This document summarizes how to identify and treat patients experiencing allergic reactions. It discusses the differences between mild allergic reactions and the life-threatening anaphylaxis, including various signs and symptoms. It outlines the steps for assessing, caring for, and monitoring patients, including when to assist with an epinephrine auto-injector. These include obtaining vital signs and history, applying oxygen, reassessing after epinephrine administration, and consulting medical direction if the patient's condition worsens or improves.

1. Chapter Allergies Sixteen

2. Chapter How to identify a patient experiencing an allergic reaction Differences between a mild allergic reaction and anaphylaxis How to treat the patient experiencing an allergic reaction Who should be assisted with an epinephrine auto-injector CORE CONCEPTS Sixteen

3. Allergic Reaction An exaggerated reaction by the body’s immune system to any substance Anaphylaxis A life-threatening allergic reaction that causes shock (hypoperfusion) and airway swelling K EY TERMS

4. Insect Stings Foods Medications Plants Common Causes of Allergic Reactions

5. Skin (Continued) Signs and Symptoms Itching Hives Flushing Warm, tingling feeling Swelling (especially face, neck, hands, feet, tongue)

6. Tightness in throat/chest Cough Rapid, labored, noisy breathing Hoarseness Stridor and wheezing Respiratory Signs and Symptoms (Continued)

7. Increased heart rate Low blood pressure Cardiac (Continued) Signs and Symptoms

8. Itchy, watery eyes and Generalized Findings runny nose Headache Sense of impending doom (Continued) Signs and Symptoms

9. Decreasing mental status Signs and symptoms of shock (hypoperfusion) or respiratory distress Signs and Symptoms

10. Patient ASSESSMENT Allergic Reactions Signs and Symptoms Initial assessment Focused history and physical exam Baseline vital signs and SAMPLE history (Continued)

11. Patient ASSESSMENT Allergic Reactions Signs and Symptoms What is patient allergic to? What was patient exposed to? How was the patient exposed? What signs and symptoms does patient have? (Continued)

12. Patient ASSESSMENT Allergic Reactions Signs and Symptoms How have the signs and symptoms progressed? What interventions has patient received?

13. Obtain SAMPLE history. Take vital signs.

14. Apply high- concentration oxygen. If the patient meets criteria, assist in patient’s own epi-pen® administration.

15. Patient CARE Allergic Reactions Emergency Care Steps Reassess in 2 minutes. Record reassessment findings. If patient does not have epinephrine auto-injector, transport immediately. (Continued)

16. Patient CARE Allergic Reactions Emergency Care Steps Epinephrine is needed if patient: Has come in contact with something that caused an allergic reaction in the past. (Continued)

17. Patient CARE Allergic Reactions Emergency Care Steps Epinephrine is needed if patient: Shows signs and symptoms of Complains of respiratory distress. shock (hypoperfusion) (Continued) Sometimes patient exhibits BOTH. OR

18. Patient CARE Allergic Reactions Emergency Care Steps Epinephrine is needed if patient: Has a prescribed epinephrine auto-injector. (Continued)

19. Patient CARE Allergic Reactions Emergency Care Steps When the patient does not have respiratory distress or shock (hypoperfusion): Continue with focused Do not give epinephrine. assessment.

20. A IRWAY MANAGEMENT IN ALLERGIC REACTIONS

21. Note The patient may need aggressive airway management immediately, or very soon, because of swelling in the airway or respiratory compromise.

22. Patent shows signs of Indications epinephrine to patient. Medical direction authorizes epinephrine. Epinephrine Auto-Injector allergic reaction. Physician has prescribed

23. NONE, when used in life-threatening situations Contraindications Epinephrine

24. Auto-injector Medication Form Epinephrine

25. Adult Dosage Child One auto-injector One pediatric auto-injector Epinephrine

26. Injector prescribed for Administration this patient? Expiration date past? Liquid cloudy or discolored? Epinephrine

27. If medical direction authorizes epi, remove safety cap. Place injector against patient’s mid-thigh, push and hold for 10 seconds.

28. Dispose of injector and record administration.

29. Epinephrine auto-injectors use needles to administer epinephrine. Injectable drugs are not commonly used at the EMT-B level. This truly life-saving drug is an exception. There are two important points to stress to a new EMT-B: After the auto-injector is placed against the patient’s thigh, it must be held in place to allow the medication to be injected. Simply pressing and immediately removing the device will be ineffective. After the device is used, it must be considered a contaminated sharp and treated accordingly: disposed of in a sharps container! P RECEPTOR P EARL

30. Actions Dilates bronchioles Constricts blood vessels Epinephrine

31. Increased heart rate Pallor and dizziness Chest pain Headache, excitability, and anxiety Nausea and vomiting Side Effects Epinephrine

32. Transport. Continue focused Reassessment Strategies assessment of airway, breathing, and circulation. Epinephrine

33. If patient’s condition WORSENS: Reassessment Strategies Consult medical direction about another dose. Treat for shock. Be prepared to use CPR/AED. Epinephrine

34. Reassessment Strategies If patient’s condition IMPROVES: Continue oxygen. Treat for shock (hypoperfusion). Epinephrine

35. 1. Explain how to identify a patient experiencing an allergic reaction. 2. What are the differences between a mild allergic reaction and anaphylaxis? 3. How is an allergic reaction treated? 4. When and how should the EMT-B assist a patient with an epinephrine auto-injector? R EVIEW QUESTIONS