1. Allergic Reactions Your immune system gone wrong….

2. Allergen Something that causes an allergic reaction Something that causes an allergic reaction

3. Allergic Reaction An exaggerated reaction by the body’s immune system to any substance

4. Anaphylaxis A LIFE-THREATENING allergic reaction which causes shock (hypoperfusion) and airway swelling A LIFE-THREATENING allergic reaction which causes shock (hypoperfusion) and airway swelling

5. Common causes of allergic reactions: The usual suspects: Insect Stings (Bees, Wasps) Plants (Poison Ivy, Poison Oak) Foods ( Peanuts, and Shellfish) Medications Environmental (Dogs, Cats, Molds)

6. Signs & Symptoms Skin Itching Rash/Hives – red, itchy, raised blothches Flushing Warm, tingling feeling Swelling (especially face, neck, hands, feet, tongue)

7. Allergic Reaction - Signs & Symptoms

8. Signs & Symptoms Respiratory Tightness in throat/chest Cough Rapid, labored, noisy breathing Hoarseness Stridor and wheezing

9. Signs & Symptoms Cardiac Increased heart rate Low blood pressure

10. Signs & Symptoms With a SEVERE allergic reaction: Decreasing mental status Signs and symptoms of shock ( hypoperfusion ) or respiratory distress

11. Latex A latex allergy is a reaction to a material on or contained in latex. A latex allergy is a reaction to a material on or contained in latex. Mild Acute Mild Acute Redness Redness Itching, burning, and tingling Itching, burning, and tingling Mild Chronic Mild Chronic Dry, cracked and scaly skin Dry, cracked and scaly skin No way to predict how serious reactions will develop. Severe (Urticaria/asthma/anaphylaxis) Severe (Urticaria/asthma/anaphylaxis) Immediate (0-30 minutes) with spread to areas remote to site contact (respiratory distress to anaphylaxis) Immediate (0-30 minutes) with spread to areas remote to site contact (respiratory distress to anaphylaxis)

12. Shock - HYPOPERFUSION Why does the body go into shock? 5 Gallons

13. TREATMENT Perform initial assessment Perform initial assessment Perform focused history and physical exam Perform focused history and physical exam 1. History of allergies? 2. What was the patient exposed to? 3. How was the patient exposed? 4. What effects? 5. Progression 6. Interventions

14. TREATMENT Assess baseline v.s. & SAMPLE history Assess baseline v.s. & SAMPLE history Administer oxygen if not already done Administer oxygen if not already done Determine if pt. has prescribed epi pen available. Assist with administration Determine if pt. has prescribed epi pen available. Assist with administration Follow local protocol for epi pen use when working with an EMS service Follow local protocol for epi pen use when working with an EMS service Contact M/C Contact M/C Reassess in 2 minutes & document findings Reassess in 2 minutes & document findings

15. Relationship to Airway Management The pt. may need aggressive airway management immediately because of swelling in the airway or respiratory compromise The pt. may need aggressive airway management immediately because of swelling in the airway or respiratory compromise The pt’s condition may be stable initially but deteriorate to the point where he/she needs aggressive airway management The pt’s condition may be stable initially but deteriorate to the point where he/she needs aggressive airway management

16. Epinephrine Auto-Injectors

17. Medications Epinephrine Auto-injector Epinephrine Auto-injector Generic – epinephrine Generic – epinephrine Trade – adrenaline Trade – adrenaline Dose Dose Adult – one adult auto-injector (0.3mg) Adult – one adult auto-injector (0.3mg) Child/Infant – one child/infant auto-injector (0.15mg) Child/Infant – one child/infant auto-injector (0.15mg) Action Action Dilation of bronchioles Dilation of bronchioles Constriction of blood vessels Constriction of blood vessels Improves perfusion Improves perfusion

18. Epinephrine is needed if the pt. Has come in contact with something that caused an allergic reaction in the past Has come in contact with something that caused an allergic reaction in the past AND IF The patient has prescribed epinephrine auto- injector The patient has prescribed epinephrine auto- injector AND IF Patient shows S/S of shock (hypoperfusion) Patient shows S/S of shock (hypoperfusion) OR OR Complains of respiratory distress Complains of respiratory distress (sometimes BOTH) (sometimes BOTH)

19. 1. Check medication name, expiration date, clarity of solution

20. 2. Remove safety cap.

