OPTIONAL LESSON Anaphylaxis and Epinephrine Auto-Injector Lesson Length: 54 minutes GUIDANCE FOR THE INSTRUCTOR To complete this lesson and meet the lesson objectives, you must: Discuss all points in the Introduction topic (stand-alone courses only). Conduct lectures for: Preventing Disease Transmission Anaphylaxis (Severe Allergic Reaction) Signals of Anaphylaxis Care for Anaphylaxis Types of Kits Available Show the video segment, Assisting with an Epinephrine Auto-Injector (2:56). Conduct the Epinephrine Auto-Injector skill practice session. Conduct the Lesson Wrap-Up. LESSON OBJECTIVES After completing this lesson, participants will be able to: Identify the signals of anaphylaxis. Describe the care given 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 given to EMS personnel. Demonstrate the use of an epinephrine auto-injector. Demonstrate appropriate handling, use and disposal of an epinephrine auto-injector. MATERIALS, EQUIPMENT AND SUPPLIES One training auto-injector device per two participants Nonlatex disposable gloves (multiple sizes) First Aid/CPR/AED DVD or course presentation supplement Instructor s Note: The Anaphylaxis and Epinephrine Auto-Injector lesson is designed to be taught in about 1 hour. The lesson can be presented as a stand-alone lesson or add-on lesson to a First Aid course or any other First Aid/CPR/AED course. If it is presented as a stand-alone lesson, all course participants must possess a current CPR certification. This module may be taught only where allowed by state and local regulations. Instructors may need to meet additional requirements. This module was developed to address the need for training in the use of an epinephrine auto-injector device. The instructor should emphasize during the module that: This information is provided as a 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 module. Optional Lesson: Anaphylaxis and Epinephrine Auto-Injector 1
This lesson is not a substitute for: 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. Before this lesson, participants should be familiar with and know how to: Recognize and respond to an emergency. Follow the emergency action steps, CHECK CALL CARE. Follow standard precautions to reduce the risk of disease transmission during and after giving care. Recognize the signals of a heart attack. Identify the signals of a breathing emergency. Demonstrate how to care for a person who is having a breathing emergency. Demonstrate how to give CPR to a person. OPTIONAL TOPIC: INTRODUCTION Time: 7 minutes WELCOME Discussion IM, Chapters 1 and 2 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. 1. Introduce yourself. 2. Have participants introduce themselves. 3. Have participants print their names on the Course Record and Course Record Addendum or the Activity Report. 4. Explain the purpose of American Red Cross First Aid/CPR/AED courses. 5. Inform participants of completion requirements. 6. Review any facility policies and procedures, including emergency exits, telephones, restrooms, drinking fountains and policies on eating or drinking in class. Identify any designated areas for eating, drinking or smoking. 7. Tell participants that the purpose of this module is to give individuals the knowledge and skills necessary to recognize and give care to a person in anaphylaxis until advanced EMS personnel arrive and take over. This module includes the demonstration of an epinephrine auto-injector device. 8. Inform participants that for successful course completion and certification, they are required to: Possess a current (issued within 1 year) American Red Cross certification in CPR Adult or equivalent (for stand-alone lessons). Participate in all course activities. Demonstrate competency in all required skills. HEALTH AND SAFETY PRECAUTIONS FOR THE COURSE Discussion Appendix C: Health Precautions and Guidelines During Training 1. Explain to participants that standard precautions will be followed during this training. 2. Hand out the Student Training Kits for CPR and/or First Aid Training or equivalent training supplies as applicable and identify the contents. 3. Ask participants to privately inform you if they have any medical condition or disability that might affect course participation. 2 First Aid/CPR/AED Online Instructor Resources 2011 The American National Red Cross
