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  • 1. EpiPen Administration Newberg School District Revised 5/2010
  • 2. You may feel like this now….
  • 3. But after this presentation, you’ll feel like this…
    • .
  • 4. Introduction
    • Anaphylaxis is a sudden severe allergic reaction
    • Sensitive individuals can experience reactions from:
      • Food
      • Medication
      • Insect stings
      • Exercise
      • Other
  • 5. Introduction, cont’d.
    • In the US each year there are:
      • Approximately 50 deaths due to insect stings
      • Approximately 100 deaths related to food allergies
  • 6. Immediate injection of epinephrine is the single factor most likely to save a life during anaphylaxis!
  • 7. Explanation of Laws
    • Person must meet qualifications for training
      • Be 21 years of age or older
      • Reasonable expectation to come into contact with sensitive individuals
      • Complete approved training program
  • 8. Who Should Be Trained ?
    • Public or private school employees
    • Camp counselors or employees
    • Youth organization staff or volunteers
    • Forest rangers
    • Foremen of forest workers
    • Any person with exposure to risk
  • 9. Who Should Be Trained ?
    • Additional training
      • These persons are strongly encouraged to obtain and maintain current training in approved First Aid and CPR course
  • 10. Training Overview
    • Recognizing Anaphylaxis
    • What can trigger anaphylaxis?
      • Insect stings, food, medication, other
    • For each allergen:
      • Avoidance measures
    • Developing an Emergency Plan
  • 11. Training Overview, continued
    • Treatment for Anaphylaxis
      • Basic information about epinephrine
      • How to give epinephrine
      • Sequence of steps for responding to anaphylaxis
    • Quiz
    • Demonstration
  • 12. What is ANAPHYLAXIS?
    • Anaphylaxis is a generalized, immediate life-threatening reaction to a foreign protein or allergen
      • Insect’s venom
      • Food
      • Medication
      • Pollen
      • Other
  • 13. What is Anaphylaxis?
    • Severe life-threatening allergic reactions are rare
    • Immediate administration of epinephrine is vital
    • Person may be unable to self-administer
    • Person may have no history of allergic response
  • 14. What is Anaphylaxis?
    • The 2 key steps in saving a life are:
      • Recognition of anaphylaxis when it occurs; and
      • Swift administration of epinephrine
  • 15. Recognizing Anaphylaxis
    • There are many possible symptoms
    • There may be only one symptom, or there may be many!
    • What symptoms has the person experienced before
    • Reactions vary from person to person
  • 16. Recognizing Anaphylaxis
    • Anaphylaxis usually occurs quickly
      • Reaction can start within seconds
      • Death can occur within minutes
      • Delayed reactions are also possible
      • It is never safe to assume just because a allergic reaction did not occur with pervious allergen exposure that one will not develop a serious reaction in the future.
  • 17. Symptoms Of Anaphylaxis (slide 1 of 3)
    • Sneezing, wheezing, or coughing
    • Shortness of breath / Difficulty breathing
    • Tightness in chest
    • Difficulty swallowing
    • Hoarseness
    • Swelling of eyes, lips, face, tongue or elsewhere
  • 18. Symptoms Of Anaphylaxis (slide 2 of 3)
    • Sweating and anxiety
    • Nausea, abdominal pain, vomiting and diarrhea
    • Dizziness and/or fainting
    • Loss of bowel or bladder control
    • Sense of impending doom or death
    • Rapid or weak pulse
  • 19. Symptoms Of Anaphylaxis (slide 3 of 3)
    • Flushed skin or extreme pallor
    • Itching, with or without hives
    • Raised red rash in any area of the body
    • Burning sensation, especially in face or chest
    • Blueness around lips, inside lips, or eyelids
    • Loss of consciousness
  • 20. Possible Allergens - Insects
    • It is estimated that 8 in every 1,000 people are allergic to insect stings
    • Stinging insects account for 40 to 100 deaths per year in the U.S.
  • 21. Possible Allergens - Insects
    • Bees, wasps, hornets and yellow jackets cause most fatal reactions
    • Yellow jackets are most common in the Pacific Northwest
    • Insects are more likely to sting during the late summer and fall
    • Bees are more likely to sting on warm, bright days
  • 22. Insect Identification
    • If possible, it is important to identify stinging insects, but this should never delay treatment!
