1. Assisting Students With Severe Allergies: Epinephrine Auto-injector Training Instructor’s Name: Myra Pickard, RN BSN, NCSN

2. July 20062 Anaphylaxis Basics  What is anaphylaxis? It is a rapid, severe allergic reaction that occurs when a person is exposed to an allergen (something to which the person is allergic). Anaphylaxis can result in death within minutes. Death may be caused by:  Swelling that shuts off the airway or  A dramatic drop in blood pressure.

3. July 20063 Anaphylaxis Basics  What causes anaphylaxis? It is a rapid, severe allergic reaction that occurs when a person is exposed to an allergen (something to which the person is allergic). Exposure to the allergen triggers the body to release chemicals into the bloodstream to protect itself from the allergen. In people with severe allergies the chemicals released by the body can cause breathing difficulty, swelling, dizziness, shock, and even death.

4. July 20064 Common Triggers for Anaphylaxis Bee, wasp, yellow jacket and fire ant stings Foods such as peanuts, milk, eggs, fish, shellfish and some food additives Medications Latex, found in elastic waistbands, balloons, and some gloves In some cases the exact trigger is not known

5. July 20065 Signs and Symptoms of anaphylaxis Most Distinctive signs  Hives, itchy skin, Swelling or flushing (sudden redness) of the throat, lips, tongue, or around the eye  Wheezing, shortness of breath, coughing Metallic taste or itching in the mouth Abdominal cramps, nausea, vomiting, or diarrhea Incresed heart rate

6. July 20066 Other common symptoms Metallic taste or itching in the mouth Abdominal cramps, nausea, vomiting, or diarrhea Increased heart rate Sudden decrease in blood pressure and paleness Sudden feeling of weakness Anxiety or an overwhelming sense of doom Collapse to Loss of consciousness

7. July 20067 Anaphylaxis Basics  Every person is different and symptoms vary.  It is important, if possible, to know the specific symptoms for the student that you will assist.  Symptoms appear within a few seconds after the exposure to the trigger.

8. July 20068 Anaphylaxis Basics  Anaphylaxis is a medical emergency.  Death can occur within minutes.  Anaphylaxis requires immediate attention.

9. July 20069 Treating Anaphylaxis Preventing anaphylaxis is the first goal, avoiding substances that trigger severe allergic reactions. Epinephrine is the medication used tp treat anaphylaxis which comes in a spring loaded syringe already filled with the right amount of medication (epinephrine auto-injector).

10. July 200610 Epinephrine  Epinephrine is a chemical that narrows the blood vessels and opens the airways.  This reverses the low blood pressure and wheezing caused by the allergic reaction.  How is epinephrine packaged? 0.30 milligrams (mg) – usually for individuals weighing more than 66 pounds 0.15 mg – usually for individuals weighing less than 66 pounds

11. July 200611 Side Effects of Epinephrine Severe headache Blurred vision Flushed skin Fast or irregular heart rate Sweating Nausea and vomiting Pale skin Dizziness Weakness or muscle tremors Apprehension, nervousness, and anxiety

12. July 200612 Storage of Epi Pen  How should the epinephrine auto- injector be stored? Keep at room temperature. Do not refrigerate. Keep out of direct sunlight. Store in its plastic container.

13. July 200613 Anaphylaxis Basics  When using an epinephrine auto-injector it is important to call 911 to get emergency care for the student.  Emergency care is important because the effects of epinephrine can wear off and there is a chance of a second reaction.  Send the used epinephrine auto-injector with the student to the emergent care facility.

14. July 200614 Responding in Case of Anaphylaxis  Epinephrine Auto-injector Caution  Accidental injection into the hands or feet may result in loss of blood flow to the affected area. If this occurs go immediately to the nearest emergency department for treatment.  Do not remove the safety cap until you are ready to inject this medication. Never put your fingers over the tip when removing the safety cap or after the safety cap has been removed.

15. July 200615 Documentation  What to document? Note time of event What you observed What the student reported or did What you did What happened after you did what you did Note time of call for emergency assistance and the time of arrival Note time of call to parent/legal guardian and the results of call Note notification of appropriate individuals following event

16. July 200616 Reporting  Student Assistance Any assistance provided to an assigned student must be reported immediately to the school administrator on duty and/or the school nurse. The nurse who is providing oversight for the school must be notified within 24 hours. A nurse will review the event and actions taken.

17. July 200617  Questions  Practice

18. July 200618 References  American Academy of Allergy, Asthma & Immunology (www.aaai.org)www.aaai.org  Anapen (www.anapen.com) (www.anapen.com/a_anapen/a_anapen.htm)www.anapen.comwww.anapen.com/a_anapen/a_anapen.htm  EpiPen (www.allergic-reactions.com) (www.allergic- reactions.com/pdf.PatientInsert.pdf) (www.allergic- reactions.com/howtouse.aspx)www.allergic-reactions.comwww.allergic- reactions.com/pdf.PatientInsert.pdfwww.allergic- reactions.com/howtouse.aspx  Food Allergy & Anaphylaxis Network (www.foodallergy.org)www.foodallergy.org  Litarowsky, Murphy, & Carham (October 2004). Evaluation of an Anaphylaxis Training Program for Unlicensed Assistive Personnel, The Journal of School Nursing, 20(5), 279 – 284.  National Association of School Nurses, Position Statement: The Role of School Nurses in Allergy/Anaphylaxis Management. (www.nasn.org)www.nasn.org  Twinject (www.twinject.com) (www.twinject.com/hcp/useinstru.asp)www.twinject.comwww.twinject.com/hcp/useinstru.asp