1. anaphylactic reaction?
What is an
anaphylactic reaction?

2. Symptoms of Anaphylaxis
May occur within seconds to more than an hour
Flushing, itching, hives
Rapid, irregular pulse
Feelings of anxiety
Swelling of the throat and tongue with breathing difficulty
Symptoms of rhinitis or asthma
Runny nose, sneezing, wheezing
Vomiting, diarrhea, stomach cramps
Low blood pressure, light-headedness, loss of consciousness

3. Incidence of Anaphylaxis
About 10,000 cases per year in North America
Underreported
Less severe cases may mistaken for asthma or simple hives
Approximately 50 deaths per year from insect stings

4. Prescription Anaphylactic Medication
EpiPen
Adults and children > 30 kg
0.3 mg epinephrine
EpiPen Jr
Children < 30 kg
0.15 mg epinephrine
EpiPen 2-Pak and EpiPen Jr. 2-Pak

5. EpiPens Important Notes
Protect from extreme heat or cold
Be aware of the expiration date
Examine contents of the auto-injector periodically to make sure that solution is clear and does not contain any particulates
Make sure that family and friends of patient are instructed on use
Consider requesting multiple pens, for home, school, work etc.

6. EpiPens Directions For Use
Unless completely unavoidable, someone other than the individual experiencing anaphylaxis should administer the injection.
1. Remove cap (yellow or green)
2. Grasp in fist with black tip pointing downward
3. Pull off grey safety release
4. Hold black tip near thigh
5. Swing and jab firmly into outer thigh
6. Hold firmly against the thigh for 10 seconds
The window will be red when injection is complete
7. Remove from thigh and massage area of injection for 10 seconds
8. Note time of injection
9. Call 911 or go to Emergency Department
10. Put used EpiPen back into storage holder and take with patient to ED
11. Give used EpiPen to attending physician for examination and tell them when injection was given

7. Mosquito
Which diseases can they transmit?

8. West Nile virus
Malaria

9. Mosquito bites

10. Flea
Which diseases can they transmit?

11. Bubonic plague
Endemic typhus

12. Flea Bite

13. Sarcoptes scabiei
“scabies”
How are they transmitted?

14. Physical contact from an infected person

15. Scabies infection on abdomen

16. Bedbugs

17. Ticks
Which diseases can they transmit?

18. Rocky Mountain Spotted fever
Lyme disease

19. Chiggers

20. Chigger bites

21. Spiders
Brown recluse
Black widow

22. Brown recluse bite

23. patient with an insect bite?
When do you refer a
patient with an insect bite?

24. Systemic symptoms
< 2 years of age
History of tick bite and
possible infection/systemic
effects
Signs of infection

25. What is the nonpharmacologic treatment for an insect bite patient?

26. Avoidance of insects
Use of insect repellents

27. Insect Repellents Most contain DEET Picaridin is a new repellent
n,ndiethyl-m-toluamide
Most in concentrations of 7% - 40%
Some up to 100%
Adverse effects: skin rashes, burning/tingling sensation, some rare cases of central nervous system reactions including seizures, ataxia and encephalopathy
Apply to skin and clothing
Wash skin (especially face) after going inside
Picaridin is a new repellent
Better safety profile than DEET
Length of action similar to long acting DEET products
Less odor/lighter feeling
Comparable price

28. What is the pharmacologic
treatment for insect bites?

29. OTC Pharmacologic Treatment
Topical Anesthetics
Benzocaine
Dibucaine
Phenol
3-4 times daily
Up to 7 days
Topical Antihistamines
Diphenhydramine
Systemic Antihistamines
Not specifically indicated but used for this
Diphenhydramine, chlorpheniramine, loratadine
Counterirritants
Camphor
Menthol
3-4 times daily
Up to 7 days
Hydrocortisone
Skin Protectants
Zinc oxide
Calamine
Titanium dioxide

30. Insect Stings Signs and Symptoms Often caused by
Localized pain, itching, irritation, swelling
Often caused by
Hornets, bees, yellow jackets

31. When do we refer an
insect sting?

32. Refer Insect Stings If….
Hives, swelling, dizziness, nausea, vomiting, difficulty breathing
Significant allergic response away from the local site of the sting
Previous severe reaction to bite or sting
Personal or family history of significant allergic reaction (eg. hayfever)
< 2 years of age

