These videos appear later in the presentation; you may want to preview them prior to class to ensure they load and play properly. Click on the links above in slideshow view to go directly to the slides.
Planning Your Time: Plan 70 minutes for this chapter.
Allergic Reactions (40 minutes)
Self-Administered Epinephrine (30 minutes)
Note: The total teaching time recommended is only a guideline.
Core Concepts:
How to identify a patient experiencing an allergic reaction
Differences between a mild allergic reaction and anaphylaxis
How to treat a patient experiencing an allergic reaction
Who should be assisted with an epinephrine auto-injector
Teaching Time: 40 minutes
Teaching Tips: Relate the pathophysiology of anaphylaxis to previous lessons on shock and respiratory problems. Discuss how the signs and symptoms may be similar. Multimedia graphics may be helpful in demonstrating patient assessment of an allergic reaction. Use examples of real-life allergic reaction and anaphylaxis to add realism to pathophysiology. Spend time discussing how to differentiate anaphylaxis. Epinephrine is not a benign drug, and EMTs should take care to give it only in the correct circumstances. Teach providers to be constantly alert for anaphylaxis. Rapid changes occur.
Covers Objective: 20.3
Point to Emphasize: An allergic reaction is an exaggerated immune response to a foreign invader in the body.
Covers Objective: 20.3
Covers Objective: 20.3
Covers Objective: 20.4
Knowledge Application: Have students work in small groups. Assign each group a negative effect of an allergic reaction (for example: bronchoconstriction). Have each group describe how assessment would identify that effect (for example: bronchoconstriction = wheezes).
Covers Objective: 20.4
Point to Emphasize: Anaphylaxis is a severe and systemic form of an allergic reaction and should be considered a life-threatening emergency.
Discussion Topic: Define allergy. How is an allergic reaction different from an anaphylactic reaction?
Covers Objective: 20.5
Point to Emphasize: Food, insect bites and stings, plants, and certain medications can cause allergic reactions.
Discussion Topic: Discuss the potential causes of an allergic reaction. Describe at least three common allergies.
Knowledge Application: Assign common causes of allergy. Ask students to research and report on prevalence, severity, and morbidity and mortality.
Critical Thinking: How might an ingested allergen cause a different reaction from that of an injected allergen? Why might these reactions present differently?
Covers Objective: 20.5
Point to Emphasize: Food, insect bites and stings, plants, and certain medications can cause allergic reactions.
Discussion Topic: Discuss the potential causes of an allergic reaction. Describe at least three common allergies.
Knowledge Application: Assign common causes of allergy. Ask students to research and report on prevalence, severity, and morbidity and mortality.
Critical Thinking: How might an ingested allergen cause a different reaction from that of an injected allergen? Why might these reactions present differently?
Covers Objective: 20.5
Covers Objective: 20.6
Covers Objective: 20.6
Talking Points: Swelling (edema) is most common in the face (especially the eyes and lips), neck, hands, feet, or tongue.
Covers Objective: 20.6
Talking Points: Swelling (edema) is most common in the face (especially the eyes and lips), neck, hands, feet, or tongue.
Covers Objective: 20.6
Talking Points: Hives, also known as urticaria, can be localized, especially around the area of a bite or sting, or generalized, presenting over wide areas of the body.
Covers Objective: 20.6
Covers Objective: 20.6
Covers Objective: 20.6
Covers Objective: 20.6
Point to Emphasize: Anaphylaxis can be identified by the signs of an allergic reaction plus airway, breathing, or circulatory challenges.
Discussion Topic: Describe the common signs and symptoms of an allergic reaction and of anaphylaxis. What signs are specific to anaphylaxis?
Covers Objective: 20.6
Point to Emphasize: Patient assessment will determine if the patient is having an anaphylactic reaction or just an allergic reaction. Beware, however, for allergy can rapidly progress to anaphylaxis.
Covers Objective: 20.6
Covers Objective: 20.6
Class Activity: Describe scenarios involving various patients having allergic reactions and anaphylactic reactions. Have a class discussion about whether the signs and symptoms described in each case would be classified as an allergic reaction or an anaphylactic reaction.
Knowledge Application: Use a programmed patient and/or multimedia graphics. Demonstrate various types of allergic reactions and ask groups of students to use patient assessment to identify anaphylaxis.
Covers Objective: 20.6
Covers Objective: 20.6
Covers Objective: 20.6
Covers Objective: 20.7
Discussion Topic: Discuss the indications for epinephrine.
Covers Objective: 20.6
Knowledge Application: Describe various patients with allergic reactions. Ask students whether they would administer epinephrine. Critique the decision and discuss.
