EpiPen Review For Teachers/Staff CONCORD PUBLIC SCHOOLS CONCORD-CARLISLE REGIONAL SCHOOL DISTRICT

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1 EpiPen Review For Teachers/Staff CONCORD PUBLIC SCHOOLS CONCORD-CARLISLE REGIONAL SCHOOL DISTRICT

2 Objectives: Recognize early signs of an allergic reaction State immediate and safe response Administer EpiPen accurately Activate the Emergency Response System

3 Legal Implications First aid given in good faith in an emergency situation protects the provider from civil liability. See Mass General Laws c.71,s.55a First aid is the immediate and temporary care provided to a victim of an injury or illness until the service of a physician can be obtained. Examples of life saving techniques are listed below: Cardiopulmonary respiration (CPR) Heimlich maneuver Giving epinephrine By law, the EpiPen is the only as needed medication that can be given by trained school personnel. Scheduled meds may be delegated at the discretion of the school nurse.

4 Pre-Test List three causes of an allergic reaction Give three signs of an allergic reaction Demonstrate how to administer an EpiPen

5 Responsibilities of Staff: Be aware of children at risk Identify allergic signs and symptoms Familiarize yourself with the student s Individual Emergency Plan Administer EpiPen only to those who have a prescription Initiate Emergency Response System: Call for help Call the school nurse Call 911

6 Definition, Causes & Considerations Anaphylaxis

7 What is Anaphylaxis? Anaphylaxis or general body reaction Definition: the overwhelming response of the body to exposure to an allergen which is life-threatening. It is not a minor allergic response or food intolerance.

8 Anaphylaxis: Common Causes Insect stings: bees, wasps, hornets, yellow jackets, fire ants (South) Food: peanuts, tree nuts, shellfish, fish, milk, eggs, wheat Medications: antibiotics, aspirin, seizure meds, muscle relaxants Exercise: not clearly understood, may be a combination of factors Latex: inhaled particles, contact

9 Anaphylaxis: Food Considerations Cross contamination: occurs when item is in close contact or proximity to offending foods i.e. located in storage container in bakery Cross reaction: item is made up of similar structure i.e. mango and cashews Hidden ingredients: read labels as some items may be listed under alternate names i.e. milk - whey, casein

10 Signs & Symptoms Anaphylaxis

11 Skin Hives Swelling Itchy red rash Eczema flare

12 Gastrointestinal Cramps Nausea Vomiting Diarrhea Gas

13 Respiratory Eyes itchy, watery Runny nose Stuffy nose Sneezing Cough Itching or swelling of lips Change in voice Difficulty swallowing Tightness in chest Wheezing Shortness of breath Repetitive throat clearing

14 Cardiovascular Decreased blood pressure Increased heart rate Shock

15 Neurological Impending doom Weakness

16 Treatment Anaphylaxis

17 Treatment: Early recognition of signs and symptoms and early treatment are important. EpiPen (epinephrine) is the drug of choice: If student has had a suspected exposure If the student is having any of the above signs or symptoms If the signs and symptoms are progressive Anyone who receives epinephrine must be seen in the Emergency Room and evaluated by an MD.

18 Medication Administration: The Rule of Thumb for administering any medication is to observe the Five Rights : Right person Right medicine Right dose Right route Right time Checking the EpiPen: note child s name on package, expiration date and color through the clear window on EpiPen: It should be clear and colorless. If discolored or brown or the presence of a precipitate, it should be replaced.

19 Overview: Administration of EpiPen How? Use child s own EpiPen with correct dosage. Take out of sleeve, remove the blue top, hold in fist-like manner. Swing and firmly push orange tip against outer thigh AND hold for a count of ten seconds. Pen clicks when activated. Remember to take note of time. Warning: be sure to avoid touching the orange tip where the needle will eject upon pressure. Where? Outer (lateral) aspect of upper thigh. Expose skin if possible to avoid pressure from any object that could pre-trigger the EpiPen. It may be given through clothing. Why? To reverse the effects of a severe allergic reaction. When? With known exposure or beginning symptoms of a severe reaction according to the Individual Emergency Plan.

20 How? Use child s own EpiPen with correct dosage. Take out of sleeve, remove the blue top, hold in fistlike manner.

21 Warning: be sure to avoid touching the orange tip where the needle will eject upon pressure.

22 Where? Outer (lateral) aspect of upper thigh. Expose skin if possible to avoid pressure from any object that could pre-trigger the EpiPen. It may be given through clothing. Use swinging motion to push firmly against outer thigh, so it clicks AND hold for 10 seconds.

23 How The EpiPen Works: The design is an auto injector system which is spring loaded and activated by pressure. Use only once and discard by returning to plastic sleeve or give to EMT. The needle will be covered by the orange sleeve after auto injection. Epinephrine counters the effects of an allergic reaction in the cardiovascular and respiratory systems: constricts blood vessels relaxes muscles in lungs reverses swelling and hives stimulates the heartbeat Onset: begins working in seconds Duration: short, between minutes

24 EpiPen Dosage: EpiPen 0.30 (over 50 lbs) EpiPen Jr 0.15 (under 50 lbs)

25 EpiPen Storage: Store in dark places. Avoid extremes in temperature and light. Do not keep in car or refrigerator.

26 EpiPen Side Effects: *palpitations *increased heart rate *sweating *dizziness *nervousness & anxiety nausea & vomiting respiratory difficulty pallor weakness tremor headache apprehension cardiac arrhythmias

27 EpiPen Warning: Self-Injection If you inject yourself inadvertently, particularly in the extremities, seek medical care in the Emergency Room as Epinephrine will cause blood vessels to constrict resulting in tissue damage. Epinephrine is usually safe to give and in life saving situations, it is essential.

28 EpiPen: Calling 911 Always stay with the child. Call or if possible direct someone to call 911. Direct someone to meet EMTs at nearest entrance. Give information: I have a student with anaphylaxis and have given Epinephrine. Stay on the line until further directed by dispatcher.

29 EpiPen: Development of Reaction Reactions are unpredictable in the way they develop. Some may be mild initially and respond to the medication. Others may develop quickly to a generalized, serious anaphylactic reaction within minutes. It is important to be aware of a Bi-phasic reaction. This can occur after the initial reaction, within minutes or up to hours. It is often unexpected and could be life threatening. Anyone who receives an EpiPen (epinephrine) must be seen in the Emergency Room and evaluated by an MD.

30 EpiPen Procedure: Review Steps Recognize signs and symptoms Stay calm Call for help (nurse, 911) Give EpiPen (take note of time administered) Stay with child

31 Post Test List three causes of an allergic reaction Give three signs of an allergic reaction Demonstrate how to administer an EpiPen

32 Post Review: Demonstration (Required) This training is not complete until you demonstrate EpiPen administration competency to your building School Nurse. Please go to your building Nurse to demonstrate correct EpiPen administration. Your building nurse is always available to answer any questions or concerns.

33 References Anderson et al (1995) Asthma and Allergy Foundation The Comprehensive School Health Manual Food Allergy Network Massachusetts General Laws Credits The Bradford Family: William, Robbie, and Sally Sue Howard, MEd, MA Nicki Richards, RN, BSN, MS Kate Bell, RN, MEd

34 End of Presentation.

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