1. Care for Students with Severe Allergies

2. Anaphylaxis: Definition and Interesting Facts Anaphylaxis: –Is a rapid, severe allergic response –Is not always due to an obvious cause –Is not always easy to avoid, even when the cause is known –Is not always accompanied by hives

3. The most commonly documented causes of anaphylaxis include: Food allergies Insect venom Medications Latex Exercise & “unknown” cause are less common causes of anaphylaxis

4. The most distinctive symptoms of anaphylaxis include: Hives/itchy skin Swelling of the throat, lips, tongue, or around the eyes Difficulty breathing or swallowing

5. Other common symptoms of anaphylaxis may include the following: A metallic taste or itching in the mouth Generalized flushing, itching, or redness of the skin Abdominal cramps, nausea, vomiting, or diarrhea Increased heart rate, rapidly decreasing blood pressure (paleness) Anxiety or an overwhelming sense of doom Weakness, collapse, loss of consciousness [Always ask if there are “any know allergies”]

6. Epinephrine (AKA:Adrenaline): Medication of choice for severe allergic reactions Constricts blood vessels Relaxes lung muscles to improve breathing Reverses swelling Increases heart rate

7. Epinephrine, continued: Available by prescription in a single-dose auto-injector called an Epi-pen (or double dose Twin-Jet) Site of injection: thigh Can be given through clothing Needle should be held in place for 10 seconds Call 911

8. Side effects of Epinephrine include: Rapid heart rate Palpitations Sweating Nausea and vomiting Respiratory difficulty Other cardiac (heart) problems

9. Everyone experiencing a severe allergic reaction: Must have 911/emergency medical care following the administration of epinephrine One dose of epinephrine may not be enough!! –Can have a biphasic reaction: a reoccurrence requiring additional treatment

10. Be Prepared Know where the EpiPens are stored ◦ EpiPens are stored at room temperature Be familiar with students who have EpiPens Review the health care plans for students who have EpiPens Frequently review CPR

11. Administration of Epi-Pen Remove pen from cylinder/ check expiration date and fluid clarity Grasp the EpiPen and form a fist around the unit. With the other hand, pull off the GRAY Safety cap. Hold the black tip near the outer thigh. Never put thumb, fingers, or hand over the black tip

12. Jab the black tip firmly into the OUTER THIGH so that the auto injector is perpendicular (at a 90 Degree angle) to the thigh. You will hear a click. (The EpiPen can be injected through the victims clothing, if necessary.) Hold the EpiPen firmly in place for 10 seconds and then remove it from the thigh.

13. m Massage the injection site for 10 seconds. Check the black tip: ◦ If the needle is exposed, the dose has been given ◦ If the needle is not exposed, repeat Return the used EpiPen to the plastic container. Give the used EpiPen to paramedics.

14. Repeat Epi- Pen Administration If symptoms continue and paramedics do not arrive, use a new EpiPen and re- inject 15 to 20 minutes after the initial injection. Continue to monitor the victim’s airway and breathing

15. Continue Monitoring Observe the victim for signs of shock. Cover the victim with a blanket. Monitor the victim’s airway and breathing. Begin CPR immediately if the victim stops breathing.

16. Students at WHRHS with a documented risk of anaphylaxis : Are advised to carry an auto-injector (Epi- pen) and be allowed to self-medicate as needed (if capable). Are sent an Anaphylaxis Care Plan to be completed. –Includes instructions & authorization for use of medication from MD and parent (example of approved care plan attached) Are asked to provide an extra Epi-pen to be stored in the Health Office in an unlocked storage site.

17. Summary at WHRHS response to symptoms of anaphylaxis for students with documented risk: REACT QUICKLY: radio communication/alert Allow student to self-medicate when possible If incapable, administration of Epi-pen by trained personnel Call 911-notify EMS if Epinephrine has been given Call parent, &/or others as directed on care plan or emergency card Document event & place in health file

18. Epinepherine Auto-Injector (Epi-Pen) Designees needed

19. Special thanks to: Jean Litarowsky, School Nurse San Mateo Union High School, and the Vista Unified School District, California for presentation content