Allergic Reactions and the use of an Epi-Pen

Allergic Reactions and the use of an Epi-Pen

Goals Define the terms: Allergen, Allergic Reaction, Anaphylaxis, Epinephrine and Auto-injector Understand what an allergic reaction is, its effects on the body, and how to tell when an allergic reaction has progressed to Anaphylaxis Learn how to assess a patient in Anaphylaxis Learn when and how to use the Epinephrine Auto- Injector Understand the effects the Epi-Pen has on the body and how to move forward once it has been administered Understand these within the scope of NYS-EMT B Protocol

Definitions: Allergen- An allergen is a normally harmless foreign body that causes an excessive immune system response resulting in an Allergic Reaction. Allergic Reaction- A hypersensitivity of the immune system to a particular substance, resulting in itchiness, red eyes, and hives. Anaphylaxis- An allergic reaction that leads to shock from the swelling of the larynx and the spasm of smooth muscle, such as the trachea (causing wheezing), and the arteries and veins (vasodilation). Can lead to death if untreated. Epinephrine- Also known as adrenaline, Epinephrine is a hormone and drug used to speed the cardiopulmonary system. It is naturally found in the body but in the case of anaphylaxis, is injected. Auto-injector- An Auto-Injector includes a spring-loaded syringed containing, in this case, Epinephrine.

Allergens, as explained in the definition, are foreign bodies that enter our body and cause a reactions. Some common allergens include: Insects, foods, plants, medications, and others such as dust, makeup, soap, etc. Note that Latex is a common allergen and that we use non-latex gloves to avoid any issues.

So, what s the big deal if these foreign bodies enter our system? It isn t a big deal. But our bodies don t know that. Our bodies, sometimes almost randomly, believe that certain substances are harmful to us. So what does the body do to harmful things? It gets rid of them. The body, like with an germ, bacteria, or virus, forms antibodies to the allergen the first time they encounter each other. The body is prepared for next time to fight off this foreign invader. The next time the body is exposed to it, the antibodies will attack the substance, isolate it, and attempt to destroy it, and in the process, release chemicals, among them: histamines.

Ok, so what s the big deal with these chemicals? Histamine, along with these other chemicals, causes a release of fluids from blood and the spasms of smooth muscles. This leads to vasodilation, and the spasm and possible inflammation of the larynx. 6

Allergic Reactions Versus Anaphylaxis The difference between the two is simply a difference in degree. An allergic reaction is either localized to one part of the body (the part of the body exposed) or if it is throughout the body, it is not severe. In EMS, anaphylaxis is when an allergic reaction disrupts the ABC s, bringing about symptoms of shock. Until we see symptoms of shock, in the case of an allergic reaction, we rapid transport. Once shock is brought about, we have new things to consider. Mild Allergic Reaction Likely Anaphylaxis

Anaphylactic Reactions With Respiratory Distress or Hypoperfusion Note: Request Advanced Life Support if available. Do not delay transport to the appropriate hospital. I. Assure that the patient s airway is open and that breathing and circulation are adequate. Suction as necessary. II. Administer high concentration oxygen.

Note: In pediatric patients, maintain a calm approach to both parent and child. Allow the child to assume and maintain a position of comfort or to be held by the parent/guardian, preferably in an upright position. III. Determine that the patient has a diagnosed history of anaphylaxis, severe allergic reactions, and/or a recent exposure to an allergen or inciting agent. IV. If cardiac and respiratory status is normal, transport the patient while performing frequent ongoing assessments. V. If either cardiac or respiratory status are abnormal, proceed as follows: A. If the patient is having severe respiratory distress or hypoperfusion and has been prescribed an epinephrine auto injector, assist the patient in administering the epinephrine. If the patient s auto injector is not available or is expired, and the EMS agency carries an epinephrine auto injector, administer the epinephrine as authorized by the agency s medical director. 9

B. If the patient has not been prescribed an epinephrine auto injector, begin transport and contact Medical Control for authorization to administer epinephrine if available. VI. Contact Medical Control for authorization for a second administration of the epinephrine auto injector, if needed. VII. Refer immediately to any other appropriate protocol. VIII. If cardiac arrest occurs, perform CPR according to AHA/ARC/NSC standards and refer to the Cardiac Arrest Protocol. IX. Transport immediately. X. Ongoing assessment. Obtain and record the patient s initial vital signs, repeat enroute as often as the situation indicates. Be alert for changes in the patient s level of consciousness. XI. Record all patient care information, including the patient s medical history and all treatment provided, on a Prehospital Care Report (PCR). XII. If epinephrine has already been administered, continue to reassess respiratory effort and vital signs, transport immediately. NYS EMT-B Basic Life Support Protocols M 3

Signs of anaphylaxis as defined by the NYS EMT-B Basic Life Support Protocols M 3 Signs of allergic reactions i.e. hives, swelling, red eyes, runny nose, itchiness etc. Signs of hypoperfusion or shock Signs of respiratory distress either cardiac or respiratory status is abnormal

What to do in the case of a patient with anaphylaxis

What to do in the case of a patient with anaphylaxis Patient with history of anaphylaxis If Epi-pen is available and not expired, you may assist in the administration of the Epi-pen. If patient does not have Epi-pen or it is expired, you may use your own and administer it. Patient without history of anaphylaxis If patient is not prescribed an Epi-pen, you may not give one, unless given consent of medical direction. 13

What to do in the case of a patient with anaphylaxis If patient does not show improvement after one dose of epinephrine, you must call medical control in order to consider second dosage Continue ongoing assessment, vitals at least every 5 minutes, and be sure to pay attention to level of consciousness Transport immediately and rapidly Record everything in detail properly on the Pre-hospital Care Report (PCR)

What to do in the case of a patient with anaphylaxis So what is an Epi-pen and how does it work? The full name for an Epi-pen is an Epinephrine Auto-Injector. Epinephrine is a hormone and drug created by the adrenal glands. It is the same as adrenaline. It increases heart rate. It also loosens the spasms caused by the anaphylaxis. This loosens the bronchioles and the trachea, allowing the passage of air through to the lungs. However, this same drug can lead to an extreme that could cause dizziness, excitability, chest pain, and even Acute Myocardium Infarction. It is important to know your protocol to protect your patient, but, even more so, yourself.

The epinephrine is injected using a device called an auto injector. These are used to automatically inject medication intravenously.

When injecting oneself or when injecting someone else with an Epi-pen, it should be done in the anterior medial thigh. First remove the cap. Take a full grip on the sides of the injector, making sure not to put your thumb on either end. As always make sure you are using BSI standard precautions. Press it firmly into the patient s thigh and hold for approximately 10 seconds.

Pediatric Note The dosages for adults and children differ. They are: Adults:.3 mg Children(under 66 pounds):.15 mg

Questions, ideas, comments or concerns? That wasn t too bad now was it? Let s do some practice identifying the differences between anaphylaxis and a nonlife threating allergic reaction and when we can and can t use an Epi-pen.

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