Aim To identify the signs and symptoms of anaphylaxis and provide emergency care.

Transcription

1 Community Health Policies, Procedures and Guidelines Procedures Aim To identify the signs and symptoms of anaphylaxis and provide emergency care. Equipment Adrenaline autoinjectors: o EpiPen Jr or Anapen 0.15mg (150 micrograms) Jr for children 10-20kg, aged approximately 1-5 years - coloured green. OR o EpiPen or Anapen 0.3mg (300 micrograms) for children over 20kg, aged approximately over 5 years -coloured yellow. Adrenaline 1:1000, mg per ml o Adrenaline 1:1000 contains 1mg of adrenaline per ml of solution in a 1mL glass vial. o 1mL syringe o Hazardous disposal container for sharps. OR Table 1 Less than 1 year ml 1 2 years (approx. 10 kg) 0.1 ml 2 3 years (approx. 15 kg) 0.15 ml 4 6 years (approx. 20 kg) 0.2 ml 7 10 years (approx. 30 kg) 0.3 ml years (approx. 40 kg) 0.4 ml 13 years and over (over 40 kg) 0.5 ml (The Australian Immunisation Handbook) ASCIA Action Plan for Anaphylaxis - Australasian Society of Clinical Immunology and Allergy (ASCIA). Date Issued: 2007 Review Date: 2015

2 Key Points Adrenaline is the first line of treatment for anaphylaxis (not antihistamine). An adrenaline autoinjector should be administered as soon as possible when it has been identified that an individual is experiencing anaphylaxis. If in doubt, give an adrenaline autoinjector. In an emergency, assuming the child is school-aged and weighs 10kg or more, if a junior adrenaline autoinjector pen (0.15mg) is not available use a regular adrenaline autoinjector pen (0.3mg) / or if an autoinjector pen is not available substitute adrenaline from 1:1000 vial using Table 1 to identify the correct dose. Education and health staff in schools do not need parental consent to give an adrenaline/ adrenaline autoinjector for the emergency treatment of anaphylaxis. Nursing staff working within the scope of their nursing practice may provide adrenaline drawn from the 1:1000 adrenaline vial, intramuscularly into the thigh (not deltoid region), in the emergency treatment of anaphylaxis. Anaphylaxis in children is most commonly caused by food allergies or insect stings/bites. Any food can cause anaphylaxis. The most common food allergens are peanuts, tree nuts (e.g. hazelnuts, cashews, and almonds), eggs, cow s milk, wheat, soybean, fish, shellfish, and sesame. Other causes include medications, vaccinations and latex. A severe allergic reaction can occur within minutes and usually within 20 minutes, but can occur up to 2 hours following exposure to the allergen. The reaction may start out with mild symptoms and progress to anaphylaxis, but not in all cases. Adrenaline autoinjectors are single use only. Anaphylaxis symptoms have the potential to recur after administration of adrenaline, so an ambulance must be called. Further adrenaline may be repeated after 5 minutes as needed. Individuals should be observed in a medical facility for four hours post anaphylaxis. An ASCIA Action Plan for Anaphylaxis should be stored with the adrenaline autoinjector. Adrenaline autoinjectors should be stored in a cool dark place at room temperature - but NOT refrigerated and must be readily available when needed and not in a locked cupboard. Staff involved in immunisation provision should refer to specific adrenaline Australian Immunisation Handbook for managing anaphylaxis. and t/handbook-home