HEALTH AND SAFETY PRECAUTIONS FOR THE COURSE Continued 4. Tell participants that when giving first aid care or CPR/AED, personal protective equipment items, such as disposable gloves or CPR breathing barriers, that are soiled with blood or body fluids are considered to be 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. 5. Tell participants that workplaces also have a designated employer representative who can advise on the individual facility s exposure control plan. TOPIC: ANAPHYLAXIS (SEVERE ALLERGIC REACTION) Time: 7 minutes ANAPHYLAXIS Lecture Presentation Slides E.1 E.2 PM, page 158 1. Approximately 2 million people in the United States are at risk for anaphylaxis. About 400 to 800 deaths 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. 2. Allergic reactions are caused by the activity of the immune system. The body recognizes and protects itself from antigens by producing antibodies. These antibodies fight 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. 3. Mild allergic reactions can cause redness or irritation around the site of exposure. 4. Severe allergic reactions, in which air passages may swell and restrict breathing, include signals of shock. 5. Anaphylaxis usually occurs suddenly, within seconds or minutes after contact with the substance. 6. Death may occur quickly. SIGNALS OF ANAPHYLAXIS Lecture Presentation Slide E.3 PM, page 158 1. The signals of anaphylaxis include: Weakness, dizziness or confusion. Swelling of the face, throat or tongue. Rash or hives. Tight feeling in the chest and throat. Difficulty breathing, wheezing or shortness of breath. Trouble breathing can progress to a blocked airway due to swelling of the lips, tongue, throat and larynx (voice box). Low blood pressure. Shock. 2. Unconsciousness and death may occur if anaphylactic shock is not treated. 3. An injection of epinephrine can help relax the muscles of the respiratory system. Optional Lesson: Anaphylaxis and Epinephrine Auto-Injector 3
TOPIC: CARE FOR ANAPHYLAXIS Time: 10 minutes CARE FOR ANAPHYLAXIS Guided Discussion and Lecture PM, pages 158 160 1. Tell participants to imagine a situation in which you are the only person available to help someone having an allergic reaction. 2. Lead participants in a brief discussion by asking: As the person s throat begins to swell and close, what would you do? If medication was available to help the person, how could you help? What things would you check before giving care? 3. Cover the following points during the discussion. Call or have someone call 9-1-1 or the local emergency number. You may help a person with an auto-injector when: The person has a history of allergies or allergic reactions. A person is having a severe allergic reaction. The person asks for assistance in administering epinephrine. The person provides you with his or her own prescribed auto-injector. Your state law permits it. The effects of epinephrine are relatively short in duration, so persons having severe allergic reactions require additional medications that can be provided only by a hospital. If the person is conscious and able to talk, ask the person the following questions: What is your name? What happened? How do you feel? Do you feel any tingling in your hands, feet or lips? Do you feel pain anywhere? Do you have any allergies? Do you have prescribed medications to take in case of an allergic reaction? Do you know what triggered the reaction? How much and how long were you exposed? Do you have any medical conditions or are you taking any medications? Check the person head to toe: Visually inspect the person s body. Observe for signals of respiratory distress or allergic reactions. Look for a medical identification (ID) tag, bracelet or necklace. Check the person s head. Observe for swelling of the face, neck or tongue. Notice if the person is drowsy, is not alert, confused or is exhibiting slurred speech. Check the skin s appearance. Look at the person s face and lips. Is the skin cold or hot? Unusually wet or dry? Pale, bluish or flushed? Check the person s chest. Ask if he or she is experiencing pain during breathing. Notice rate, depth of breaths, wheezes or gasping sounds. 4 First Aid/CPR/AED Online Instructor Resources 2011 The American National Red Cross
