1. Copyright DCrowe July 2014 All Rights Reserved This presentation contains audio. Please adjust or turn up the sound on your computer. Life-Threatening Allergies & Epinephrine Training

2. Copyright DCrowe July 2014 All Rights Reserved Life-Threatening Allergies & Epinephrine Training Doreen Crowe, MEd, BSN, RN Director of Nursing Services Wilmington Public Schools

3. Copyright DCrowe July 2014 All Rights Reserved Life-Threatening Allergies & Epinephrine Training The speaker has no conflict of interest to declare. This program did not receive commercial support.

4. Copyright DCrowe July 2014 All Rights Reserved PURPOSE To provide unlicensed* school personnel with basic knowledge and skills to administer epinephrine by auto- injection in a life-threatening situation. *Refers to Medical license

5. Copyright DCrowe July 2014 All Rights Reserved OBJECTIVES 1. Identify common causes of allergic emergencies 2. Accurately recognize general and student- specific warning signs of allergic emergency 3. Accurately identify student for whom the epinephrine is prescribed 4. Accurately read and interpret the emergency medication administration plan 5. Correctly follow directions on the medication administration plan

6. Copyright DCrowe July 2014 All Rights Reserved OBJECTIVES (cont.) 6. Accurately read the epinephrine label and follow directions from the label 7. Administer epinephrine by auto-injector 8. Safely handle epinephrine in an auto-injector 9. Accurately describe the school’s plan for responding to emergencies 10. Access resources appropriately, including emergency medical services, school nurse, parents and physician

7. Copyright DCrowe July 2014 All Rights Reserved THE COMMON CAUSES OF ALLERGIC EMERGENCIES Food Food Insect Stings Insect Stings Medication Medication Latex Latex Exercise (uncommon) Exercise (uncommon)

8. Copyright DCrowe July 2014 All Rights Reserved FOOD Eight Foods account for 90% of all food- allergic reactions

9. Copyright DCrowe July 2014 All Rights Reserved INSECT STINGS Bees Wasps Yellow Jackets Hornets Fire Ants

10. Copyright DCrowe July 2014 All Rights Reserved MEDICATION Antibiotics Anesthesia

11. Copyright DCrowe July 2014 All Rights Reserved LATEX GlovesBand-Aids Balloons

12. Copyright DCrowe July 2014 All Rights Reserved EXERCISE Occurs rarely Occurs rarely Typically occurs within a few hours after eating a specific food Typically occurs within a few hours after eating a specific food

13. Copyright DCrowe July 2014 All Rights Reserved WHAT IS ANAPHYLAXIS? May occur immediately (seconds) or delayed (hours) May occur immediately (seconds) or delayed (hours) Individuals with Asthma are at an increased risk of a severe reaction Individuals with Asthma are at an increased risk of a severe reaction A potentially life-threatening medical condition occurring in allergic individuals after exposure to an allergen

14. Copyright DCrowe July 2014 All Rights Reserved WHAT ARE SYMPTOMS OF ANAPHYLAXIS? Skin Hives Itchy rash Swelling of face or extremities Mouth Itchy, tingling or swelling of mouth, tongue or lips Throat** Itchy throat Tight throat Hoarseness Drooling Stomach Abdominal cramps Nausea Vomiting Diarrhea Lungs** Short of breath Wheezing Repetitive cough Heart** Faint Weak pulse Low blood pressure Pale or blue Other** Anxiety Panic Itchy, watery red eyes **Potentially Life-threatening

15. Copyright DCrowe July 2014 All Rights Reserved HOW MIGHT A CHILD DESCRIBE A REACTION? “My tongue is itching, burning or tingling” “My tongue is itching, burning or tingling” “My mouth feels funny” “My mouth feels funny” “There’s something stuck in my throat” “There’s something stuck in my throat” “My lips feel tight” “My lips feel tight” “There’s a frog in my throat” “There’s a frog in my throat”

16. Copyright DCrowe July 2014 All Rights Reserved WHAT IS A BIPHASIC REACTION? A second wave of symptoms that may occur two to four hours later

17. Copyright DCrowe July 2014 All Rights Reserved WHAT IS EPINEPHRINE? Epinephrine is also known as Adrenalin Epinephrine is also known as Adrenalin Works to: Works to: constrict blood vessels, raise blood pressure, relax smooth muscles in lungs to improve breathing constrict blood vessels, raise blood pressure, relax smooth muscles in lungs to improve breathing *Note: Antihistamines and inhalers/bronchodilators are not to be depended upon to treat a severe reaction such as anaphylaxis, Use Epinephrine. Epinephrine is the medicine of choice for treatment of anaphylaxis

18. Copyright DCrowe July 2014 All Rights Reserved HOW IS EPINEPHRINE DELIVERED? There are 2 Types of Auto-Injectors: There are 2 Types of Auto-Injectors: Auvi-Q Auvi-Q Epipen Epipen There are two strengths: There are two strengths: Adult 0.3mg Adult 0.3mg Child 0.15mg Child 0.15mg

