6.5.1_anaphylaxis_final.pdf

7/27/2019 6.5.1_Anaphylaxis_final.pdf

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Community HealthPolicies, Procedures and Guidelines

Procedures

Date Issued: 2007 6 ProceduresDate Reviewed: 2007, 2012 6.5 Emergency CareReview Date: 2015 6.5.1 AnaphylaxisEQuIP: 1.1.1

6.5 Emergency Care

6.5.1 Anaphylaxis

Aim

To identify the signs and symptoms of anaphylaxis and provide emergency care.

Equipment

• Adrenaline autoinjectors:

o EpiPen® Jr or Anapen ® 0.15mg (150 micrograms) Jr for children 10-20kg, aged approximately 1 - 5 years - coloured green.

OR

o EpiPen® or Anapen® 0.3mg (300 micrograms) for children over 20kg,aged approximately over 5 years -coloured yellow.

OR

• Adrenaline 1:1000, mg per mL

o Adrenaline 1:1000 contains 1mg of adrenaline per mL of solution in a1mL glass vial.

o 1mL syringeo Hazardous disposal container for sharps.

Table 1

Less than 1 year 0.05–0.1 mL

1–2 years (approx. 10 kg) 0.1 mL





13 years and over (over 40 kg) 0.5 mL

(The Australian Immunisation Handbook)

• ASCIA Action Plan for Anaphylaxis - Australasian Society of ClinicalImmunology and Allergy (ASCIA).



6 ProceduresDate Reviewed: 2007, 2012 6.5 Emergency CareReview Date: 2014 6.5.1 AnaphylaxisEQuIP: 1.1.1

Key Points

• Adrenaline is the first line of treatment for anaphylaxis (not antihistamine).An adrenaline autoinjector should be administered as soon as possiblewhen it has been identified that an individual is experiencing anaphylaxis.

• If in doubt, give an adrenaline autoinjector.

• In an emergency, assuming the child is school-aged and weighs 10kg ormore, if a junior adrenaline autoinjector pen (0.15mg) is not available use aregular adrenaline autoinjector pen (0.3mg) / or if an autoinjector pen is notavailable substitute adrenaline from 1:1000 vial using Table 1 to identify thecorrect dose.

• Education and health staff in schools do not need parental consent to givean adrenaline/ adrenaline autoinjector for the emergency treatment ofanaphylaxis.

• Nursing staff working within the scope of their nursing practice may provideadrenaline drawn from the 1:1000 adrenaline vial, intramuscularly into thethigh (not deltoid region), in the emergency treatment of anaphylaxis.

• Anaphylaxis in children is most commonly caused by food allergies orinsect stings/bites.

• Any food can cause anaphylaxis. The most common food allergens arepeanuts, tree nuts (e.g. hazelnuts, cashews, and almonds), eggs, cow’smilk, wheat, soybean, fish, shellfish, and sesame.

• Other causes include medications, vaccinations and latex.

• A severe allergic reaction can occur within minutes and usually within 20minutes, but can occur up to 2 hours following exposure to the allergen.

• The reaction may start out with mild symptoms and progress toanaphylaxis, but not in all cases.

• Adrenaline autoinjectors are single use only.

• Anaphylaxis symptoms have the potential to recur after administration ofadrenaline, so an ambulance must be called. Further adrenaline may berepeated after 5 minutes as needed.

• Individuals should be observed in a medical facility for four hours postanaphylaxis.

• An ASCIA Action Plan for Anaphylaxis should be stored with the adrenalineautoinjector.

• Adrenaline autoinjectors should be stored in a cool dark place at roomtemperature - but NOT refrigerated and must be readily available whenneeded and not in a locked cupboard.

• Staff involved in immunisation provision should refer to specific adrenalineAustralian Immunisation Handbook for managing anaphylaxis.http://www.immunise.health.gov.au/ and

http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home




Process

PROCEDURE ADDITIONAL INFORMATION

1. Assess symptoms Symptoms of anaphylaxis – a severe allergic

reaction can include;

• difficulty breathing or noisy breathing,

• swelling of the tongue,

• swelling / tightness in the throat,

• difficulty talking and / or a hoarse voice,

• wheezing or persistent coughing,

• young children may appear pale and floppy,

•abdominal pain or vomiting (when associatedwith an allergic reaction to an insect sting orbite).

• persistent dizziness

• loss of consciousness and / or collapse.

2. Lay person flat and elevatelegs- (if conscious)

3. If unconscious placehim/her on the left side andposition to keep airwayclear.

Do not allow person to stand or walk (even ifsymptoms have subsided).