33. Nonpharmacologic Treatment of Insect Stings
Remove stinger – scrape
Cold compresses
Reduces inflammation, swelling and pain
Avoid attracting insects
Don’t wear perfume, scented lotions, brightly colored clothing
Change clothes if they get soiled with food
Use caution when picnicking

34. OTC Pharmacologic Treatment
Topical Anesthetics
Benzocaine
Dibucaine
Phenol
3-4 times daily
Up to 7 days
Topical Antihistamines
Diphenhydramine
Systemic Antihistamines
Not specifically indicated but used for this
Diphenhydramine, chlorpheniramine, loratadine
Counterirritants
Camphor
Menthol
3-4 times daily
Up to 7 days
Hydrocortisone
Skin Protectants
Zinc oxide
Calamine
Titanium dioxide

35. How do you differentiate between scabies, head lice
body lice and pubic lice and
What treatment do you
recommend for each?

36. Scabies Signs and Symptoms Treatment
Pimple-like irritations, burrows or rash of the skin, especially the webbing between the fingers; the skin folds on the wrist, elbow, or knee; the penis, the breast, or shoulder blades.
Intense itching, especially at night and over most of the body.
Sores on the body caused by scratching. These sores can sometimes become infected with bacteria.
May take 4-6 weeks to see signs after infestation
Treatment
Needs prescription medication for eradication
Topical hydrocortisone and topical antihistamines for itching
Wash all clothing and bedding in the house

37. Head Lice Signs and Symptoms Treatment
Tickling feeling of something moving in the hair.
Itching, caused by an allergic reaction to the bites.
Irritability.
Sores on the head caused by scratching. These sores can sometimes become infected.
Treatment
Wash all bedding, clothing, spray treat cushions, headrests
Pyrethrins (retreat after 7-10 days) or permethrin
Before applying treatment, remove all clothing from the waist up.
Do not use a creme rinse or combination shampoo/conditioner before using lice medicine. Do not re-wash hair for 1-2 days after treatment.
Have the infested person put on clean clothing after treatment.
If a few live lice are still found 8-12 hours after treatment, but are moving more slowly than before, do not retreat. Comb dead and remaining live lice out of the hair. The medicine may take longer to kill lice.
Nit (head lice egg) combs, often found in lice medicine packages, should be used to comb nits and lice from the hair shaft. Many flea combs made for cats and dogs are also effective.
After treatment, check hair and comb with a nit comb to remove nits and lice every 2-3 days. Continue to check for 2-3 weeks until you are sure all lice and nits are gone.

39. Body Lice Signs and Symptoms Treatment Itching and rash
Long term infection would lead to thickened skin, especially around the groin, waist and upper thighs
Sores from scratching
Treatment
Wash all clothing in VERY HOT water
Pyrethrins and permethrin are effective, but usually not necessary

40. Pubic Lice (Crabs) Signs and Symptoms Treatment
Itching in the genital area
Visible nits or crawling lice
Treatment
Wash the infested area; towel dry.
Thoroughly saturate hair with lice pyrethrin. Leave medication on for 10 minutes. Thoroughly rinse off medication with water. Dry off with a clean towel.
Following treatment, most nits will still be attached to hair shafts. Nits may be removed with fingernails.
Put on clean underwear and clothing after treatment.
To kill any lice or nits (attached to hairs) that may be left on clothing or bedding, machine-wash those washable items that the infested person used during the 2-3 days before treatment. Use the hot water cycle (130°F). Use the hot dryer cycle for at least 20 minutes.
Dry-clean clothing that is not washable.
Inform any sexual partners that they are at risk for infestation.
Do not have sex until treatment is complete.
Repeat treatment in 7-10 days if lice are still found.

41. Pyrethrin Indicated for head lice and pubic lice
Available in foams, shampoos, solutions and gels
Use with lice comb
Retreat after 7-10 days
Adverse effects
Irritation, erythema, itching
May be used on infants
Individuals allergic to chrysanthemums or ragweed should not use

42. Permethrin Indicated for head lice Available as a cream rinse
Re-treatment not required
Adverse effects
Itching, burning, stinging, scalp irritation
Individuals allergic to chrysanthemums or ragweed should not use
Do not use on children < 2

43. Alternatives to Pyrethrin and Permetherin Products
Rid Pure Alternative
Dimethicone
Licefreee
Sodium Chloride