3 Process PROCEDURE ADDITIONAL INFORMATION 1. Assess symptoms Symptoms of anaphylaxis a severe allergic reaction can include; difficulty breathing or noisy breathing, swelling of the tongue, swelling / tightness in the throat, difficulty talking and / or a hoarse voice, wheezing or persistent coughing, young children may appear pale and floppy, abdominal pain or vomiting (when associated with an allergic reaction to an insect sting or bite). persistent dizziness loss of consciousness and / or collapse. 2. Lay person flat and elevate legs- (if conscious) 3. If unconscious place him/her on the left side and position to keep airway clear. 4. Give adrenaline autoinjector or appropriate calculated adrenaline dose. Do not allow person to stand or walk (even if symptoms have subsided). If breathing is difficult allow to sit up. If in doubt, give the adrenaline/ adrenaline autoinjector. Adrenaline is life saving and must be used promptly. Withholding or delaying the giving of adrenaline can result in deterioration and death. If adrenaline is given to a child who does not have anaphylaxis, the child will experience raised heart rate and become pale and sweaty, and may feel anxious and shaky, but there will be no lasting ill effects. Instructions for administration are written on the pen. 5. Call and ambulance Phone 000 (landline) or 112 (mobile phone network). If no timely ambulance service (e.g. rural setting) arrange for the child to be transported to a health service or medical practitioner. Two people to travel with the child (one driving, one monitoring

4 PROCEDURE 6. Inform parents as soon as practicable. 7. Give further adrenaline if no response after 5 minutes- repeat dose every 5 minutes until improvement occurs. 8. Monitor vital signs until ambulance arrives ADDITIONAL INFORMATION and providing reassurance). If on a school site, inform school Principal or delegate as soon as possible. Continue providing reassurance. Further doses of adrenaline can be provided every 5 minutes, should signs and symptoms persist/ relapse. Use clinical judgement to monitor vital signs applicable to the first aid situation, which may include: Consciousness Respiration rate Heart rate Commence CPR if necessary. Send used adrenaline vial/adrenaline autoinjector with ambulance. Provide ambulance officers with clinical details to assist client treatment- sequence of events, time and dosages of adrenaline. All cases of anaphylaxis must be sent to hospital for further observation and treatment. 9. Document events as soon as possible. 10. Advocate for debriefing post-incident Use appropriate CHS records (Community health forms) to document sequence of events, clinical notes, communications and decision-making. Provide the Principal with required information for their critical incident reporting. Individuals involved in the incident may benefit from post incident counselling. Review responses and sequence of events, and suggest changes to policies and practice if necessary. 11. Follow up Ensure a suitable emergency action plan is provided by parents/guardians to follow for future events. Encourage follow-up medical care for the individual.

5 7 steps to allergy awareness in schools. 1. Understand roles and responsibilities. 2. Determine what allergies you need to manage. 3. Assess the risk of allergen exposure. 4. Minimise the risk of allergen exposure. 5. Train staff and plan emergency response. 6. Communicate with the school community. 7. Review and assess management strategies. For more information see Anaphylaxis management guidelines in schools Note The Health, Safety and Civil Liability (Schools and Childcare Services) Act 2010 supports trained staff in schools and child care to administer an adrenaline autoinjector, without parental consent, to a child they believe to be experiencing anaphylaxis, whether or not that child has been prescribed an adrenaline autoinjector. The POISONS REGULATIONS 1965 Part 5: Sale, supply and use of poisons, Division 3, General r. 41D Adrenaline for schools or child care services, enables schools and child care services to keep and supply an adrenaline autoinjector for general use.

6 Useful Links Anaphylaxis: Key messages for health professionals - Department of Health 2011, Anaphylaxis, Resources for anaphylaxis management in schools and child care services in Western Australian, Perth. Health, Safety and Civil Liability (Children in Schools and Child Care Services) Bill , Western Australia, Government of Western Australia: Department of Premier and Cabinet /$File/Bill126-1B.pdf Remote Area Nursing Guidelines (4 th ed). 2005, Department of Health WA. mergency_guidelines.pdf The Australian Immunisation Handbook 9th Edition. 2008, The Australian Government: Department of Health and Aging, National Health and Medical Research Council, The Australasian Society of Clinical Immunology and Allergy (ASCIA) The Australasian Society of Clinical Immunology and Allergy (ASCIA) elearning package at