19. Copyright DCrowe July 2014 All Rights Reserved How do you administer Epinephrine? Using the 6 Rights:

20. Copyright DCrowe July 2014 All Rights Reserved RIGHT STUDENT 1. Identify the student with a KNOWN allergy 2. Accurately read and interpret student specific Allergy Action Plan 3. Accurately read the prescription label on epinephrine package

21. Copyright DCrowe July 2014 All Rights Reserved RIGHT MEDICATION Epipen/Epipen Jr. >> OR <<Auvi-Q

22. Copyright DCrowe July 2014 All Rights Reserved RIGHT DOSE Adult 0.3 mg Adult 0.3 mg Child 0.15mg Child 0.15mg Lasts approximately 15 minutes Lasts approximately 15 minutes

23. Copyright DCrowe July 2014 All Rights Reserved RIGHT ROUTE Large Outer Thigh Large Outer Thigh May be administered through clothing May be administered through clothing Hold in place for 5-10 seconds Hold in place for 5-10 seconds Remove carefully Remove carefully Massage area where administered Massage area where administered Note: lie the person down with legs elevated to increase cardiac output

24. Copyright DCrowe July 2014 All Rights Reserved RIGHT TIME Student is in Anaphylaxis

25. Copyright DCrowe July 2014 All Rights Reserved RIGHT DOCUMENTATION School district specific School district specific MDPH Report of Epinephrine Administration: MDPH Report of Epinephrine Administration: https://www.surveymonkey.com/s/EpiPen2014

26. Copyright DCrowe July 2014 All Rights Reserved How do you administer Epinephrine? Step 1 Remove Cap Step 2 EPIPENAUVI-Q Pull Red Safety Cover Swing & jab into outer thighPlace against outer thigh, then press firmly

27. Copyright DCrowe July 2014 All Rights Reserved SCHOOL PROTOCOL 1. Call 911 from a school phone 2. Specify the problem: “A student is in Anaphylaxis & was given Epinephrine” 3. Specify location at school 4. Note time of Epinephrine administration & hand over to EMS upon arrival 5. Call parent to meet student at closest medical facility

28. Copyright DCrowe July 2014 All Rights Reserved EPIPEN STORAGE & HANDLING Properly store at room temperature* Properly store at room temperature* Color in window will be clear Color in window will be clear Avoid accidental injection to yourself or you will require immediate attention at an Emergency Room Avoid accidental injection to yourself or you will require immediate attention at an Emergency Room *Avoid storing in cooler or vehicle

29. Copyright DCrowe July 2014 All Rights Reserved Label Reading 1. Peanuts 2. Tree Nuts 3. Eggs 4. Milk 5. Wheat 6. Soy 7. Shellfish 8. Fish FDA manufactured foods may contain the 8 major food allergens:

30. Copyright DCrowe July 2014 All Rights Reserved Label Reading Read all labels carefully Read all labels carefully Look for product disclaimers, i.e. manufactured in a facility that produces peanuts/tree nuts Look for product disclaimers, i.e. manufactured in a facility that produces peanuts/tree nuts Avoid cross-contact or cross-contamination Avoid cross-contact or cross-contamination Strict avoidance of an allergen is the key to preventing a life-threatening reaction Strict avoidance of an allergen is the key to preventing a life-threatening reaction

31. Copyright DCrowe July 2014 All Rights Reserved Label Reading: Peanut-Free Diet Artificial nuts Artificial nuts Mixed nuts Mixed nuts Peanut butter, oil, flour or protein hydrosylate Peanut butter, oil, flour or protein hydrosylate Baked goods Baked goods Candy (including chocolates) Candy (including chocolates) Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients Avoid Peanuts or any of the following ingredients:

32. Copyright DCrowe July 2014 All Rights Reserved Label Reading: Tree Nut-Free Diet Almonds Almonds Artificial nuts Artificial nuts Brazil nuts Brazil nuts Cashew Cashew Chestnut Chestnut Coconut Coconut Hazelnut Hazelnut Macadamia Macadamia Marzipan/Almond paste Marzipan/Almond paste Mixed nuts Pecan Pesto Pine nut Pistachio Praline Walnut Baked goods Candy (including chocolates) Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients Avoid Tree Nuts or any of the following ingredients:

33. Copyright DCrowe July 2014 All Rights Reserved Label Reading: Milk-free Diet Butter, Buttermilk Butter, Buttermilk Casein Casein Cheese Cheese Lactose, Lactulose Lactose, Lactulose Candy (including chocolates) Candy (including chocolates) Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients Avoid Milk or any of the following ingredients: Sour Cream Sour Cream Whey Whey Yogurt Yogurt Baked Goods Baked Goods Chocolate Candy Chocolate Candy

34. Copyright DCrowe July 2014 All Rights Reserved Label Reading: Egg-free Diet Albumin Albumin Eggnog Eggnog Globulin Globulin Lysozyme Lysozyme Mayonnaise Mayonnaise Baked Goods Baked Goods Ice cream Ice cream Pasta Pasta Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients Avoid Eggs or any of the following ingredients:

