ProTrainings Anaphylaxis Course

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2 ProTrainings Anaphylaxis Course Welcome to your ProTrainings Anaphylaxis Course. This course must be taken as a classroom course and must be conducted with a ProTrainings approved instructor. You can find approved instructors by searching on or by contacting us directly on support@protrainings.eu or This manual is designed to be used exclusively by students who have completed a ProTrainings Anaphylaxis Course or a course that has been certified by an ITG or ProTrainings approved instructor. You can validate your certificate, as well as receive a PDF version, online from the bottom of On completion of a classroom course, you will receive a certificate and a wallet sized card. You can validate your certificate on any of our online sites using your student number. You can receive updates and weekly refresher s once you have set up your login online; these are automatically set up for online students. If you do not have a login, support@protrainings.eu. For more information on first aid and medical issues register free at for the latest news and details of how you can view on itunes, Reku, YouTube and many other formats. If you have any problems with login or certificates or call us. This course is CPD certified and you can download your free certified CPD statement from your ProTrainings login area. Example of the ProTrainings classroom certificate you will receive in the post after your course. Online courses you print your certificate online. Copyright ProTrainings Europe Ltd all rights reserved 2

3 Course Description Our ProTrainings Anaphylaxis Course is based on the latest guidelines and will enable students to understand the emergency treatment of anaphylaxis. Practice your practical skills as often as you can to keep your skills fresh. We will send you weekly video s to refresh your skills on anaphylaxis and other first aid subjects. It is recommend that all first aiders refresh their skills every year, and you can complete our video online course to meet this recommendation. Remember to enter your instructor s discount code to receive a discount off any online course. In this manual we will review some basic first aid procedures as well as cover the specific anaphylaxis subjects and the use of auto-injectors. If you do not have it already we recommend that you complete a first aid course online or with one of our approved instructors. Click the links to see some of the useful courses that we have available: or What is Anaphylaxis? Anaphylaxis is a severe and potentially fatal allergic reaction. It may start suddenly within seconds or minutes, or take a few hours to develop following contact with an allergen. Allergens are substances that are capable of producing an allergic reaction. A severe anaphylactic reaction is sometimes known as anaphylactic shock. Anaphylaxis can cause the blood pressure to drop quickly, resulting in fainting or even sustained loss of consciousness. It can also cause severe breathing difficulties. Common food triggers: Peanuts, tree nuts Fish and shellfish Fruit Dairy products such as milk and eggs Sometimes, the cause may be unknown but anaphylaxis can also be triggered by: Venom from stinging or biting insects. Wasp and bee venom are the most common insect allergens. On rare occasions stings from hornets and bumblebees can also cause allergic reactions Medicine most commonly antibiotics, aspirin or ibuprofen Latex Copyright ProTrainings Europe Ltd all rights reserved 3

4 Allergic Reactions The body can suffer various reactions to stings, chemicals, food or gases. In most cases the reaction is mild, although uncomfortable. For example, if a bee stung you on your hand, your hand would hurt and swell. For someone who suffers from an allergic reaction or anaphylaxis shock, their body would react violently, causing severe anxiety, red blotchy skin especially around the neck and face, swelling of the mouth, tongue, face and neck, and a rapid pulse. As the reaction becomes more severe they would suffer from breathing difficulties and, in some cases, respiratory arrest. Food substances such as peanuts commonly cause allergic reactions in children and adults. Even a very small trace of nut can cause a patient to have an anaphylactic reaction and this will come on very quickly. If this happens you need to activate the EMS immediately. Make the patient sit down, keep them calm and, if they have it, get their medication. Anaphylaxis sufferers often carry an EpiPen, Emerade or Jext, and some may just have tablets. The auto-injectors are single dose, automatic injectors that deliver a pre-dosed amount of drug into the body and are normally administered by the patient. Allergic reactions can happen because of drugs, poisons, plants, inhalation or insect stings. Signs and Symptoms Altered level of consciousness Hallucinations Burning sensation in the chest and throat Excessive sweating Difficulty breathing Nausea and vomiting Severe abdominal cramping Rashes/hives Treatment Activate EMS by phoning 999 or 112, place patient in a position of comfort Look for obvious bites and stings Locate the patients prescribed medicine, inhaler or auto injector Assist the patient to utilise the device Once the drug has been administered, the patient usually starts to feel better within minutes; however, it is still an EMS emergency. Copyright ProTrainings Europe Ltd all rights reserved 4

