The document provides training on recognizing and treating anaphylaxis reactions using epinephrine auto-injectors (EpiPens). It outlines symptoms of anaphylaxis, potential allergens like foods, insects and medications. It details steps for EpiPen administration including obtaining, storing and handling the device. Trainees learn to follow the "Five Rights" of using epinephrine - having the right student, medication, dose, route of injection and timely administration. Responding to reactions may require activating emergency services and locating additional trained staff.

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

37. EMERGENCY PLAN 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…”