module 5 anaphylaxis - revive2survive
TRANSCRIPT
What Is Anaphylaxis? Anaphylaxis is the most severe form of allergic reaction and is potentially life threatening. It must be treated as a medical emergency, requiring immediate treatment and medical attention. Anaphylaxis:
• Usually occurs within 20 minutes of exposure to the trigger
• A generalised allergic reaction which often involves more than one body system
• Is an immune response
• If the casualty has both asthma and severe allergy symptoms treat them with the EpiPen first
Anaphylaxis involves the respiratory and/or circulatory system
HOW DOES AN ALLERGY OCCUR?
• An allergy is an abnormal immune response
• An allergen is a substance (chemical) that causes the allergic reaction.
• When someone has been exposed to a substance such as a bee sting venom, the person’s immune system mistakenly overreacts.
• When the person is exposed to that allergen again, tissues in the body release histamine and other substances which then cause the symptoms of an allergic reaction.
• Food (peanuts, nuts, milk, seafood, eggs, fruit etc.) • Insect bites and stings • Medications (aspirin, antibiotics, herbal etc.) • Latex • Even a minuscule amount of food can cause a
severe reaction
The body can absorb the allergen in one of four ways: INJECTION, INGESTION, INHALATION and SKIN CONTACT
Common Triggers
Severe Reaction
• Difficult/noisy breathing
• Swelling of tongue
• Swelling/tightness in throat
• Difficulty talking and or/ hoarse voice
• Wheezy, persistent cough
• Persistent dizziness or collapse
• Pale and floppy (young children)
Mild-Moderate Reaction • Swelling lips, face and eyes • Tingling in mouth • Abdominal pain, vomiting
(Insect allergy –vomiting, this is a sign of anaphylaxis) • Body redness , hives or welts, itching
SIGNS AND SYMPTOMS
How does adrenalin/epinephrine work?
• Adrenalin is naturally produced by the adrenal glands in times of stress.
• When swelling occurs as an allergic reaction, the soft tissue within the casualty’s throat can also swell, compromising the airway.
• Adrenalin rapidly reverses severe effects of allergic reactions by reducing throat swelling, relaxing and opening the airways and maintaining blood pressure.
• There should be no adverse side effects from the use of adrenalin.
EpiPen® – Adrenalin Auto-Injector
•Contains one single, pre-measured dose of adrenaline.
•Have an expiry date of approximately 12 months. The expiry date is listed on the side of the device. An expired EpiPen should not be used unless it is the only device available or directed by Emergency Services.
•A prescription is required to purchase an Epipen.
•Are designed for use by anyone, including those not medically trained.
Adrenalin Auto-Injectors
Junior auto-injectors are available, for children approximately between 1-5yrs (7.5-20kg)
Adult dose- 0.3mg
Junior dose-0.15mg
If no other option an an adult pen can be given to children weighting over 7.5kg
• An adrenaline auto injector for general use may be administered to a person who appears to have anaphylaxis, but have not been previously diagnosed to be at risk of anaphylaxis.
•You do not need to call 000 for permission to administer an auto injector, follow ASCIA Action Plan for directive
•EpiPens should be replaced if past their used by date, heat effected or have been administered
Treating Children
• Individual Anaphylaxis Management Plan • ASCIA Individual Action Plan • Risk Minimisation Strategy • Communication Plan • Staff Training Strategies To Avoid Allergens: • Bee stings, outdoor activities • Foods-crafts, cooking • Excursions, special events
Prevention is better than treatment
There are 3 types of ASCIA Action Plans
• Green: Allergic Reactions (Personal)
• Red: Anaphylaxis (Personal) for use with EpiPen®
• Orange: Anaphylaxis (General) for use with EpiPen®
Action plans and auto injectors should be kept in a centralised location which is out of sight of the general public, including parents and other children.
• Action Plans must be signed off by a doctor.
• Action Plans must be updated every 12 months or after an allergic reaction.
• Be prepared in consultation with the individual, parent or carer
ASCIA ACTION PLANS
• Lay the victim flat; do not stand or walk. If breathing is difficult, allow to sit (if able)
• Check for dangers
• Stay with the victim
• If the reaction is due to an insect allergy, remove the stinger with your fingernail or a credit card
• Administer adrenaline auto injector- note the time
• Call ambulance- 000. Provide time the reaction started, time adrenaline administered and vital signs
• If difficulty in breathing continues after 5 minutes,
administer further doses
• Commence CPR if breathing stops
What do you do if a severe reaction occurs?
