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EpiPen Administration

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1 EpiPen Administration
Your School Nurse/Designee will work with you regarding use and storage of the EpiPen. An individual Emergency Action Plan(EAP) will be given to you for each child requiring an EpiPen. Keep the EAP in the white envelope of the emergency flip chart. This program has been designed to train the school staff member who may have to administer an EpiPen in the event that a student has a life-threatening allergic reaction.

2 Epinephrine is the treatment of choice for allergic reactions…

3 Epinephrine… It quickly constricts blood vessels, raising blood pressure It relaxes smooth muscles in the lungs to improve breathing

4 Epinephrine continued…
It stimulates the heart beat It works to reverse the hives and swelling around the face and lips

5 How is epinephrine stored?
According to your school policy. Stable at room temperature until the marked expiration date Do not freeze, refrigerate, or expose to extreme heat or sunlight…it will cause it to oxidize and go bad..and turn brown. …The auto-injector is quite durable, but it may be damaged if mishandled.

6 How is epinephrine handled?
Before using, make sure solution is clear and colorless 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 Room (ER) The loss of blood flow is a result of the blood vessel constriction action of the epinephrine, the same action which, in the large blood vessels of the body, will help keep someone from going into shock. In the emergency department the hands and feet are immediately injected with a medication to counteract the effects of the epinephrine.

7 How is epinephrine handled?
Be aware that after an injection there will be a needle extending from the end of auto-injector. After using epinephrine, the auto-injector should be placed back in the original container and given to EMS personnel to take to the ER. Be aware that after the injection there will be a needle extending from the end of the auto-injector.

8 The 5 “RIGHTS” of epinephrine administration…
Right student Right medication Right dose Right route Right time

9 Right student… Identify each student with the known allergy.
Familiarize yourself with each student’s EAP and know the location of the medicine. Be sure to bring the EpiPen on field trips for each student. Continue to communicate with the School Nurse/Designee through the school year regarding possible changes in the treatment for each student. You should be able to easily identify the student within a group of students.

10 Right medication… Epinephrine is available in an auto injector called an EpiPen

11 Right dose… An EpiPen comes in TWO different doses:
EpiPen mg (over approx.66 lbs.) EpiPen Jr mg (under approx 66 lbs.) Make sure you have the right prescription dose for the child Always make sure you have the right EpiPen dose for the student. The physician will have ordered the correct dose and auto-injector ahead of time. You simply have to make sure you have the EpiPen belonging to your student. It will be in the bag labeled with the student’s name along with the student’s emergency care plan. (Show an example of student-labeled bag with EpiPen and ECP). As you can see, the label for the adult EpiPen is different from the EpiPen Jr.

12 Right routes… The EpiPen is administered into the large outer thigh muscles On bare skin Through clothes It can be administered into a bare thigh or through clothing. Here you see people practicing with an EpiPen trainer, hence the different color of the EpiPen.

13 Right time… Based on student’s symptoms and EAP
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. Some students may need the EpiPen immediately upon exposure to the allergen before symptoms even start. Other students may require Benadryl or similar antihistamine medication immediately upon presumed exposure, with EpiPen administration at the first sign of a reaction to an allergen. The physician makes this determination in collaboration with the nurse and parents. The student’s ECP clearly outlines the steps to take in the event of allergen exposure. Any of the listed symptoms would require immediate EpiPen administration and 911 activation if exposure to an allergen has occurred, regardless of what’s written on an ECP.

14 Steps in EpiPen administration… Call School Nurse and Call 911
Call for HELP! 911 Have two adults (if possible) Have student sit down Look at the directions on the EpiPen It states: Form fist around auto-injector (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. 5. Hold firmly in thigh for 10 seconds You’ve done the 5 “rights” and now it’s time to actually administer the medication. Review slide. All you have to do is follow the directions.

15 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

16 After EpiPen administration you must remember to…
Notify nurse/designee. Document the time of administration Follow ISD/Facility policy regarding notification of parent/guardian regarding incident, student’s condition, and hospital destination. The time of administration is important so that the EMS personnel will know how soon they can administer additional epinephrine, usually minutes after the first dose if student still has symptoms.

17 What about field trips? Being the ever-prepared teacher you are, you will see the nurse at least 2 days prior to leaving to review the student’s EAP and answer any questions you may have. Encourage parents of students with an EpiPens to attend field trips. Be sure you take the EpiPen and the EAP in the flip chart on field trip. Explain to the student the need for a buddy that can run to get you in the event of an allergen exposure.

18 Field trips cont. You must have telephone access to call 911 at all times while off school property with students

19 A quick review… Case study
You are the teacher in charge of a class you have just taken outside for a math problem. It’s spring and the flowers are blooming and the bees, unbeknownst to you, are buzzing. You have a child with a known bee allergy requiring immediate EpiPen administration if stung. You’ve made it a point, because you are an astute teacher, to check with your nurse to review your student’s EAP in the flip chart and secure his EpiPen before going outside. The unthinkable happens… You, the teacher, have been trained by your wonderful nurse in management of life-threatening allergies in schools and in EpiPen administration.

20 What are the steps you would take?
Have student sit down and administer the EpiPen immediately Keep student warm, reassured, and away from allergen Send someone to call 911 Send for the School Nurse Once the students go to the front office with the word “allergy” and the student’s name, we know you have administered an EpiPen and there is a life-threatening situation. The front office staff will immediately call 911 requesting paramedic backup and dispatch the nurse to your location.

21 You are now prepared to administer an EpiPen in a life-threatening allergic emergency!
Congratulations! Now all allergic children will have a safer environment at school and on field trips because you will know what to do. Congratulations! Now all allergic children will have a safer environment at school and on field trips because you will know what to do.

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