    • Only the honey bee leaves a “stinger”
  • 23. How to Avoid Insect Stings
    • Stinging insects are attracted to:
      • Light yellow and blue colors
      • Sweet drinks (soft drinks, juice, beer)
      • Cosmetics, lotions, perfumes, and hair spray
      • Paint fumes
      • Food odors
      • Heat given off by dark colors
  • 24. Increased Risk of Insect Stings Associated With:
    • Picnics, cooking / eating outdoors
    • Areas of trash / garbage
    • Areas of insect habitat
    • Flowers
    • Bright colored clothing
    • Fragrant perfumes / cosmetics
    • Exposed skin
    • Becoming excited
  • 25. How To Avoid Insect Stings
    • Sensitive or suspected sensitive person should wear:
      • Smooth, hard finish white or tan clothing
      • Hats
      • Long sleeved shirts and slacks
      • Socks and shoes
    • Gently brush insects away - don’t swat
  • 26. Four types of insect sting reactions
    • Normal
    • Localized
    • Toxic
    • Anaphlatic
  • 27. What is not an anaphylactic reaction to insect sting?
  • 28. What is not an anaphylactic reaction to insect sting? Continued
    • Localized Reactions To Insect Stings
    • Allergic reaction to allergen
    • Involves pain, itching and swelling
      • Larger area of swelling than normal reaction
      • Swelling extends and crosses major joint line
      • Swelling does not involve other areas of body
    • May be delayed
    • Symptoms may last up to one week or more
  • 29. Intervention Steps For Normal and Localized Reactions
    • Remove stinger as soon as possible
    • Cleanse sting site
    • Apply ice pack
    • Elevate limb
    • Reassure and calm the person
    • Observe for at least 30 minutes to 60 minutes
  • 30. Toxic Reactions To Stings
    • Systemic reaction results from multiple stings (usually 10 or more)
    • Symptoms may include:
      • Gastrointestinal, diarrhea, vomiting
      • Drowsiness, fainting, or unconsciousness
      • Generalized swelling
      • Headache and fever
      • Muscle spasms or convulsions
  • 31. Intervention Steps For Toxic Reactions
    • Stay with person - delegate call to 9-1-1
    • Observe for symptoms of anaphylaxis
    • Give epinephrine if necessary
    • Remove stingers promptly
    • Reassure and calm person
    • Have person transported for medical help
  • 32. Possible Allergens-Foods
      • Nearly any food can trigger an allergic reaction at any age
      • Food allergies are most common in children and appear to be increasing in frequency
      • Approximately 4 percent of US children have a food allergy
      • The food does not have to digest to cause an anaphalatic reaction. Do not delay treament.
  • 33. Possible Allergens - Foods
    • Foods most often associated with anaphylaxis:
    • Peanuts
      • Most common cause of anaphylaxis in children
      • The food most frequently causing fatal reactions
    • Fish and shellfish
      • Shellfish are the food most frequently causing
      • anaphylaxis in adults
    • Tree Nuts
    • Eggs
    • Soy
    • Milk
    • Wheat
  • 34. Food Avoidance
    • Avoid exposure to known allergens
    • Inform food preparation personnel of known allergies
    • Lunch swapping or sharing should be avoided
    • Read labels on food & skin-care products
    • Avoid cross-contamination
  • 35. Possible Allergens - Medications
    • A person may experience reactions to any medication at any time
    • Most common medications to cause reactions:
      • Penicillin
      • Aspirin
      • Allergy injections
  • 36. Other Possible Allergens
    • Pollens
    • Latex
      • Gloves, balloons, rubber bands,
      • ace wraps, first aid tape, erasers, bungee cord
    • Unknown substances
    • Excerise
    • Prepare for identified and unidentified individuals
    • Know where the epinephrine is kept
    • Who is trained to give epinephrine
    • Who is 1 st aid/CPR trained
    • Review the plan yearly
  • 38. Identifying the sensitive individual
    • Steps to take BEFOREHAND:
    • Who in your group has a history of severe allergic reactions?
    • Get signed consent for emergency treatment.
    • Know how to get emergency help
      • Where is the nearest hospital? EMT unit?