BLUE TO THE SKY ORANGE TO THE THIGH
• Remove the blue safety cap and hold against the casualty’s outer thigh
• Push against thigh until you hear a “click”
• Hold in place for 3 seconds
• You should start to see improvement within a minute eg color and breathing
• If there is no relief for the casualty and further doses are available, repeat every 5 minutes until the ambulance arrives
• Monitor the casualty and keep the casualty laying down, no walking to the ambulance.
• Give the used Epipen® to paramedics.
• If you accidently inject yourself with the casualty’s EpiPen, lay down, contact your Local Poison Information Centre and administer the generic EpiPen to the casualty
Another child's auto-injector can be used if no other option is available. This must be replaced immediately!
To Administer the Injector
After the arrival of an ambulance it is vital to they receive a proper handover. Information they require:
• Introduce the casualty
• The history including time the reaction started
• Time you administered the adrenaline
• Hand the used adrenaline injector/s to the ambulance team
Always be calm and reassured of what is happening
Medical Handover
• Debrief staff and children (talk to the children about their emotions and response to an event)
• Notify relevant authorities e.g. The child has left via ambulance
• Replace auto-injectors
• Update action plan
• Review procedure
Think About Your Situation • Where are the children's auto-injectors kept?
• How would l get the generic auto-injector in a hurry?
• Do l have a mobile phone to call someone?
• Do the children/students carry their auto-injector with them?
• Do their friends know how to recognise signs, symptoms and/or administer the auto-injector (EpiPen®)?
Post- Incident Review and Actions
After an incident it is important to observe children for signs of stress:
•Observe their behaviour, has anything changed
•If upset ask if they want to talk about it
•Offer reassurance in an honest and truthful way
•Listen attentively, be calm and supportive
•If they don’t want to talk they may want to draw pictures to describe how they are feeling
•Talk to the parents/carers on your observations
Stress Management
Employers have a responsibility to provide a safe caring environment for those whoa re in their care. Key steps are:
•Find out which individuals are at risk of Anaphylaxis – obtain current medical information
•Develop individual Anaphylaxis Management Plans for those who have been identified
•Implement practical strategies to avoid exposure to known allergens
•Develop communication to raise awareness of anaphylaxis. This includes age appropriate education of children with allergies
•Ensure staff are trained in treating anaphylaxis
•Ensure ASCIA Action Plans and adrenaline auto-injectors are stored together in an unlocked location
•Develop an Emergency Response Plan for Anaphylaxis
•Review management plans annually or always after an anaphylaxis event
For examples of risk minimisation strategies for schools, preschools and childcare service www.allergy.org.au/images/scc/ASCIA_Risk_minimisation_strategies_table_030315.pdf
Risk Minimisation
It is important that everyone in a workplace/school/ childcare facility is aware of the seriousness of severe allergic reactions, how to avoid them and the correct emergency first aid response. This information should be circulated amongst:
•Workplace first aiders
•Students
•Teachers/early childhood staff
•Parents/careers/volunteers
•Casual or specialist staff
•Caterers or canteen staff
•Providers of camp/conferences
•Incursions visitors
•Excursion facilitators
Communication Plan
Key information which should be communicated are:
•Those at risk
•Awareness of the seriousness of the condition
•Triggers of allergic reactions
•The signs and symptoms
•Where are the ASCIA Action Plans are kept
•Where are the auto-injectors stored
•How to deal with it, including use of adrenaline auto-injectors
Communication plans should be reviewed annually to ensure it’s effectiveness.
Communication Plan
To find out current information , guidelines, protocols and state information, contact:
• Australasian Society of Clinical Immunology and Allergy (ASCIA) www.allergy.org.au
• Department of Education – for Schools and Childcare www.education.vic.gov.au
• Australian Children's Education & Care Quality Authority www.acecqa.gov.au
• Australian Resuscitation Council www.resus.org.au/guidelines
• Education and Care Services National Law www.education.vic.gov.au/childhood/providers/regulation/Pages/anaphylaxis.aspx
Current Information