ANAPHYLAXIS AND EPINEPHRINE AUTO-INJECTOR

Transcription

1 ANAPHYLAXIS AND EPINEPHRINE AUTO-INJECTOR Lesson Length: 1 hour Instructor s Notes: The Anaphylaxis and Epinephrine Auto-Injectors lesson is designed to be taught in approximately 1 hour. The lesson can be presented as an add-on lesson to the CPR/AED for Professional Rescuers and Health Care Providers course or any other Red Cross course. If it is presented as a stand-alone lesson, all course participants must possess a current CPR certification. This lesson may only be taught where state and local regulations allow. Instructors may need to meet additional requirements. The lesson was developed to address the need for training in the use of an epinephrine auto-injector. The instructor should emphasize during the presentation of the lesson that: This information is provided as general guidance only. In the event of differing advice, actual instructions or protocols from a health care provider for a specific person or situation should take precedence over instruction in this lesson. This lesson is not a substitute for current practices followed by personnel in settings such as camps. Examples of proactive steps include: Obtaining health information about respiratory problems, along with instructions and permission to administer treatment. Following guidelines as determined by a health care provider. Checking medication(s) for expiration date. Knowing the plan of action for the setting in an emergency. LESSON OBJECTIVES After completing this lesson, participants should be able to: Identify the signs and symptoms of anaphylaxis. Describe the care provided to a person experiencing anaphylaxis. Describe the appropriate assessment and documentation of the person s response to an epinephrine auto-injection. Describe how to report the event of an allergic reaction and your care to emergency medical services (EMS) personnel. Demonstrate appropriate handling, use and disposal of an epinephrine auto-injector. Demonstrate the use of an epinephrine auto-injector. GUIDANCE FOR THE INSTRUCTOR To complete this lesson and meet the lesson objectives, you must complete the following: Discuss all points in the Introduction topic (stand-alone courses only). Conduct lectures for: Health Precautions During the Course. Anaphylaxis (Severe Allergic Reaction). Signs and Symptoms of Anaphylaxis. Caring for Anaphylaxis. CPR/AED for Professional Rescuers and Health Care Providers Online Resources 2011 The American National Red Cross 1

2 Show the video segment, Anaphylaxis and Epinephrine Auto-Injectors. Conduct the Assisting with an Epinephrine Auto-Injector skill session. Conduct the Lesson Wrap-Up. MATERIALS, EQUIPMENT AND SUPPLIES Auto-injector training device (one per two participants) Non-latex disposable gloves (one pair per participant) CPR/AED for Professional Rescuers and Health Care Providers DVD, course presentation or streaming video segment TOPIC: INTRODUCTION Time: 20 minutes Discussion Instructor s Note: If this training is conducted immediately after a CPR course or if you are continuing this training with the same group of participants from a previous session, skip the introduction. Introduce yourself. Have participants introduce themselves. Have participants print their names on the Course Record and Course Record Addendum or the Activity Report. Inform participants of completion requirements. Review any facility policies and procedures, including emergency exits, telephones, restrooms, drinking fountains, and eating or drinking in class. Identify any designated areas for eating, drinking and smoking. Tell participants that the purpose of this module is to give individuals the knowledge and skills necessary to recognize and provide care to a person experiencing anaphylaxis until more advanced medical personnel take over. This module includes the demonstration of an epinephrine auto-injector device. Inform participants that the requirements for successful course completion and certification are: Possess a current American Red Cross certification in CPR Adult or equivalent. Participate in all course activities. Demonstrate competency in the required skill. HEALTH AND SAFETY PRECAUTIONS FOR THE COURSE Discussion Explain to participants that standard precautions will be followed during this training. Ask participants to privately inform you if they have any medical condition or disability that might affect course participation. Tell participants that when providing care, personal protective equipment (PPE) such as disposable gloves or CPR breathing barriers that are soiled with blood or body fluids are considered contaminated and a biohazard and must be disposed of properly. Instructions for cleaning up blood or other body fluids can be found on redcross.org. Tell participants that workplaces also have a designated employer representative who can advise on the individual facility s exposure control plan. 2 CPR/AED for Professional Rescuers and Health Care Providers Online Resources 2011 The American National Red Cross

