIC REACTION? • A second wave of symptoms that may occur two to four hours later

16. WHAT IS EPINEPHRINE? • Epinephrine is the medicine of choice for treatment of anaphylaxis • Epinephrine is also known as Adrenalin • It quickly constricts blood vessels, raising blood pressure • It relaxes smooth muscles in lungs to improve breathing

17. WHAT IS AN EPIPEN? • An auto-injector that administers Epinephrine • There are two strengths: • Adult 0.3mg • Child 0.15mg Older Packaging Newer Packaging

18. How do you administer an Epipen? Using the 5 Rights: • Right Student • Right Medication • Right Dose • Right Route • Right Time Step 1 Remove Cap Step 2 Swing & jab into outer thigh

19. RIGHT STUDENT • Identify the student with a known allergy • Accurately read and interpret student specific emergency medication administration plan • Accurately read the prescription label on epinephrine package

20. RIGHT MEDICATION • Epipen OR • Epipen Jr.

21. RIGHT DOSE • Adult 0.3 mg • Child 0.15mg • Lasts approximately 15 minutes

22. RIGHT ROUTE • Large Outer Thigh • May be administered through clothing • Hold in place for 5-10 seconds • Remove carefully • Massage area where administered

23. RIGHT TIME • Student is in Anaphylaxis

24. 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 • Note time administered & give to Emergency Medical Services upon arrival

25. SCHOOL PROTOCOL • Call 9-911 from a school phone • Specify the problem: “A student is in Anaphylaxis & was given an Epipen” • Specify entrance • Note time of Epipen administration & hand over to EMS upon arrival • Call parent to meet student at closest medical facility

26. LIABILITY • Epipen Trained personnel are protected by the Good Samaritan law • Refresher training is renewable annually

27. APPROPRIATE RESOURCES • School Nurse • School Physician • Parent • Emergency Medical Services (EMS)

28. “There is no cure for food allergies. Strict avoidance of the offending allergen is the key to preventing a life-threatening reaction.”

29. REFERENCES • http://www.foodallergy.org • Managing Life Threatening Food Allergies in Schools, 2002, Massachusetts Department of Education, available at http://www.doe.mass.edu/cnp/news02/allergy.pdf • American Academy of Allergy, Asthma and Immunology, Anaphylaxis in Schools and Other Child-Care Settings, available at http://www.aaaai.org/media/resources/academy_statements/position_statements/ps34.asp • Massachusetts Department of Public Health: School Health Unit • http://www.epipen.com

30. COURSE COMPLETION • Please take the Post-Test Post-test requires Adobe reader - download it here. • Then see a School Nurse to demonstrate proper Epipen administration with a training pen Thank You!