Anaphylaxis and Epinephrine

1. Anaphylaxis and Epinephrine The Role of the EMT-Basic

2. Review the signs & symptoms & types of allergic reactions Review of emergency care of a patient experiencing an anaphylactic reaction Develop a basic knowledge of epinephrine & it�s administration Identify situations when epinephrine may be indicated Goals

3. What Is Medical Control? Off-Line / Standing Orders Online Medical Control contact with an emergency department physician at the receiving facility

4. Common Causes of Allergic Reactions

5. Mild Allergic Reactions

6. Severe Allergic Reaction A Clear History of Allergen Exposure AND Signs and Symptoms including: Shock (hypoperfusion) Respiratory distress Wheezing, stridor, cough, hoarseness Chest / throat tightness

7. Itching, skin flushing Urticaria (hives) (look at the torso!) and /or swelling (Especially the face and the extremities) Severe Allergic Reaction

8. Severe Allergic Reaction Increased Pulse Decreased Blood Pressure Nausea & Vomiting Altered Mental Status Sense of impending doom especially with history of anaphylaxis

9. Epinephrine Generic Name Epinephrine Trade Name EpiPen EpiPen Jr. Adrenalin

10. EpinephrineActions Dilates bronchioles Constricts blood vessels Increases heart rate Increases cardiac output

11. EpinephrineIndications Signs and symptoms of severe allergic reaction

12. EpinephrineContraindications None when dealing with anaphylaxis!

13. EpinephrineDosage Adult 1 adult Epi-pen auto-injector (0.3 mg) Child Child: greater than 10 kg and fit on a pediatric length based resuscitation tape (Broselow tape). Epi-pen Jr. auto-injector (0.15 mg)

14. EpinephrineRoute Deep Intramuscular Injection Lateral thigh, midway between waist and knee

15. Epinephrine Side Effects Increased pulse rate Pallor Dizziness Chest Pain Headache Nausea Vomiting Excitability / nervousness Anxiety Syncope

16. Epi auto-injector Administration Remove safety cap from auto-injector Hold auto-injector from center (Do Not place thumb over either end!) Place against patient�s thigh Lateral portion, midway between waist and knee

17. Epi auto-injector Administration Push until auto-injector activates Hold until medication injected (10 seconds). Record Time Record Response to Medication

18. Patient Assessment Routine Patient Care Scene Size-up Initial Assessment (watch the airway!)

19. Focused Physical Assessment Reassess ABCs Breath Sounds Baseline Vital Signs O2 Saturation Assess respiratory system Assess cardiovascular system

20. Call ALS Administer oxygen Assess respiratory status Assess cardiac status Vital signs If patient has signs / symptoms of an allergic reaction (hives, itch, anxiety) but is otherwise hemodynamically stable, contact medical control for further direction. If trained to do so, administer Epi-Pen 0.3 mg or Epi-Pen Jr 0.15 mg IM for patient with signs / symptoms of anaphylaxis. Do not delay transport, except for epinephrine administration. Consider ALS intercept

21. Ongoing assessment Monitor A-B-Cs Reassess vital signs Oxygen! Watch for changes in patient condition

22. Ongoing Assessment If the patient deteriorates... Oxygenate Contact Medical Control for order for second dose Prepare for resuscitation Oxygenate Treat for shock

23. Ongoing Assessment Contacted Medical Control to administer a second auto-injector. Be prepared to perform CPR if patient deteriorates.

24. Communication What? Assessment Finding Treatments Result of Treatment Who? Other EMS providers Receiving Facility personnel

25. Questions?