Covers Objective: 20.6
Knowledge Application: Describe various patients with allergic reactions. Ask students whether they would administer epinephrine. Critique the decision and discuss.
Covers Objectives: 20.6 and 20.7
Talking Points: You should probably not administer epinephrine for a simple allergic reaction. Epinephrine is a potent drug with potential complications and should not be given without serious consideration. In this case medical control may be able to offer better insight. The findings that would indicate administration in a patient with an allergic reaction include respiratory distress and shock.
Covers Objective: 20.3
Video Clip
Allergic Reaction—Anaphylaxis
What causes anaphylaxis?
What happens to the patient's blood pressure during an anaphylactic reaction?
Explain why a severe allergic reaction can result in respiratory failure.
Covers Objective: 20.3
Video Clip
Information About Allergic Rhinitis
What is allergic rhinitis?
What happens when someone with a sensitized immune system inhales an allergen?
Discuss the role of histamine in an allergic reaction.
What are some treatments for allergic rhinitis?
Teaching Time: 30 minutes
Teaching Tips: Relate epinephrine to previous discussions on the sympathetic nervous system. Discuss how they relate. Have epinephrine auto-injectors and/or auto-injector training devices on hand for demonstration purposes. Always follow sharps safety procedures when handling actual injectors. Take time to discuss anaphylaxis and the true indications of epinephrine. Compare these indications with potential side effects of the medication. Discuss the absolute need for reassessment.
Covers Objective: 20.8
Point to Emphasize: Epinephrine is a natural hormone produced by the body. It is given in cases of anaphylaxis to constrict blood vessels and dilate the bronchioles.
Discussion Topic: Describe the indications for the use of epinephrine.
Covers Objective: 20.8
Covers Objective: 20.8
Point to Emphasize: Epinephrine is indicated in anaphylactic reactions but not in localized allergic reactions.
Discussion Topic: Describe the side effects of the use of epinephrine.
Class Activity: Present a variety of allergic reaction and anaphylaxis scenarios to the class. Ask students whether they would administer epinephrine. Discuss the decision-making process.
Covers Objective: 20.9
Point to Emphasize: An auto-injector is a spring-loaded needle and syringe with a single dose of epinephrine that will automatically release and inject the medication. People with severe allergies commonly carry these devices to deploy in the event of an anaphylactic reaction.
Knowledge Application: Review various types of epinephrine auto-injectors. Review the steps in administering each type.
Covers Objective: 20.9
Point to Emphasize: An auto-injector is a spring-loaded needle and syringe with a single dose of epinephrine that will automatically release and inject the medication. People with severe allergies commonly carry these devices to deploy in the event of an anaphylactic reaction.
Knowledge Application: Review various types of epinephrine auto-injectors. Review the steps in administering each type.
Covers Objective: 20.9
Point to Emphasize: Always consider the "five rights" of medication administration before administering an epinephrine auto-injector.
Knowledge Application: Use programmed patients and practice assisting with an epinephrine auto-injector. Pay particular attention to explaining the steps to the patient.
Covers Objective: 20.9
Discussion Topics: Describe the steps involved in correctly administering an epinephrine auto-injector. Describe the circumstances that might indicate the need for additional epinephrine administration.
Covers Objective: 20.9
Discussion Topics: Describe the steps involved in correctly administering an epinephrine auto-injector. Describe the circumstances that might indicate the need for additional epinephrine administration.
Covers Objective: 20.10
Point to Emphasize: In a severe anaphylactic patient, additional doses of epinephrine may be necessary.
Knowledge Application: Use programmed patients to present reassessment scenarios. Have students work through the decision-making process of secondary epinephrine administration.
Covers Objective: 20.7
Class Activity: Take a voluntary class poll. Find out what types of allergies are present in the class. How severe have prior reactions been? Ask willing students to discuss.
Covers Objective: 20.9
Skill Demonstration: Using a manikin and an auto-injector training device, demonstrate the proper procedure for administering medication via an auto-injector device.
Talking Points: Indications include signs of an allergic reaction plus respiratory distress and/or shock. Allergic reactions are caused by an exaggerated immune response. Common allergens include medications, insects, and foods.
Talking Points: Skin signs include flushing, tingling sensation, and hives. Respiratory signs include difficulty breathing, wheezing, and difficulty speaking. Cardiovascular signs include increased heart rate, hypotension, and pale skin.
Talking Points: Probably not yet and definitely not until you contact medical control. Although this patient is at high risk due to his known allergy, he does not yet have the signs of anaphylaxis. He is breathing normally and no signs of shock are present. You should reassess frequently and consult medical control.