CARE FOR ANAPHYLAXIS Continued When EMS arrives, describe the following: The person s experience What occurred The signals observed The care given When epinephrine was given Location of the injection site How the person reacted to the medication TOPIC: EPINEPHRINE AUTO-INJECTOR Time: 25 minutes EPINEPHRINE AUTO-INJECTOR Lecture Presentation Slides E.4 E.5 PM, pages 159 160 1. People who know that they are extremely allergic to certain substances may carry an anaphylaxis kit. 2. The kit contains a dose (or two) of epinephrine, a drug that works in the body to counteract the anaphylactic reaction. 3. Individuals who are at risk for severe allergic reactions should wear a medical ID tag, bracelet or necklace. 4. An auto-injector is a way to administer epinephrine. The auto-injector is a springloaded syringe system with a single dose of epinephrine. 5. An auto-injector is available only through a prescription. 6. Auto-injectors are available in doses of 0.3 mg for adults and 0.15 mg for children weighing 33 to 66 pounds. 7. In some cases, you may need to assist the 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 also may include taking it out of the plastic tube or assisting the person with the injection. 8. Leave the safety cap on until it is ready to use. 9. Never put your finger over the tip (needle end) when removing the safety cap or after the safety cap has been removed. 10. The auto-injector unit requires special care when using and disposing. Give it to the EMS personnel when they arrive. 11. Properly dispose of any contaminated or potentially contaminated object. EPINEPHRINE AUTO-INJECTOR Video 1. Tell participants that you are going to show them a video on epinephrine auto-injectors. 2. Show the video segment, Assisting with an Epinephrine Auto-Injector (2:56). DVD or Presentation Slide E.6 Optional Lesson: Anaphylaxis and Epinephrine Auto-Injector 5
OPTIONAL: EPINEPHRINE AUTO-INJECTOR SKILL SESSION Watch then Practice Presentation Slide E.7 1. Tell participants that they are going to practice using an epinephrine auto-injector. 2. Participants may use only an epinephrine auto-injector training device. 3. To avoid injury during practice, warn participants not to strike their partner too hard with the training injector. 4. Tell participants to take their disposable gloves and training device to the practice area. 5. Have participants choose a partner; one person will be the responder and one will be the conscious victim. 6. Using disposable gloves and the auto-injector training device, have participants follow along as you guide them through the steps for using an epinephrine auto-injector. 7. Review the steps of using an epinephrine auto-injector as a group. 8. Have participants change places and repeat the skill. 9. Record participants successful completion of this skill on the Participant Progress Log. LESSON WRAP-UP Presentation Slide E.8 1. What are some signals of anaphylaxis? Answers: Responses should include the following: Weakness, dizziness or confusion. Swelling of the face, throat or tongue. Rash or hives. Tight feeling in the chest and throat. Difficulty breathing, wheezing or shortness of breath. Low blood pressure. Shock. 2. Do you have to have a prescription for epinephrine auto-injector? Answer: Yes, epinephrine is considered a medication that can be prescribed only by a physician. 3. Why is anaphylaxis considered an emergency? Answer: Death from anaphylaxis usually occurs because the person s breathing is severely impaired. 4. When should you call 9-1-1 or the local emergency number? Answer: Always call 9-1-1 or the local emergency number for someone experiencing anaphylaxis. 6 First Aid/CPR/AED Online Instructor Resources 2011 The American National Red Cross
Optional Skills Practice Assisting with an Epinephrine Auto-Injector SKILL CHART ASSISTING WITH AN EPINEPHRINE AUTO-INJECTOR Determine whether the person has already taken epinephrine or an antihistamine. If so, administer a second dose only when EMS personnel are not present or delayed and if signals of anaphylaxis persist after a few minutes. Check the label to confirm that the prescription of the auto-injector is for this person. Check the expiration date of the auto-injector. If it has expired, DO NOT USE IT. If the medication is visible, confirm that the liquid is clear and not cloudy. If it is cloudy, DO NOT USE IT. Note: If possible, help the person self-administer the auto-injector. To care for a conscious person if the patient is unable to self-administer the auto-injector, and if local and/or state regulations allow: 1. Locate the outside middle of one thigh to use as the injection site.* 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 patient 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. Recheck the person s breathing and observe his or her response to the medication. 7. Handle the used auto-injector carefully, placing it in a safe container. Give it to EMS personnel when they arrive. *If injecting through clothing, press on the area with a hand before injecting to determine that there are no obstructions at the injection site, such as keys, coins or the side seam of trousers. Optional Lesson: Anaphylaxis and Epinephrine Auto-Injector 7