Anaphylaxis in Schools

Recognizing Anaphylaxis &

Epi-pen Administration

Betsy Stoffers RN 2010

Common causes Food (most commonly – peanuts,

walnuts, pecans, shellfish, eggs, milk, soy, and wheat)

Medication Insect stings Latex

Less common causes Exercise Food-dependent exercise-induced

anaphylaxis (occurs when a person eats a specific food and exercises within 3-4 hours after eating)

Idiopathic anaphylaxis (anaphylaxis with no known apparent cause)

General symptoms of anaphylaxis Mouth: itching, tingling, or swelling

of lips, tongue, and mouth Skin: Hives, itchy rash, swelling on

the face or extremities Gut: Nausea, abdominal cramps,

vomiting, diarrhea General: Panic, sudden fatigue,

chills.

Life-threatening symptoms Throat: Tightening of the throat,

hoarseness, hacking cough Lung: Shortness of breath,

repetitive coughing, wheezing Heart: Passing out, fainting,

paleness, blueness Most dangerous symptoms are

breathing difficulties and fainting.

Anaphylaxis is likely when: Acute onset of symptoms (several

minutes to two hours after exposure) of skin/mucosal – hives, swelling, flush & breathing problems or fainting.

Any TWO of the general symptoms. ANY of the life-threatening symptoms.The severity of symptoms can change

quickly.

Bi-phasic reaction Some individuals have an

anaphylactic reaction and the symptoms go away only to return a few hours later.

This bi-phasic reaction often presents in the respiratory system, therefore -

After a severe reaction observation in a hospital setting is necessary.

Administration of Epinephrine

Steps in the Emergency Use of an Epinephrine Auto-

InjectorEpi-Pen

Steps in the Emergency Use of an Epinephrine Auto-Injector (Epi-Pen)

Determine if anaphylaxis is reasonably suspected based on symptoms present.

Do not leave the child alone – Call 911 Most severe allergic reactions in

children involve trouble breathing. Children will need to sit calmly and upright. HOWEVER if there is fainting let the child lie down with legs raised.

Administration of Epinephrine Auto-Injector

Grasp auto-injector in one hand and form a fist around the unit.

Remove gray activation cap. Hold tip near outer thigh. Swing and jab firmly into outer thigh.

Hold in place and count to 10. Remove from thigh and massage

area.

Administration of Epinephrine Auto-Injector

Check the tip. If the needle is exposed the dose was delivered. If not exposed repeat the administration. Note the time.

Remain with student. Await emergency personnel. Give auto-injector to emergency personnel and time of administration.

Emergency Medical Services*911*

After Epinephrine has been administered, emergency medical care MUST be obtained immediately because severely allergic students may need basic life support if they stop breathing.

A delayed or bi-phasic reaction may occur.

Transportation to an emergency room must occur after epinephrine is given.

References

Training Protocols for the Emergency Administration of Epinephrine. New Jersey Department of Education. September 2008.