What is Anaphylaxis?What is Anaphylaxis?Is this a problem at school?Is this a problem at school?

Goals for today

• Understand what anaphylaxis is and what the signs and symptoms of a reaction are

• Learn how we are going to manage anaphylaxis at school

• Practice using an EpiPen and Twinjet auto-Injector for epinephrine

Anaphylaxis is...

• An allergic reaction that can affect the entire body

• It can be fatal • It happens quickly• It often has an identifiable cause

It can affect the whole body

• Skin• Breathing• Heart• Stomach• Head

How fast is fast?• Symptoms can occur within

minutes to two hours after contact with the allergy causing substance

• In rare instances, it may occur up to four hours later

Common Causes• Food• Medication• Insect stings• Latex• Some have an unknown

cause

Who is at risk?• Anyone with a previous history• Individuals with food allergies

(Particularly allergies to shellfish, peanuts, and tree nuts)

• People with asthma are at an increased risk

Signs and symptoms• Tingling sensation• Rash...itching... burning• Metallic taste• Sensation of warmth• Breathing difficulty... Changes in

skin color• Nausea, vomiting, diarrhea, or

cramps• Anxiety, dizziness, headache• Drop in blood pressure• Loss of consciousness

Essentials of school Management…

• Written Classroom Health Care Plan developed by the school nurse and signed by the health care provider.

• Able to recognize of the signs and symptoms of anaphylaxis at school

• Prompt administration of epinephrine.• Transport to closest emergency facility

Management of Anaphylaxis at school

This is really a 4 tiered effort...• Developing a Classroom Health Care

Plan that includes the emergency plan• The Immediate phase at exposure• The phase after the initial treatments• The Prevention Plan

Developing the Classroom Health Care

PlanYour school nurse can help here.• The plan should cover the

emergency steps to follow.• It should include the necessary

trainings.• It also should cover prevention

plans as well.

Immediately• Clear and secure the airway as

needed. Observe for breathing.• Rapidly assess level of

consciousness• Consider Epinephrine... Is this

anaphylaxis?• Have someone call 911

Second Phase• If this is anaphylaxis, give the

epinephrine and/or benedryl as ordered by the Health Care Provider

• Stay with the student• Have them stay laying down.

Elevate their legs if possible.• Make sure 911 has been called

Transport… 3rd Phase

• Once epinephrine has been given, the student must have further care at the closest emergency facility

• Epinephrine lasts for only about 15-20 minutes.

• Follow the advice of the emergency responders.

What is Epinephrine?• It is a hormone produced by all of

us in the adrenal glands• It is often referred to as Adrenaline

How Does Epinephrine Work?

• Epinephrine has three major actions that are of critical importance in the treatment of anaphylaxis because it: – Constricts blood vessels and – It is a Bronchodilator – Help keeps the blood pressure stable.

Epinephrine...• Adverse reactions to epinephrine

include a fast heart rate; transient, moderate anxiety; apprehensiveness; restlessness; tremor; weakness; shakiness; dizziness; sweating; palpitations; pallor; nausea and vomiting; headache; and/or respiratory difficulties.

Epinephrine!

•EpiPen •Twinjet

Prevention of anaphylaxisis the 4th

Phase

• Medic-Alert identification• Teach appropriate avoidance measures• Be observant... watch for the signs and

symptoms of an anaphylactic reaction.

Avoidance!• What about nut free zones?• Consider a nut free table in the

cafeteria.• A nut free classroom is another

consideration

Quiz Time• What is anaphylaxis?• What are the symptoms of a

reaction?• Who is at risk for an anaphylactic

reaction?

What is an EpiPen• EpiPen® is an auto-injector that administers epinephrine (also known as adrenalin).

How to use the EpiPen

Remove the Epipen from the plastic tube

Remove the gray cap

Put the gray cap against the middle of

the outer side of the upper leg

Hold for 10 seconds

To insure the dose was given...

• Check for the red bar• Check to make sure the needle came out• Give your used EpiPen to a healthcare worker

for proper disposal. Do not throw away in a regular trash can

Let’s Practice

How to use a Twinjet1. Pull off the GREEN end cap

labeled "1." You will now see a GRAY cap. Never put your thumb, finger,or hand over the GRAY cap.

Next...2. Pull off the RED end cap labeled

"2."

Then...• 3. Put the GRAY cap against

the middle of the outerside of your thigh (upper leg) as shown. It can gothrough clothes, if necessary.

• 4. Press down firmly until the needle enters the middle ofthe outer side of your thigh through your skin. Hold it inplace while slowly counting to 10.

After 10 Seconds• Remove the Twinjet from your skin. • Check the GRAY cap; if the needle is

exposed, the dose was given. If not, repeat #3 and #4.Get ready for the second dose. Get emergency medical help right away.

Get Ready in Case You Need a Second

Dose • Unscrew and remove the GRAY

cap. Beware of theexposed needle.

• Holding the BLUE hub at the needle base, pull thesyringe from the barrel.

Then...Slide the YELLOW or ORANGE collar

off the plunger.

Decide if You Need a Second Dose

• If your symptoms have not improved within about 5 minutes since the first injection, you need a secondinjection.

• If a second dose is not needed, throw away the unused medication as directed.

Inject the Second Dose • Put the needle into your thigh

(upper leg), through your skin, as shown.

• Push the plunger down all the way.

• Remove Twinjet from your skin.

Proper Disposal • Give your used Twinjet to a

healthcare worker for proper disposal. Do not throw away in a regular trash can.

• Prepared by: Mary Clark RN, NCSN• Reviewed by: Paula Peterson APNP

Primary Children’s Hospital Salt Lake City, Utah

• JMJ Publishers• 1156 Wilson Ave.• Salt Lake City, Utah 84105• 801 467-5083