3 TOPIC: ANAPHYLAXIS (SEVERE ALLERGIC REACTION) Time: 5 minutes Lecture Points Approximately 2 million people in the United States are at risk for anaphylaxis. About 400 to 800 deaths that occur in the United States are caused by anaphylaxis. Death can occur within minutes of exposure to an antigen (a foreign substance that brings on the allergic reaction). Fortunately, some deaths can be prevented if anaphylaxis is recognized immediately and cared for quickly. Allergic reactions are caused by the activity of the immune system. The body recognizes and protects itself from antigens by producing antibodies to fight the antigens. Antibodies are found in the liver, bone marrow, spleen and lymph glands. When the immune system recognizes an antigen, it releases chemicals to fight these foreign substances and eliminate them from the body. Mild allergic reactions can cause redness or irritation around the site of exposure. Severe allergic reactions in which air passages may swell and restrict breathing are referred to as anaphylactic shock. Anaphylaxis usually occurs suddenly, within seconds or minutes after contact with the substance. Death may occur quickly. With proper assessment and intervention, many deaths are preventable. TOPIC: SIGNS AND SYMPTOMS OF ANAPHYLAXIS Time: 5 minutes Lecture Points The signs and symptoms of anaphylaxis include: Itching (of tongue, armpits, groin or any part of the body). Weakness, dizziness or confusion. Swelling of the face, throat or tongue or any part of the body. Rash or hives. Nausea, abdominal pain and vomiting. Tight feeling in the chest and throat. Difficulty breathing/wheezing. Low blood pressure. Shock. Difficulty swallowing. Red, watery eyes. Rapid heart rate. Sudden collapse or cardiac arrest. Unconsciousness and death, which might occur if anaphylactic shock is not treated. Difficulty breathing can progress to an obstructed airway as the tongue, throat and bronchial passageways swell. An injection of epinephrine can help relax the muscles of the respiratory system. CPR/AED for Professional Rescuers and Health Care Providers Online Resources 2011 The American National Red Cross 3

4 TOPIC: CARING FOR ANAPHYLAXIS Time: 20 minutes Lecture Points People who know they are extremely allergic to certain substances may carry an anaphylaxis kit. The kit contains a dose of epinephrine (a form of adrenaline) that can be injected into the body to counteract the anaphylactic reaction. Individuals who are at risk for severe allergic reactions should wear a medical identification (ID) bracelet or necklace. An auto-injector is a way to administer epinephrine. An auto-injector is available only through a prescription. An epinephrine auto-injector contains a preloaded dose of epinephrine (0.3 mg for adults or 0.15 mg for children weighing between 33 pounds and 66 pounds) in a spring-loaded plunger that injects the drug when activated by pushing the auto-injector against a large muscle mass. Always follow medical direction and/or local protocols and the manufacturer s instructions for the specific device. In some cases, you may need to assist a person using his or her kit. This may include getting the pen or kit from a purse, car or home or out of a specially designed carrier or belt. It may also include taking it out of the plastic tube or assisting the person with the injection. Important precautions to keep in mind when assisting with an epinephrine auto-injector include: Determining if the person has already taken epinephrine or an antihistamine and, if so, only administering a second dose when more advanced medical personnel are not present and if anaphylactic symptoms persist for a few minutes. Checking the label to confirm that the prescription is for the person. Checking the expiration date and, if expired, not using it. Inspecting the liquid to make sure that it is clear and, if it is cloudy, not using it. Leaving the safety cap on until the auto-injector is ready to use. To assist with the administration of an epinephrine auto-injector, you should follow these general guidelines: Size-up the scene; perform a primary assessment. Look for a medical ID tag or bracelet. Call for more advanced medical personnel if the person is unconscious, having difficulty breathing, is complaining of throat tightening or explains that he or she is subject to severe allergic reactions. Provide care for life-threatening conditions. Check a conscious person to determine the substance involved, route of exposure and effects. Obtain information about the person, what happened and how he or she is feeling, if the person is conscious and able to talk. Check the person from head to toe, visually inspecting the body, noting any signs and symptoms of respiratory distress or allergic reactions, swelling of the face or tongue and tightening of the throat, skin appearance, and chest movement and pain. Provide care for respiratory distress. Document any changes in condition over time. 4 CPR/AED for Professional Rescuers and Health Care Providers Online Resources 2011 The American National Red Cross

