What is Anaphylaxis?

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What is Anaphylaxis?

• Is this a problem at school?

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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

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Anaphylaxis is...

• An allergic reaction that can affect the entire
  body
• It can be fatal
• It happens quickly
• It often has an identifiable cause

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It can affect the whole body

• Skin
• Breathing
• Heart
• Stomach
• Head

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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

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Common Causes

• Food
• Medication
• Insect stings
• Latex
• Some have an unknown cause

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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

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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

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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

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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

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Developing the Classroom Health Care Plan

• Your 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.

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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

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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

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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.

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What is Epinephrine?

• It is a hormone produced by all of us in the
  adrenal glands
• It is often referred to as Adrenaline

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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.

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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.

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Epinephrine!

• EpiPen
• Twinjet

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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.

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Avoidance!

• What about nut free zones?
• Consider a nut free table in the cafeteria.
• A nut free classroom is another consideration

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Quiz Time

• What is anaphylaxis?
• What are the symptoms of a reaction?
• Who is at risk for an anaphylactic reaction?

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What is an EpiPen

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

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How to use the EpiPen
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Remove the Epipen from the plastic tubeRemove
the gray cap
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• Put the gray cap against the middle of the
  outer side of the upper leg

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Hold for 10 seconds
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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

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Lets Practice
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How to use a Twinjet

1. 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.

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Next...

• 2. Pull off the RED end cap labeled
  "2."

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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.

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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.

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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.

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Then...

• Slide the YELLOW or ORANGE collar off the
  plunger.

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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.

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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.

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Proper Disposal

• Give your used Twinjet to a healthcare worker for
  proper disposal. Do not throw away in a regular
  trash can.

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• Prepared by Mary Clark RN, NCSN
• Reviewed by Paula Peterson APNP
• Primary Childrens Hospital
• Salt Lake City, Utah
• JMJ Publishers
• 1156 Wilson Ave.
• Salt Lake City, Utah 84105
• 801 467-5083