5 Living with Anaphylaxis For patients living with a severe allergy, it is important to: Know what triggers the allergy and avoid these at all times Know how to recognise the symptoms of anaphylaxis Have your auto injectors available at all times and ensure they are in date Register your auto injector on services like Jext auto-injectors expiry alert service. They will or text you when the expiry date is near to ensure you get a repeat prescription Understand how and when to correctly take your medicines Practise with your simulator and repeat training Make friends, family and colleagues aware of how to recognise the symptoms of anaphylaxis and how to administer your treatment(s) Where should an Auto-Injector be kept? Copyright ProTrainings Europe Ltd all rights reserved 5

6 Adrenaline Auto-Injectors Adrenaline is the drug of choice for first-line treatment of anaphylaxis because it works quickly to reverse the symptoms of an anaphylactic reaction. An auto-injector is a simple way of delivering the adrenaline. There are different brands available, such as: Jext EpiPen Emerade Others are available and new ones are sometimes released, but these are the main ones being used. Different units have different benefit; the Emerade being the latest unit available. When adrenaline is injected into the muscle of the thigh, it acts quickly to constrict blood vessels, which helps to stop swelling around the face and lips, and relaxes the lungs, which improves breathing. Adrenaline also stimulates the heart, and helps raise lowered blood pressure. The sooner the injection is given, the better. However, you should seek professional medical assistance immediately after using your auto-injector. You should be prepared to administer a second treatment after 5-15 minutes if there is no improvement or if the original symptoms return. Each auto-injector can only be used once. Copyright ProTrainings Europe Ltd all rights reserved 6

7 Emerade Auto-Injectors The Emerade is a new auto-injector and you use it slightly different from others. Emerade is an adrenaline auto-injector used for the emergency treatment of severe acute allergic reactions (anaphylaxis) to foods, medicines or insect stings. It can also be used for exercise induced anaphylaxis. If you experience anaphylaxis, use your Emerade immediately. With the Emerade you leave the needle in for just 5 second rather than 10 second with other brands. Use Emerade immediately if signs or symptoms of anaphylaxis occur. Read the instructions carefully and follow your doctor s advice. Do not hesitate to use your Emerade, even if you are not sure if you have anaphylaxis. Emerade is intended for single use. However, if your symptoms do not improve a second injection of Emerade may be administered 5-15 minutes after the first injection. It is therefore recommended that you consult with your doctor whether you carry more than one Emerade. Emerade is available in three doses. The dose is determined by your doctor. As a guide: Children between 15 kg and 30 kg - Emerade 150mcg. The dose may need to be increased as your child grows. This should be discussed with your doctor. Patients over 30 kg - Emerade 300mcg or Emerade 500mcg. Copyright ProTrainings Europe Ltd all rights reserved 7

8 Jext Auto-Injectors The latest adrenaline auto-injector is the Jext. It has many benefits over other units as it is designed to be more flexible in use and last longer. Jext is a single-use adrenaline auto-injector. Each Jext injects a pre-measured single dose of adrenaline for the emergency treatment of anaphylaxis. The needle is contained within the Jext unit before use and is automatically covered by the black needle shield after use. Jext has been designed to be simple and reliable. The Jext auto-injector has a two-year shelf life, so it is a longer lasting unit, and with the needle guard it is also a safer unit to use. Copyright ProTrainings Europe Ltd all rights reserved 8

