Recognizing Anaphylaxis in School
Kristin Casey, R.N.
Elizabeth Gartman, R.N.
Common Causes ofCommon Causes of
Allergic EmergenciesAllergic Emergencies
Bee stingsBee stings
What Happens in an AllergicWhat Happens in an Allergic
What is Anaphylaxis ?What is Anaphylaxis ?
• Anaphylaxis is the widespread and
systemic reaction of chemical mediators
affecting the skin, respiratory, GI, and
• This is a life-threatening emergency!!
Signs of Anaphylaxis
• Itching, swelling of
tongue, face, lips
• Tightening of throat,
shortness of breath,
Signs of Anaphylaxis continued
• Hives, rash
Signs of Anaphylaxis continued
• Thready pulse,
• pale skin color
• Sense of
Treatment of AnaphylaxisTreatment of Anaphylaxis
• Anaphylaxis must be treated with an
Epipen. This is injected into the thigh and
works to constrict blood vessels and dilate
or relax smooth muscles in the lungs to
improve breathing, stimulates the
heartbeat, and works to reduce the hives
and swelling around the face and lips.
Administration of EpinephrineAdministration of Epinephrine
• Right patient
• Right medication
• Right dose
• Right route
• Right time
Epinephrine DosagesEpinephrine Dosages
• Epinephrine is available in 2 strengths:
• Epipen Jr 0.15 mg (use in children up to
• Epipen 0.30 mg over 60 pounds.
How Epinephrine WorksHow Epinephrine Works
• Epinephrine quickly relaxes smooth
muscles in the lungs to improve breathing,
constricts blood vessels, stimulates the
heartbeat, and works to reverse hives and
swelling around the face and lips.
Effects of EpipenEffects of Epipen
• The effects of the injection wear off in ten
to twenty minutes. Therefore immediate
activation of the 911 system is essential.
How is Epinephrine Stored?How is Epinephrine Stored?
• Epinephrine is available in what is
called an autoinjector. It is stored at
room temperature and should not be
subjected to any extremes in
temperature. The solution is clear
and colorless and should be replaced
if it is not.
How to Administer an EpipenHow to Administer an Epipen
Remove autoinjector from box or cylindrical container
after making sure the name on the label is for the correct
Pull off blue activation cap.
Hold orange tip near outer thigh.
Swing and jab firmly into outer thigh until autoinjector
Hold in place and count to 10. Remove the Epipen and
massage the injection area for 10 seconds.
Common Side Effects of
• Increase in heart rate
• nervousness or anxiety
Important InformationImportant Information
• After injecting the Epipen and removing
from the student, the needle is retracted
back into the autoinjector lessening the
risk of accidental needle stick.
• If an accidental needle stick occurs,
medical care should be sought.
• Send Epipen container to the hospital with
• If in doubt about the need to administer
Epinephrine then go ahead and give it.
”If it’s more than skin, put it in.”
• Most deaths from allergic reactions occur
because epinephrine was not
Protocol for Handling LifeProtocol for Handling Life
Threatening EmergencyThreatening Emergency
• Observe student
• Recognize symptoms of anaphylaxis
• Administer Epipen
• Call 911 and tell dispatcher that patient
has been given Epipen
• Call parents
• Notify physician
Field TripsField Trips
• All trips out of the school building, even
those to schools within our district, must
be reported to school nurse 2 weeks prior
to the trip. If there is a student with an
Epipen, the nurse will then send home a
“permission to delegate form” to the
student’s parent to sign. The nurse must
be able to delegate to one person whose
name will be on that form. The nurse can
delegate to staff members only!!!
Additional Epipen InformationAdditional Epipen Information
• For more information on Epipens and life
threatening emergencies visit the