If breathing is difficult allow to sit up.

4. Give adrenalineautoinjector or appropriatecalculated adrenalinedose.

If in doubt, give the adrenaline/ adrenalineautoinjector.

Adrenaline is life saving and must be usedpromptly. Withholding or delaying the giving ofadrenaline can result in deterioration and death.

If adrenaline is given to a child who does not haveanaphylaxis, the child will experience raised heartrate and become pale and sweaty, and may feelanxious and shaky, but there will be no lasting illeffects.

Instructions for administration are written on thepen.

5. Call and ambulance Phone 000 (landline) or 112 (mobile phonenetwork).

If no timely ambulance service (e.g. rural setting)arrange for the child to be transported to a healthservice or medical practitioner. Two people totravel with the child (one driving, one monitoring




PROCEDURE ADDITIONAL INFORMATION

and providing reassurance).

6. Inform parents as soon aspracticable.

If on a school site, inform school Principal ordelegate as soon as possible.

7. Give further adrenaline ifno response after 5minutes- repeat doseevery 5 minutes untilimprovement occurs.

Continue providing reassurance.

Further doses of adrenaline can be providedevery 5 minutes, should signs and symptomspersist/ relapse.

8. Monitor vital signs untilambulance arrives

Use clinical judgement to monitor vital signsapplicable to the first aid situation, which mayinclude:

• Consciousness

• Respiration rate

• Heart rate

Commence CPR if necessary.

Send used adrenaline vial/adrenaline autoinjectorwith ambulance.

Provide ambulance officers with clinical details toassist client treatment- sequence of events, timeand dosages of adrenaline.

All cases of anaphylaxis must be sent to hospitalfor further observation and treatment.

9. Document events as soonas possible.

Use appropriate CHS records (Community healthforms) to document sequence of events, clinicalnotes, communications and decision-making.

Provide the Principal with required information fortheir critical incident reporting.

10. Advocate for debriefingpost-incident

Individuals involved in the incident may benefitfrom post incident counselling.

Review responses and sequence of events, andsuggest changes to policies and practice ifnecessary.

11. Follow up Ensure a suitable emergency action plan isprovided by parents/guardians to follow for futureevents.

Encourage follow-up medical care for the

individual.




7 steps to allergy awareness in schools.

1. Understand roles and responsibilities.

2. Determine what allergies you need to manage.

3. Assess the risk of allergen exposure.4. Minimise the risk of allergen exposure.

5. Train staff and plan emergency response.

6. Communicate with the school community.

7. Review and assess management strategies.

For more information see Anaphylaxis management guidelines in schools

Note

• The Health, Safety and Civil Liability (Schools and Childcare Services) Act 2010

supports trained staff in schools and child care to administer an adrenaline

autoinjector, without parental consent, to a child they believe to be experiencing

anaphylaxis, whether or not that child has been prescribed an adrenaline

autoinjector.

• The POISONS REGULATIONS 1965 Part 5: Sale, supply and use of poisons,

Division 3, General r. 41D Adrenaline for schools or child care services, enables

schools and child care services to keep and supply an adrenaline autoinjector

for general use.




Useful Links

Anaphylaxis: Key messages for health professionals -http://docs.health.vic.gov.au/docs/doc/Anaphylaxis:-key-messages-for-health-professionals

Department of Health 2011, Anaphylaxis, Resources for anaphylaxis management in schools and child care services in Western Australian ,Perth. http://www.health.wa.gov.au/anaphylaxis/home/

Health, Safety and Civil Liability (Children in Schools and Child Care Services) Bill 2010 . 2010, Western Australia, Government of WesternAustralia: Department of Premier and Cabinet.http://www.parliament.wa.gov.au/parliament/bills.nsf/D003AAD9F5A51D3B

4825774400108250/$File/Bill126-1B.pdf

Remote Area Nursing Guidelines (4 th ed). 2005, Department of Health WA.http://www.nursing.health.wa.gov.au/docs/reports/Remote_Area_Nursing_Emergency_Guidelines.pdf

The Australian Immunisation Handbook 9th Edition . 2008, The AustralianGovernment: Department of Health and Aging, National Health and MedicalResearch Council, http://www.immunise.health.gov.au/

The Australasian Society of Clinical Immunology and Allergy (ASCIA) http://www.allergy.org.au

The Australasian Society of Clinical Immunology and Allergy (ASCIA) –e-learning package at http://www.allergy.org.au/

6.5.1_anaphylaxis_final.pdf

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