21. 3. Place the tip of the auto-injector on the side of the thigh, between the hip and the knee. Push firmly against the leg until the auto-injector activates, and hold for at least 10 seconds, or until all the medication is injected.

22. 4. Properly dispose of auto-injector, and record time.

23. Case Scenario 1 40 year old male who was stung by a bee or hornet while working outside in the yard. Your patient has developed localized swelling and redness to the sting area, and uticaria throughout his left arm and chest. He complains of pain to the effected area and a warm sensation around his arm and chest. History: no meds unknown allergies, no Phx. B/P 110/80 P 90 R 24 Allergic Reaction or Anaphylaxis

24. Case Scenario 2 70 year old male AOX2 was out side walking and was stung several times. He presents with uticaria and flushing throughout his head neck and chest. Skin is pale cool. What would you do? No known allergies has been stung once before, takes nitro prn, ASA daily lasix daily, atrovent, and vasotec. B/P 100/70 R 28 P 110 Allergic reaction or Anaphylaxis

25. Case Presentation #3 You are dispatched to an electronics manufacturing plant to see a 28-year-old woman. The woman believes she is having an allergic reaction. Security officers will meet you at the front gate and escort you to the patient. You are dispatched to an electronics manufacturing plant to see a 28-year-old woman. The woman believes she is having an allergic reaction. Security officers will meet you at the front gate and escort you to the patient. What specific information would you like at this point?

26. Case Presentation #3 You find this patient in an office area sitting at her desk. From a distance, you notice she is awake and speaking clearly. She does not appear to have any breathing difficulty. She states she had just returned from lunch and began to feel hot and light headed. Her friend pointed out that the patient’s arms and neck are very red, and that her face appears “puffy”. You find this patient in an office area sitting at her desk. From a distance, you notice she is awake and speaking clearly. She does not appear to have any breathing difficulty. She states she had just returned from lunch and began to feel hot and light headed. Her friend pointed out that the patient’s arms and neck are very red, and that her face appears “puffy”.

27. Case Presentation #3 The patient states she is allergic to peanuts but has not eaten any. She went to a health food café where she had grilled chicken and steamed vegetables. She has no other past history and takes no medications. Her last allergic rx was similar to this. Vitals are: BP- 116/70; Pulse-100; RR-20; Lung sounds-clear and equal. No difficulty swallowing, redness to her arms, chest, neck and face. The patient states she is allergic to peanuts but has not eaten any. She went to a health food café where she had grilled chicken and steamed vegetables. She has no other past history and takes no medications. Her last allergic rx was similar to this. Vitals are: BP- 116/70; Pulse-100; RR-20; Lung sounds-clear and equal. No difficulty swallowing, redness to her arms, chest, neck and face. Would you like to perform any other procedures/exams/testing or obtain other history before treating?

28. Case Presentation #3 So, what is your complete treatment plan for this patient?

29. MEDICATIONS Antihistamines: block histamine release caused by the antibody/mast cell reaction. These will start to work the first day you take them, but are the most effective after at least 3 days of round the clock use Antihistamines: block histamine release caused by the antibody/mast cell reaction. These will start to work the first day you take them, but are the most effective after at least 3 days of round the clock use Nasal and pulmonary steroid inhalers: block the allergic response. These start to be effective after 2-3 days of regular use, but are most effective at 2 weeks. Nasal and pulmonary steroid inhalers: block the allergic response. These start to be effective after 2-3 days of regular use, but are most effective at 2 weeks.

30. MEDICATIONS Decongestants: shrink membranes of the nose and sinuses, or if in an eye drop “get the red out”. They do not treat or prevent the allergic response, but do help control symptoms immediately. Decongestants: shrink membranes of the nose and sinuses, or if in an eye drop “get the red out”. They do not treat or prevent the allergic response, but do help control symptoms immediately. Oral steroids: block the allergic response. Because of serious possible side effects related to blocking the immune system, these are rarely used for allergic rhinitis, but may be used for severe asthma symptoms. Oral steroids: block the allergic response. Because of serious possible side effects related to blocking the immune system, these are rarely used for allergic rhinitis, but may be used for severe asthma symptoms.