1. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved Life-Threatening Allergies & Epinephrine Training Doreen Crowe, MEd, BSN, RN Nurse Leader Wilmington Public Schools

2. Copyrighted by Doreen Crowe, July 2013 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

3. Copyrighted by Doreen Crowe, July 2013 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. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved OBJECTIVES (cont.) 4. Accurately read and interpret the emergency medication administration plan 5. Correctly follow directions on the medication administration plan 6. Accurately read the epinephrine label and follow directions from the label

5. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved OBJECTIVES (cont.) 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

6. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved WHAT ARE COMMON CAUSES OF ALLERGIC EMERGENCIES? Food Insect Stings Medication Latex Exercise (uncommon)

7. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved FOOD Peanut Tree Nut (walnuts, cashew, pecan, hazelnut, almond) Milk Egg Fish Shellfish Soy Wheat Eight Foods account for 90% of all food- allergic reactions

8. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved INSECT STINGS Bees Wasps Yellow Jackets Hornets Fire Ants

9. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved MEDICATION Antibiotics Anesthesia

10. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved LATEX Gloves Band-Aids Balloons

11. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved EXERCISE Occurs rarely

12. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved WHAT IS ANAPHYLAXIS? A potentially life-threatening medical condition occurring in allergic individuals after exposure to an allergen May occur immediately (seconds) or delayed (hours) Individuals with Asthma are at an increased risk of a severe reaction

13. Copyrighted by Doreen Crowe, July 2013 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

14. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved HOW MIGHT A CHILD DESCRIBE A REACTION? “My tongue is itching, burning or tingling” “My mouth feels funny” “There’s something stuck in my throat” “My lips feel tight” “There’s a frog in my throat”

15. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved WHAT IS A BIPHASIC REACTION? A second wave of symptoms that may occur two to four hours later

16. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved WHAT IS EPINEPHRINE? Epinephrine is the medicine of choice for treatment of anaphylaxis Epinephrine is also known as Adrenalin It quickly constricts blood vessels, raising blood pressure It relaxes smooth muscles in lungs to improve breathing

17. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved HOW IS EPINEPHRINE DELIVERED? There are 2 Types of Auto-Injectors: Auvi-Q Epipen There are two strengths: Adult 0.3mg Child 0.15mg Older Packaging

18. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved How do you administer Epinephrine? Using the 5 Rights: Right Student Right Medication Right Dose Right Route Right Time

19. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved How do you administer Epinephrine? Step 1 <<<<Remove Cap Pull Red Safety Cover>>>> Step 2 <<<<Swing & jab into outer thigh Place against outer thigh, then press firmly>>>> EPIPENAUVI-Q

20. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved RIGHT STUDENT Identify the student with a KNOWN allergy Accurately read and interpret student specific Allergy Action Plan Accurately read the prescription label on epinephrine package

21. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved RIGHT MEDICATION Epipen/Epipen Jr. OR Auvi-Q

22. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved RIGHT DOSE Adult 0.3 mg Child 0.15mg Lasts approximately 15 minutes

23. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved RIGHT ROUTE Large Outer Thigh May be administered through clothing Hold in place for 5-10 seconds Remove carefully Massage area where administered

24. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved RIGHT TIME Student is in Anaphylaxis

25. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved EPIPEN STORAGE & HANDLING Properly store at room temperature Color in window will be clear Avoid accidental injection to yourself or you will require immediate attention at an Emergency Room Note time administered & give to Emergency Medical Services upon arrival

26. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved SCHOOL PROTOCOL 1. Call 9-911 from a school phone 2. Specify the problem: “A student is in Anaphylaxis & was given Epinephrine” 3. Specify entrance 4. Note time of Epinephrine administration & hand over to EMS upon arrival 5. Call parent to meet student at closest medical facility

27. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved LIABILITY Epipen Trained personnel are protected by the Good Samaritan law Refresher training is renewable annually

28. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved APPROPRIATE RESOURCES School Nurse School Physician Parent Emergency Medical Services (EMS)

29. Copyrighted by Doreen Crowe, July 2013 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.”

30. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved REFERENCES http://www.foodallergy.org Managing Life Threatening Food Allergies in Schools, 2002, Massachusetts Department of Education, available at http://www.doe.mass.edu/cnp/news02/allergy.pdf American Academy of Allergy, Asthma and Immunology, Anaphylaxis in Schools and Other Child-Care Settings, available at http://www.aaaai.org/media/resources/academy_statements/ position_statements/ps34.asp Massachusetts Department of Public Health: School Health Unit http://www.epipen.com http://www.auvi-q.com

31. Copyrighted by Doreen Crowe, July 2013 All Rights Reserved COURSE COMPLETION 1. Please take the Post-Test located on the Wilmington University webpagePost-Test 2. Then see a School Nurse to demonstrate proper Epinephrine administration with a training device Thank You!