Administering epinephrine for acute anaphylactic type allergic reactions

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1 Administering epinephrine for acute anaphylactic type allergic reactions Training for first aiders in schools People known to be allergic (1.5 hours) MAJ

2 2 Goal of program Reduce the morbidity and mortality associated with acute anaphylactic type allergic reactions.

3 3 Objectives of the training Understand the legal context of responding to an anaphylactic reaction. Know the roles and responsibilities of first aiders and schools. Understand the causes and mechanisms of anaphylaxis. Know the signs and symptoms of acute anaphylactic type allergic reactions. Know the protocol for administering epinephrine to a person who is known to be allergic. Know the mechanisms of action and side-effects of epinephrine. Know how to determine the right dose based on weight. Know how to use the auto-injector.

4 First responder: Person who has taken and successfully completed a training course recognized by MSSS given by a recognized organization and works for a recognized service. Ambulance technician paramedic: Person who has taken and successfully completed a college program in pre-hospital emergency care. First aider in a school: Teacher/other with no specific healthcare training. Health care professional: As per the Professional Code. 4 A few definitions

5 5 Legal context Section 3 of the Regulation respecting Professional activities that may be engaged in within the framework of pre-hospital emergency services sets out the conditions for the intra-muscular administration of epinephrine (with an auto-injection device) in an emergency, notably in schools: '' In the absence of a first responder or ambulance technician, any person may administer adrenalin with an auto-injection device to a person in the case of an acute anaphylactic allergic reaction. ''

6 6 Legal context in schools There is no longer an obligation to have followed training to be legally allowed to administer epinephrine in a situation of a severe allergic reaction. A standardized training on the subject constitutes good practice. Allows the acquisition of knowledge required to intervene safely and adequately in the presence of such reactions.

7 7 First aider training in school This course is designed for the need of a person whose: - allergy is known - which means that medication is prescribed

8 8 First aiders in schools A plus: CPR training with exposure to AED Adapted training first aiders in schools and others Condition: hand in the pre-test at the beginning of the training Length: 1.5 hours Trainers: school nurses or trainers working for another accredited organization Length of certification: three years Annual review of first aid procedures

9 9 Roles and responsibilities Role of first aiders: Help reduce anaphylaxis-related mortality Responsibilities of first aiders: Comply with the clinical protocol Keep their skills and knowledge up to date Responsibilities of schools: Make sure that auto-injectors are available at all times and replace them before the expiration date. Create the conditions that allow employees to take the required 1.5 hours of training. Notify the regional medical director of pre-hospital emergency services when epinephrine is used under this program.

10 10 Definition: anaphylaxis Allergic reaction in which the immune system reacts in an exaggerated and disproportionate way to contact with an allergenic substance (antigen). Generally multiple body systems affected. Generally very rapid after contact.

11 11 Common allergens Causal agents Foods Venom insects Medications Intensity depends on the amount of allergen.

12 12 Allergens - Foods Peanuts Tree nuts Seafood Eggs Dairy products Fruits Sesame seeds, wheat and soy + often = respiratory distress

13 13 Stinging and biting insects Bees Wasps Ants + often = shock

14 14 Allergens - Pharmaceuticals Antibiotics: Penicillin Sulfas ASA and anti-inflammatories: Aspirin NSAIDS numerous Iodine: Intravenous contrast Others

15 15 Signs and symptoms - Systems Respiratory: Difficulty, distress, respiratory arrest Cardiovascular: Shock, cardiopulmonary arrest (CPA) Gastro-intestinal: Nausea, vomiting, diarrhoea, abdominal pain Skin: Urticaria, angioedema (swelling), redness Other: Anxiety, feeling of imminent death

16 16 Presence of signs and symptoms No sign or symptom is always present during an anaphylactic reaction. During the reaction, a number of substances enter into play, including histamine. These substances cause: Narrowing of the bronchioles Dilation of blood vessels Skin lesions

17 17 Urticaria Generally raised Migratory Source:

18 Angioedema: before and after 18

19 19 Angioœdema Most worrisome Upper airway Most visible Eyes Lips

20 20 Epinephrine - Effects Opposite of the anaphylactic reaction Dilates the bronchioles Increases blood pressure Increases the heart rate palpitations Anxiety, trembling, nausea and vomiting Effects of short duration

21 21 Inclusion criteria (known allergy) Recent contact with causal agent: < 12 hours + First signs of an allergic reaction: Difficulty breathing Weakness, fainting Urticaria, itching

22 22 Exclusion Criterion None in the case of an anaphylactic type reaction.

23 23 General protocol Evaluate safety Potential dangers? / Wear gloves Primary examination Call 911 at the same time if two first aiders are present Inclusion criteria? If present, administer prescribed epinephrine Monitoring and first aid Call 911 now if first aider is alone 2nd dose, after 15 minutes if needed Take to hospital Always

24 24 Special situations Repeat the dose every 15 minutes if the inclusion criteria are still present. There is no maximum number of doses. When in doubt, administer to children. Administer even if expired (past expiration date). For adults known to have a heart disease, be more careful.

25 25 Auto-injectors Intramuscular injection Automatic Automatic dose: Adults = 0.30 mg Paediatric = 0.15 mg if > 25 kg if < 25 kg

26 The second dose of the Twinject cannot be administered because the Twinject is not an auto-injector. 26 Administering using auto-injectors Demonstrations:

27 27 Risks related to auto-injectors Accidental injection soiled Squeeze to force bleeding Clean with soap + water or disinfectant without water Immediately go to emergency room Accidental injection sterile, in a finger Apply hot compresses Place pointing down Immediately go to emergency room

28 28 Summary Anaphylaxis: disproportionate allergic reaction. First-line treatment: epinephrine. Doses: Adult: 0.30 mg Paediatric (under 25 kg): 0.15 mg Repeat: every 15 minutes as needed Always take to hospital

29 29 Acknowledgements AQAA Saint John Ambulance Canadian Red Cross CSST Heart and Stroke Foundation of Québec Canadian Ski Patrol OIIQ Lifesaving Society Table des directeurs médicaux régionaux des services préhospitaliers d urgence EPIPEN TWINJECT

30 30 Questions? Thank you for your attention. Version schools MAJ

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