      • Determine ahead of time how to call for help
  • 39. Treatment For Anaphylaxis
    • Administer epinephrine at the first sign of a systemic reaction
    • Timing is essential
    • The sooner that epinephrine is given, the greater the chance for survival
  • 40. Epinephrine
    • Powerful drug used for treatment of anaphylaxis
    • Must be obtained by prescription
    • Most immediate and effective treatment available
    • Can only be injected into fatty area under the skin, usually the lateral thigh
    • May have side effects
  • 41. What does epinephrine do in the body?
    • It quickly constricts blood vessels, raising blood pressure
    • It relaxes smooth muscles in the lungs to improve breathing
  • 42. Epinephrine continued…
    • It stimulates the heart beat
    • It works to reverse the hives and swelling around the face and lips
  • 43. Possible Side Effects/Risks Of Epinephrine
    • Rapid heart rate
    • Nervousness or anxiety
    • Nausea
    • Vomiting
    • Sweating
    • Pallor
    • Tremors
    • Headache
  • 44. Oppies
    • Accidental injection into the hands or feet may result in loss of blood flow to the affected area and will require immediate treatment in the Emergency Department (ED)
  • 45. Storage And Handling Of Epinephrine
    • Store in dark place at room temperature
      • Do not allow syringe to freeze
    • Keep away from sunlight
    • Check medication for discoloration
      • Solution should be clear
    • Check expiration date
  • 46. The 5 “RIGHTS” of epinephrine administration…
    • Right student
    • Right medication
    • Right dose
    • Right route
    • Right time
    • Every Student Every Time
  • 47. Right student…
    • Identify the student with the known allergy.
      • Use the photo on the IHP
      • Introduce yourself personally to the student prior to allergen exposure
      • Explain to the student that you will assist him/her with an EpiPen in the event of an allergen exposure.
    • The student should be able to identify you as a resource in the event of allergen exposure.
  • 48. Right medication…
    • Epinephrine is available in an auto injector called an EpiPen
  • 49. Right dose…
    • An EpiPen comes in TWO different doses:
      • EpiPen 0.3 mg (over approx.66 lbs.)
      • EpiPen Jr. 0.15 mg (under approx 66 lbs.)
  • 50. Right route…
    • The EpiPen is administered into the large outer thigh muscles
  • 51. Right time…
      • Based on student’s symptoms and ECP
        • e.g., hives spreading over the body, wheezing, difficulty swallowing or breathing, swelling in face or neck, tingling or swelling of tongue, vomiting, signs of shock, such as extreme paleness/gray color, clammy skin, loss of consciousness, or any other child-specific known symptom.
  • 52. Steps in EpiPen administration… Breathe…
    • Have student lie down
    • Look at the directions on the EpiPen
    • It states:
      • Form fist around autoinjector (black tip down)
      • With your other hand, pull off gray cap.
      • Hold black tip near outer thigh
      • Swing and jab firmly into outer thigh so
      • auto-injector is perpendicular (at 90 degree angle) to thigh.
      • Hold firmly in thigh for several 10 seconds.
      • Gently rub injection site for 10 seconds.
    Call for HELP! 911
  • 53. Responding to Anaphylaxis: How to Give Epinephrine, cont’d.
    • Carefully place the used EPIPEN®, needle-end first, into the storage tube of the carrying case, using one hand only to avoid a needle stick.
    • Screw the cap of the storage tube back on completely.
    • If possible, write the time that the medication was given on the carrying case; this can be given to the emergency medical personnel when they arrive.
  • 54. The EpiPen buys you 15 minutes of time…
    • Activating emergency services via 911 immediately is critical
    • Know who the CPR trained staff are in your building so that persons trained in life support can be dispatched to your location
  • 55. What about field trips?
    • Being the the ever-prepared teacher you are, you will see the school secretary at least 2 days prior to leaving to review the student’s IHP and answer any questions you may have.
    • You will meet with the allergic student, explaining that you will have his/her EpiPen and you will be readily available to the student throughout the trip. This includes on student’s bus and at lunchtime.
    • Student “buddy”
  • 56. You are now prepared to administer an EpiPen in a life-threatening allergic emergency!
  • 57. One more thing:
    • You must pass the EpiPen post test and demonstrate competency by being evaluated on the EpiPen trainer by your school nurse.
    • This training is good for one year only and must be repeated annually in order to remain current.
    “ I thought I was done…”