35. Copyright DCrowe July 2014 All Rights Reserved Label Reading: Shellfish-free Diet Barnacle Barnacle Crab Crab Crawfish Crawfish Krill Krill Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients Avoid Shellfish or any of the following Ingredients: Lobster Lobster Mollusks Mollusks Prawns Prawns Shrimp Shrimp

36. Copyright DCrowe July 2014 All Rights Reserved Label Reading: Wheat-free Diet Bread crumbs Bread crumbs Cereal extract Cereal extract Couscous Couscous Cracker meal Cracker meal Farina Farina Note: this list is not all inclusive and meant to serve as a reminder to read all labels for ingredients Avoid Wheat or any of the following ingredients: Flour Flour Matzoh Matzoh Pasta Pasta Wheat bran, oil, grass or protein Wheat bran, oil, grass or protein Baked Goods Baked Goods

37. Copyright DCrowe July 2014 All Rights Reserved LIABILITY Epipen Trained personnel are protected by the Good Samaritan law Epipen Trained personnel are protected by the Good Samaritan law Refresher training is renewable annually Refresher training is renewable annually

38. Copyright DCrowe July 2014 All Rights Reserved APPROPRIATE RESOURCES School Nurse School Nurse School Physician School Physician Parent Parent Emergency Medical Services (EMS) Emergency Medical Services (EMS)

39. Copyright DCrowe July 2014 All Rights Reserved “There is no cure for food allergies. Strict avoidance of the offending allergen is the key to preventing a life- threatening reaction.”

40. Copyright DCrowe July 2014 All Rights Reserved COURSE COMPLETION 1. Please take the Post Test for this module. 2. See a School Nurse to demonstrate proper Epinephrine administration with a training device Thank You! PPT Compiled by Heather Crowe, SSU Class of 2015

41. Copyright DCrowe July 2014 All Rights Reserved CONTACT INFORMATION Doreen Crowe, MEd, BSN, RN Nurse Leader Wilmington Public Schools Doreen.crowe@wpsk12.com

42. Copyright DCrowe July 2014 All Rights Reserved REFERENCES AllergyHome - Your Home for All Your Allergy Needs - AllergyHome.org. (n.d.). AllergyHomeorg. Retrieved July 14, 2014, from http://www.allergyhome.org/ AllergyHome - Your Home for All Your Allergy Needs - AllergyHome.org. (n.d.). AllergyHomeorg. Retrieved July 14, 2014, from http://www.allergyhome.org/ Anaphylaxis in Schools and Other Child Care Settings. (n.d.). American Academy of Allergy, Asthma and Immunology. Retrieved July 14, 2014, from http://www.aaaai.org/media/resources/academy_statements/positio n_statements/ps34.asp Anaphylaxis in Schools and Other Child Care Settings. (n.d.). American Academy of Allergy, Asthma and Immunology. Retrieved July 14, 2014, from http://www.aaaai.org/media/resources/academy_statements/positio n_statements/ps34.asp Food Allergy Research & Education. (n.d.). Food Allergy Research & Education. Retrieved July 4, 2014, from http://www.foodallergy.org Food Allergy Research & Education. (n.d.). Food Allergy Research & Education. Retrieved July 4, 2014, from http://www.foodallergy.org Managing Life-threatening Food Allergies in School. (n.d.). MA Department of Elementary & Secondary Education. Retrieved July 14, 2014, from http://www.doe.mass.edu/cnp/news02/allergy.pdf Managing Life-threatening Food Allergies in School. (n.d.). MA Department of Elementary & Secondary Education. Retrieved July 14, 2014, from http://www.doe.mass.edu/cnp/news02/allergy.pdf

43. Copyright DCrowe July 2014 All Rights Reserved REFERENCES School Health Services. (n.d.). Health and Human Services. Retrieved July 14, 2014, from http://www.mass.gov/dph/fch/schoolhealth School Health Services. (n.d.). Health and Human Services. Retrieved July 14, 2014, from http://www.mass.gov/dph/fch/schoolhealth NASN - National Association of School Nurses - NASN.org. (n.d.). NASN - National Association of School Nurses - NASN.org. Retrieved July 14, 2014, from http://www.nasn.org/Default.aspx NASN - National Association of School Nurses - NASN.org. (n.d.). NASN - National Association of School Nurses - NASN.org. Retrieved July 14, 2014, from http://www.nasn.org/Default.aspx The official site for Auvi-Q (epinephrine injection, USP). (n.d.). Auvi- Q. Retrieved July 4, 2014, from http://www.auvi-q.com The official site for Auvi-Q (epinephrine injection, USP). (n.d.). Auvi- Q. Retrieved July 4, 2014, from http://www.auvi-q.com The official website for EpiPen® (epinephrine) and EpiPen Jr® (epinephrine) Auto-Injectors. (n.d.).EpiPen. Retrieved July 4, 2014, from http://www.epipen.com The official website for EpiPen® (epinephrine) and EpiPen Jr® (epinephrine) Auto-Injectors. (n.d.).EpiPen. Retrieved July 4, 2014, from http://www.epipen.com