9 Copyright ProTrainings Europe Ltd all rights reserved 9

10 How to use Jext Auto-Injectors Copyright ProTrainings Europe Ltd all rights reserved 10

11 EpiPen Auto-Injectors EpiPen Auto-Injector and EpiPen Jr Auto-Injector are adrenaline auto-injectors (AAIs), containing a sterile solution of adrenaline. They are for emergency injection into the muscle (intramuscular injection) during anaphylactic episodes, which can occur without warning and be life threatening. You and a family member or carer should review instructions provided with the EpiPen (adrenaline) Auto- Injector each time you are dispensed a new device in case there are changes. Instructions may differ from one auto-injector to another. EpiPen or EpiPen Jr (adrenaline) Auto-Injector are adrenaline auto-injectors and contain one single dose per injector. They are available in two different doses, one intended for older children and adults, and the other for use in young children. Use of the auto-injector Stay with other people if possible. There is no need to undress, because the injector works through clothing. However, when possible, lift the edge of a skirt or lower trousers to avoid hitting a buckle, zipper, or contents of your pockets Hold the injector in your dominant hand with the grey safety cap nearest your thumb. The black end contains the needle and should be facing down From a distance of about 10cm, swing the EpiPen (adrenaline) Auto-Injector towards the outer thigh and jab the black end into the thigh, through clothing if necessary Hold in place for 3 seconds to allow all the medicine to be injected Remove the EpiPen and keep it safe Call 999 and state ANAPHYLAXIS. Do not drive yourself to hospital as allergic reactions sometimes come back Hand the used EpiPen (adrenaline) Auto-Injector to the ambulance or hospital staff for safe disposal Each auto-injector device can only be used once. If symptoms don t improve or get worse, you can administer a second EpiPen (adrenaline) Auto-Injector after 5-15 minutes. Copyright ProTrainings Europe Ltd all rights reserved 11

12 Checking your Auto-Injector It is important to check your auto-injector to ensure that it is in date, not damaged and has not exceeded any of the temperature limits stated by the manufacturer. It is important that you consult your doctor and pharmacist for information on the prescription that you have been given, as we can only talk generally in this manual. Check expiry date Use expiry date notification services Do not exceed temperature ranges Do not freeze Keep your auto-injector in the tube it comes in Follow doctor s recommendations Carry a second unit where prescribed Above Check the date of expiry of the auto injector. Left Check that the unit is live. The Jext has a red window when live and ready to use and this goes green if the unit has been used. Copyright ProTrainings Europe Ltd all rights reserved 12

13 Basic First Aid Advice for Anaphylaxis Emergencies In the next few pages you will find some basic advice on first aid and treatment of an allergic reaction. When someone has an anaphylaxis emergency, you should take the following action: Ensure the scene is safe Ask the patient or parent/guardian permission to help Sit or lay the patient down Locate their auto-injector Give them the auto-injector unit and allow them to use it Activate the EMS by dialling 999 or 112 Monitor, re-assure and calm the patient Even if they feel better, leave them laying or seated until the EMS arrives Where needed, a second auto-injector may be given after 5-15 minutes Monitor the time of onset and what treatment is given, then pass this information to the EMS Copyright ProTrainings Europe Ltd all rights reserved 13

14 Asking Permission to Help One simple way of protecting yourself against the fear of possible legal action is to obtain the patient s permission by saying: Hi, my name is Keith. I am a first aider. May I help you? A conscious patient may answer verbally, by nodding or maybe offering up his injured limb to you. All of these can be taken as gaining the person's consent. With an unconscious casualty, they cannot give you permission to help. However, consent can be assumed to have been given as the patient is likely to have asked for help if they were conscious. You should still ask the person and introduce yourself, but when they cannot answer you can still help. Keep talking the whole time you are helping, as the hearing is the last thing to go and the first to come back. If someone refuses your help and you are not able to help them, you can still assist by calling the EMS, referring to bosses or family members and trying to reassure them. As a first aider in the workplace, you may have a duty of care. In these cases the casualty will usually have to come to you for your help. Copyright ProTrainings Europe Ltd all rights reserved 14

