Save a Life with Epinephrine - EpiPen® Rachel Gallagher, R.N., A.P.N.P. School Nurse Consultant Wisconsin Department of Public Instruction 125 South Webster St. Madison, WI 53707 Rachel.gallagher@dpi.wi.gov

Audio Difficulties? Make sure the volume is turned up (volume button beneath the speaker’s picture) Make sure the volume on the computer is turned up (volume icon located on the right hand side of your computer taskbar) Contact your IT department If audio and visual is lost during the program, go back to: http://media2.wi.gov/dpi/catalog/, and click on the Student Services Prevention and Wellness Team link on the left, then when the SSPW Team page of archived programs appears, select the program link desired. If problem persists contact Rachel Gallagher (608) 266-8857.

This power point, web cast and competency test will satisfy the knowledge portion of medication training. To complete the medication training for this emergency medication, school personnel will need to have a their medication administration skill verified and documented by a school nurse, medical provider or adequately training parent by performing an independent demonstration of the skill. Competency checklist are available at: http://dpi.wi.gov/sspw/schlnurse.html

Overview What is anaphylaxis? What is the prevalence? What are the symptoms? What are some common allergens? What are the treatments? What are the delivery devices? Demonstration Test

What is Anaphylaxis? Is a sudden and severe immune system reaction that affects the whole body Can be life-threatening History of asthma and eczema increases prevalence of anaphylactic reactions Estimated that there is 30,000 episode causing 100 to 200 deaths per year.

What is the prevalence of anaphylaxis? 30,000 emergency room visits 2,000 hospitalizations 150 deaths Food and Drug Administration, 2007

What are some of the signs of anaphylaxis? Skin - hives, swelling, tingling and flushing of skin, sweaty skin Respiratory - respiratory distress, wheezing, coughing Cardiovascular - increased pulse, decreased blood pressure

Signs continued Gastrointestinal – nausea, vomiting and diarrhea, drooling Genitourinary – incontinency, cramping Central Nervous System – confusion, loss of consciousness Feeling of impending doom

Pictures Hives Swelling

What are some of the common allergens that cause anaphylaxis? Food Insects Drugs Exercise-induced anaphylaxis Food – Although 160 foods can cause allergic reactions in people with food allergies, 90% of the food allergic reactions are caused by 8 foods including: milk, eggs, fish crustacean shellfish, tree nuts, peanuts, wheat and soybean Insects – Bees Drugs – Exercise induced anaphylaxis is rare but can occur

What are the school responsibilities for students with anaphylaxis? Identify students with life-threatening food allergies Develop school policies and protocol for management of anaphylaxis Emergency and Individual Health Care Plan Training of staff on condition, medications, and emergency plan Develop strategies to minimize risk of exposure Emergency Care Plan – Indicates plan, contact numbers and people trained in management It also contains a student specific plan for management of anaphylaxis. The ECP is very methodically indicating if you see this do that.

Treatment of Students with Anaphylaxis? Administration of Benadryl and/or Epinephrine Call 911 Check for relapse and administer second dose of epinephrine as needed Monitor side effects Monitor status of anaphylaxis Notify parents/physician Administraton of Benadryl and Epinephrine as indicated by orders. Some physicians will have you 35% of students who receive the first dose of epinephrine will have a reoccurrence of their symptoms and require a second dose 5-10 minutes after the first dose was given. Anaphylaxis may recur 1 to 72 hours after initial signs and symptoms apparently resolve. Reported incidence of biphasic anaphylaxis varies from 1% to 23%

Epinephrine dosages .15 mg for students less than 66 pounds or 30 kilograms .30 mg for students greater than 66 pounds or 30 kilograms Epi-pen® - .3 mg Epi-pen Jr.® - .15 mg

Delivery Devices Epi-pen® New delivery device (1/10) Old device Two delivery devices that come in different strengths Old device

Steps for administration-Epi-Pen® Flip open the yellow cap of the Epi-Pen® or the green cap of the Epi-Pen® Jr. auto injector carrier tube. Slide out of carrier tube. Grasp unit with fist and orange tip down. With other hand, pull off blue safety release cap.

Steps for administration-Epi-Pen® cont. Hold orange tip near outer thigh. Swing and push against outer thigh at a right angle or perpendicular to the leg. Hold firm against thigh for 10 seconds to deliver the medications. Remove tip from leg and massage injection site for 10 seconds.

Demonstration - EpiPen®

Documentation Every dose of medication need to documented with the date, time and initials of the person administering the medication on the medication log.

Questions? School Nurse Medical Provider Parent

To Download this PowerPoint Presentation, go to:

Any comments regarding this webcast? Any suggestions on future school nursing topics? Contact: Rachel Gallagher (608) 266-8857 E-mail: rachel.gallagher@dpi.wi.gov

Take Test. Upon Completion, take test to nurse or administrator for scoring.