2. Objectives:
Recognize early signs of an allergic reaction
State immediate and safe response
Administer EpiPen accurately
Activate the Emergency Response System
3. Legal Implications
First aid given in good faith in an emergency situation
protects the provider from civil liability.
See Mass General Laws c.71,s.55A
First aid is the immediate and temporary care provided to
a victim of an injury or illness until the service of a
physician can be obtained. Examples of life saving
techniques are listed below:
Cardiopulmonary respiration (CPR)
Heimlich maneuver
Giving epinephrine
By law, the EpiPen is the only “as needed” medication
that can be given by trained school personnel.
Scheduled meds may be delegated at the discretion of the
school nurse.
4. Pre-Test
List three causes of an allergic reaction
Give three signs of an allergic reaction
Demonstrate how to administer an EpiPen
5. Responsibilities of Staff:
Be aware of children at risk
Identify allergic signs and symptoms
Familiarize yourself with the student’s Individual Emergency
Plan
Administer EpiPen only to those who have a prescription
Initiate Emergency Response System:
Call for help
Call the school nurse
Call 911
7. What is Anaphylaxis?
Anaphylaxis or “general body reaction”
Definition: the overwhelming response of the body to
exposure to an allergen which is life-threatening.
It is not a minor allergic response or food intolerance.
8. Anaphylaxis: Common Causes
Insect stings:
bees, wasps, hornets, yellow jackets, fire ants (South)
Food:
peanuts, tree nuts, shellfish, fish, milk, eggs, wheat
Medications:
antibiotics, aspirin, seizure meds, muscle relaxants
Exercise:
not clearly understood, may be a combination of factors
Latex:
inhaled particles, contact
9. Anaphylaxis: Food Considerations
Cross contamination:
occurs when item is in close contact or proximity to
offending foods
i.e. located in storage container in bakery
Cross reaction:
item is made up of similar structure
i.e. mango and cashews
Hidden ingredients:
read labels as some items may be listed under alternate
names
i.e. milk - whey, casein
17. Treatment:
Early recognition of signs and symptoms and early
treatment are important.
EpiPen (epinephrine) is the drug of choice:
If student has had a suspected exposure
If the student is having any of the above signs or
symptoms
If the signs and symptoms are progressive
Anyone who receives epinephrine must be seen in
the Emergency Room and evaluated by an MD.
18. Medication Administration:
The Rule of Thumb for administering any medication
is to observe the “Five Rights”:
Right person
Right medicine
Right dose
Right route
Right time
Checking the EpiPen: note child’s name on package,
expiration date and color through the clear window
on EpiPen:
It should be clear and colorless.
If discolored or brown or the presence of a precipitate, it
should be replaced.
19. Overview: Administration of EpiPen
How?
Use child’s own EpiPen with correct dosage.
Take out of sleeve, remove the blue top, hold in fist-like manner.
Swing and firmly push orange tip against outer thigh AND hold for a count of ten
seconds.
Pen “clicks” when activated.
Remember to take note of time.
Warning: be sure to avoid touching the orange tip where the needle will eject upon
pressure.
Where?
Outer (lateral) aspect of upper thigh. Expose skin if possible to avoid pressure from
any object that could pre-trigger the EpiPen.
It may be given through clothing.
Why?
To reverse the effects of a severe allergic reaction.
When?
With known exposure or beginning symptoms of a severe reaction according to the
Individual Emergency Plan.
20. How?
Use child’s own EpiPen
with correct dosage.
Take out of sleeve,
remove the blue top,
hold in fist-like manner.
21. Warning: be sure to avoid touching the orange tip
where the needle will eject upon pressure.
22. Where?
Outer (lateral) aspect of
upper thigh. Expose skin if
possible to avoid pressure
from any object that could
pre-trigger the EpiPen.
It may be given through
clothing.
Use swinging motion to
push firmly against outer
thigh, so it “clicks” AND
hold for 10 seconds.
23. How The EpiPen Works:
The design is an auto injector system which is spring
loaded and activated by pressure. Use only once and
discard by returning to plastic sleeve or give to EMT. The
needle will be covered by the orange sleeve after auto
injection.
Epinephrine counters the effects of an allergic reaction in
the cardiovascular and respiratory systems:
constricts blood vessels
relaxes muscles in lungs
reverses swelling and hives
stimulates the heartbeat
Onset: begins working in seconds
Duration: short, between 10-20 minutes
27. EpiPen Warning: Self-Injection
If you inject yourself inadvertently, particularly in the
extremities, seek medical care in the Emergency
Room as Epinephrine will cause blood vessels to
constrict resulting in tissue damage.
Epinephrine is usually safe to give and in life saving
situations, it is essential.
28. EpiPen: Calling 911
Always stay with the child.
Call or if possible direct
someone to call 911.
Direct someone to meet
EMTs at nearest entrance.
Give information: “I have a
student with anaphylaxis
and have given
Epinephrine.”
Stay on the line until
further directed by
dispatcher.
29. EpiPen: Development of Reaction
Reactions are unpredictable in the way they develop.
Some may be mild initially and respond to the
medication.
Others may develop quickly to a generalized, serious
anaphylactic reaction within minutes.
It is important to be aware of a Bi-phasic reaction.
This can occur after the initial reaction, within minutes or
up to hours.
It is often unexpected and could be life threatening.
Anyone who receives an EpiPen (epinephrine) must be
seen in the Emergency Room and evaluated by an MD.
30. EpiPen Procedure: Review Steps
Recognize signs and symptoms
Stay calm
Call for “help” (nurse, 911)
Give EpiPen (take note of time administered)
Stay with child
31. Post Test
List three causes of an allergic reaction
Give three signs of an allergic reaction
Demonstrate how to administer an EpiPen
32. Post Review: Demonstration (Required)
This training is not complete until you demonstrate
EpiPen administration competency to your building
School Nurse.
Please go to your building Nurse to demonstrate
correct EpiPen administration.
Your building nurse is always available to answer
any questions or concerns.
33. References Credits
Anderson et al (1995)
Asthma and Allergy
Foundation
The Comprehensive
School Health Manual
Food Allergy Network
Massachusetts General
Laws
The Bradford Family:
William, Robbie, and
Sally
Sue Howard, MEd, MA
Nicki Richards, RN,
BSN, MS
Kate Bell, RN, MEd