15 The Fears of First Aid We have found that when people attend a first aid course, they are often reluctant participants because they have fears and concerns about administering first aid. Addressing these fears and showing that they are easily resolved makes the rest of the lesson much easier to understand and enjoy. Fear of being sued - this is the first fear people have about administering first aid. Many countries have a "Good Samaritan Act" or similar law that protects first aiders of all levels from unnecessary lawsuits. The key points to remember are to act within your training, ask permission to help, don't leave the patient unless you have to alert the EMS and act as a normal prudent person would do. Fear of infection - from blood and other body fluids. People are generally reluctant of close contact with body fluids, as well being concerned about infections such as HIV and hepatitis. This is addressed by the effective use of barriers, which will be covered later on in the lesson. Fear of doing something wrong - or simply not knowing what to do. The worst medical condition you have to deal with is when someone has no heartbeat and is not breathing. In this situation, the person is dead and you must remember that you cannot make a person any worse if they are dead. Any help you provide to that person can only increase their chance of survival. The worst-case scenario is that they will remain dead. Fear of hurting the patient - CPR is a really basic skill. Medical research tells us that any form of oxygen circulation is the most important first step in providing life support. The real problem is not in doing CPR wrong, it is in not doing CPR at all. There are some instances where you could do harm, but we will cover these as the lesson continues. Generally speaking, first aid is about caring for the person and getting the Emergency Medical Services (EMS) there as quickly as possible, and in many cases this may mean just sitting with, and providing comfort to, the patient. Fear for your own safety - ironically, in real rescues this often is not an issue. In fact, in many cases people automatically enter scenes without adequate consideration for themselves. We will be looking at scene safety and how you can use three simple steps to ensure that you keep yourself safe in a later lesson. Copyright ProTrainings Europe Ltd all rights reserved 15

16 Scene Safety Make sure you keep yourself, bystanders and the patient safe when approaching the scene of an accident. Always remember to stop, think, then act. Check for anything that may be a danger, such as broken glass, body fluids, electricity, gas or traffic. Remember that scene safety is your primary concern. Check the Scene Key questions to ask: Is it safe for me to help? What happened? How many patients are there? Am I going to need to call EMS? Do I have my personal protective equipment on and ready to use? Is there an AED available? Check the patient If it is safe to help, check the patient. Tap the patient and introduce yourself. If there is no response, activate EMS. To activate EMS, Call 999 or 112. IF PATIENT NOT BREATHING AND YOU ARE ALONE, PHONE FIRST Then start CPR, do not leave patient to go looking for an AED, the EMS will bring one IF PATIENT NOT BREATHING AND YOU ARE NOT ALONE - send someone to call the EMS and get the AED, make sure they know the location, what has happened and how many people are involved. Tell them to come back to you and tell you what the EMS has advised. When you call the EMS they will be able to give you any advice and support that you need. Work out how to use speakerphone or hands free with your phone so you can deal with the patient while getting advice. Copyright ProTrainings Europe Ltd all rights reserved 16

17 ABCD s The ABCDs concept is designed to give the first aider a guide to what to do first in a first aid emergency, and to show all the primary care and life threatening conditions. A - Airway - open the patient's airway by moving the tongue from the back of the throat, which often blocks breathing. B - Breathing - check for breathing. C - Circulation - if they are not breathing, check circulation and administer CPR. D - Defibrillation - where there is no circulation, use defibrillation to administer an electric shock. This interrupts a cardiac arrest and should allow the heart to start again. S - Serious bleeding, Shock and Spinal injury - once ABCD s are ok, we move on to these. All these will be covered in our course. Before entering into a rescue scene, the rescuer should perform an initial assessment to ensure that the scene is safe. Next, personal protective equipment should be worn to protect the rescuer before beginning to help. If alone, the rescuer may need to put the patient in the recovery position, if they are breathing, while leaving to contact EMS. If the patient is not breathing, then perform CPR. The recovery position allows the patient to breathe easily, stay safe, and it takes away the risk of them choking if they vomit. Barriers Gloves and Face Shields The fear of infection may deter some people from providing emergency first aid. Effective use of barriers, including gloves and face shields, protect both you and the patient from the risk of infection. There are special rules in some workplaces for the correct disposal of gloves and other infected materials, so it is best to check your local guidelines. There are many types of face mask, such as pocket masks or key fob masks. They come in different packages but are all basically the same. The BSi first aid kits in the work place now contain a face mask. Always use a barrier when dealing with any first aid emergency Copyright ProTrainings Europe Ltd all rights reserved 17

