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