5 CARING FOR ANAPHYLAXIS Continued Video Show the video segment, Anaphylaxis and Epinephrine Auto-Injectors (4:11). Answer participants questions about the segment. ASSISTING WITH AN EPINEPHRINE AUTO-INJECTOR Skill Session WATCH-THEN-PRACTICE Ask participants to find a partner. One person will be the rescuer; the other partner will be the person in need of assistance with the epinephrine auto-injector. Run through the steps of using an auto-injector as a group. Participants may only use an epinephrine auto-injector training device. To avoid injury during practice, warn participants not to strike their partner too hard with the training injector. Observe each participant performing the skill and evaluate completion of the skill. LESSON WRAP-UP Time: 5 minutes In review, ask participants the following questions and answer any participants questions: What are some of the signals of anaphylaxis? Answer: Responses should include the following: Itching (of tongue, armpits, groin or any part of the body) Weakness, dizziness or confusion Swelling of the face, throat or tongue or any part of the body Rash or hives Nausea, abdominal pain and vomiting Tight feeling in the chest and throat Difficulty breathing/wheezing. Low blood pressure Shock Difficulty swallowing Red, watery eyes Rapid heart rate Sudden collapse or cardiac arrest Unconsciousness and death, which may occur if anaphylactic shock is not treated Do you have to have a prescription for epinephrine kit? Answer: Yes. Epinephrine is considered a medication that only can be prescribed by a health care provider. Why is anaphylaxis considered an emergency? Answer: A death from anaphylaxis might occur because the person s breathing is severely impaired. When should you call for more advanced medical personnel? Answer: Call for more advanced medical personnel if the person is unconscious, having difficulty breathing, is complaining of throat tightening or explains that he or she is subject to severe allergic reactions. CPR/AED for Professional Rescuers and Health Care Providers Online Resources 2011 The American National Red Cross 5

6 Skill Chart Participants must perform the steps listed in the skill chart in the correct order. ASSISTING WITH AN EPINEPHRINE AUTO-INJECTOR Notes: Always obtain consent, follow standard precautions and wash your hands immediately after providing care. Check the medication to ensure that it is for the person, that it has not expired and that the liquid is clear and not cloudy. If possible, help the person self-administer the auto-injector. To care for a conscious person if he or she is unable to self-administer the auto-injector and local protocols allow: 1. Locate the outside middle of one thigh to use as the injection site. If injecting through clothing, press on the area with a hand to determine that there are no obstructions at the injection site, such as keys, coins, the side seam of trousers, etc. 2. Grasp the auto-injector firmly in your fist and pull off the safety cap with your other hand. 3. Hold the tip (needle end) near the person s outer thigh so that the auto-injector is at a 90-degree angle to the thigh. 4. Quickly and firmly push the tip straight into the outer thigh. You will hear a click. 5. Hold the auto-injector firmly in place for 10 seconds, then remove it from the thigh and massage the injection site with a gloved hand for several seconds. 6. Monitor the person s condition and observe the person s response to the epinephrine. 7. Place the used auto-injector in a proper sharps container and give it to more advanced medical personnel when they arrive. 6 CPR/AED for Professional Rescuers and Health Care Providers Online Resources 2011 The American National Red Cross