Assisting Students With Severe Allergies:

Epinephrine Auto-injector Training

Instructor’s Name: Myra Pickard, RN BSN, NCSN

July 2006 2

Anaphylaxis Basics

What is anaphylaxis? It is a rapid, severe allergic reaction that occurs

when a person is exposed to an allergen (something to which the person is allergic).

Anaphylaxis can result in death within minutes.

Death may be caused by: Swelling that shuts off the airway or A dramatic drop in blood pressure.

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Anaphylaxis Basics What causes anaphylaxis?

It is a rapid, severe allergic reaction that occurs when a person is exposed to an allergen (something to which the person is allergic).

Exposure to the allergen triggers the body to release chemicals into the bloodstream to protect itself from the allergen.

In people with severe allergies the chemicals released by the body can cause breathing difficulty, swelling, dizziness, shock, and even death.

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Common Triggers for Anaphylaxis

Bee, wasp, yellow jacket and fire ant stings Foods such as peanuts, milk, eggs, fish, shellfish

and some food additives Medications Latex, found in elastic waistbands, balloons, and

some gloves In some cases the exact trigger is not known

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Signs and Symptoms of anaphylaxis

Most Distinctive signs Hives, itchy skin, Swelling or flushing

(sudden redness) of the throat, lips, tongue, or around the eye

Wheezing, shortness of breath, coughing Metallic taste or itching in the mouth Abdominal cramps, nausea, vomiting, or

diarrhea Incresed heart rate

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Other common symptoms

Metallic taste or itching in the mouth Abdominal cramps, nausea, vomiting, or

diarrhea Increased heart rate Sudden decrease in blood pressure and

paleness Sudden feeling of weakness Anxiety or an overwhelming sense of doom Collapse to Loss of consciousness

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Anaphylaxis Basics

Every person is different and symptoms vary.

It is important, if possible, to know the specific symptoms for the student that you will assist.

Symptoms appear within a few seconds after the exposure to the trigger.

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Anaphylaxis Basics

Anaphylaxis is a medical emergency. Death can occur within minutes. Anaphylaxis requires immediate

attention.

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Treating Anaphylaxis

Preventing anaphylaxis is the first goal, avoiding substances that trigger severe allergic reactions.

Epinephrine is the medication used tp treat anaphylaxis which comes in a spring loaded syringe already filled with the right amount of medication (epinephrine auto-injector).

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Epinephrine Epinephrine is a

chemical that narrows the blood vessels and opens the airways.

This reverses the low blood pressure and wheezing caused by the allergic reaction.

How is epinephrine packaged? 0.30 milligrams

(mg) – usually for individuals weighing more than 66 pounds

0.15 mg – usually for individuals weighing less than 66 pounds

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Side Effects of Epinephrine

Severe headache Blurred vision Flushed skin Fast or irregular

heart rate Sweating Nausea and

vomiting

Pale skin Dizziness Weakness or

muscle tremors Apprehension,

nervousness, and anxiety

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Storage of Epi Pen

How should the epinephrine auto-injector be stored? Keep at room temperature. Do not refrigerate. Keep out of direct sunlight. Store in its plastic container.

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Anaphylaxis Basics When using an epinephrine auto-injector it

is important to call 911 to get emergency care for the student.

Emergency care is important because the effects of epinephrine can wear off and there is a chance of a second reaction.

Send the used epinephrine auto-injector with the student to the emergent care facility.

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Responding in Case of Anaphylaxis

Epinephrine Auto-injector Caution

Accidental injection into the hands or feet may result in loss of blood flow to the affected area. If this occurs go immediately to the nearest emergency department for treatment.

Do not remove the safety cap until you are ready to inject this medication. Never put your fingers over the tip when removing the safety cap or after the safety cap has been removed.

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Documentation What to document?

Note time of event What you observed What the student reported or did What you did What happened after you did what you did Note time of call for emergency assistance and the

time of arrival Note time of call to parent/legal guardian and the

results of call Note notification of appropriate individuals following

event

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Reporting Student Assistance

Any assistance provided to an assigned student must be reported immediately to the school administrator on duty and/or the school nurse.

The nurse who is providing oversight for the school must be notified within 24 hours.

A nurse will review the event and actions taken.

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Questions

Practice

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References American Academy of Allergy, Asthma & Immunology (

www.aaai.org) Anapen (www.anapen.com)

(www.anapen.com/a_anapen/a_anapen.htm) EpiPen (www.allergic-reactions.com) (www.allergic-

reactions.com/pdf.PatientInsert.pdf) (www.allergic-reactions.com/howtouse.aspx)

Food Allergy & Anaphylaxis Network (www.foodallergy.org) Litarowsky, Murphy, & Carham (October 2004). Evaluation

of an Anaphylaxis Training Program for Unlicensed Assistive Personnel, The Journal of School Nursing, 20(5), 279 – 284.

National Association of School Nurses, Position Statement: The Role of School Nurses in Allergy/Anaphylaxis Management. (www.nasn.org)

Twinject (www.twinject.com) (www.twinject.com/hcp/useinstru.asp)