18 Putting Gloves On Always use disposable gloves when providing first aid care. If you have a latex allergy, use a latex alternative such as nitrile or vinyl. Before providing care, make sure the gloves are not ripped or damaged. You may need to remove rings or other jewellery that may rip the gloves. Remember to use skin-to-skin and glove-to-glove. Pinch the outside wrist of the other gloved hand. Pull the glove off, turning the glove inside-out as you remove it. Hold it in the gloved hand. Use the bare hand to reach inside the other glove at the wrist to turn it inside-out, trapping the other glove inside. Dispose of gloves properly. If you have do this correctly, the outside of either glove will never touch your exposed skin. How Bloodborne Pathogens are Spread Bloodborne pathogens can be spread in a number of ways: Sexual contact is the primary mode of transmission When a contaminated sharp object cuts or punctures the skin. Parenteral examples include: needle stick, illegal drug usage, cuts from broken glass, bites When an infected body fluid gets into an open cut or mucous membrane, for example inside eyes, mouth, ears or nose When a contaminated object touches inflamed skin, acne or skin abrasion Intact skin is wonderfully created as our first defence against disease. Bloodborne pathogens cannot soak through normal, intact skin. Copyright ProTrainings Europe Ltd all rights reserved 18

19 Recovery Position Check that there are no injuries that could be made worse by moving the patient and place them carefully on their side using the recovery position. Monitor their vital signs and keep them warm and comfortable until the EMS arrive. If you suspect spinal injury and the patient is in no immediate danger, do not move them. If you have to move them on to their side, as you have to leave them to get help or they start to vomit, then use the recovery position. First aid is to prevent the patient getting worse and this can be done with some simple easy skills that will be learnt on the course. P - Preserve Life P - Prevent Deterioration - stop the situation getting worse P - Promote Recovery Copyright ProTrainings Europe Ltd all rights reserved 19

20 Information on the Jext auto-injector What is Jext? Jext is a single-use adrenaline auto-injector. Each Jext injects a pre-measured single dose of adrenaline for the emergency treatment of anaphylaxis. The needle is contained within the Jext unit before use and is automatically covered by the black tip after use. How does adrenaline work? Adrenaline occurs naturally in the body. Adrenaline injected into the muscle of the upper, outer thigh is the first choice drug for the emergency treatment of anaphylaxis because it works quickly to reverse the symptoms of an anaphylactic reaction. Adrenaline acts to raise low blood pressure, which can cause dizziness, collapse and unconsciousness in anaphylaxis. It also relaxes smooth muscle in the lungs to improve breathing, and reduces swelling around the face and lips. How should I use Jext? Always use Jext exactly as your doctor has told you. Make sure you understand in what situations you should use Jext. If you are at all unsure about how to use it, ask to have the instructions repeated by your doctor, nurse or pharmacist. Jext should be pushed firmly against the outer portion of the thigh into the largest part of the thigh muscle. When you push Jext firmly against your thigh, a spring-activated plunger will be released, which pushes the hidden needle through the seal at the end of the black needle shield, into the thigh muscle and injects a dose of adrenaline. Before you ever need to use it, you should familiarise yourself with Jext and practice using a Jext Simulator. How will I know that my Jext has worked and that I have received my medicine? When the Jext activates to deliver the medicine, a distinct click will be heard. The inspection window in the label will be filled by a white or blue coloured plastic rod to confirm that adrenaline has been injected and a needle guard will extend to cover the needle. Copyright ProTrainings Europe Ltd all rights reserved 20

21 Can Jext be used through clothing? Yes, Jext is specifically designed to reliably operate through clothing, including tough fabrics such as denim. After using Jext, what should I do? Jext should be considered as first aid and you should always seek medical attention after using it. After administering Jext, dial 999 or get someone else to do so. Pass the used Jext to a healthcare professional when you seek medical assistance. Remember to get a replacement. How do I dispose of an out-of-date Jext that has not been used? You should contact your GP surgery or your Local Authority, who will be able to advise you of the local arrangements for disposal of an out-of-date Jext. How do I use my Jext Simulator? Your Jext Simulator works in exactly the same way as a real Jext, although there is no adrenaline and no needle in the Simulator. The Jext Simulator is pale blue in colour to differentiate it from the real Jext device. Unlike a real Jext, the Simulator can be reset and used as many times as necessary to become familiar with the correct technique. Why is Jext available in different doses? Your doctor will decide the appropriate for you, and will adjust it individually for you. Adults and Children over 30kg - the usual dose for self-administered adrenaline in allergic emergencies is 300 micrograms of adrenaline for injection into the outer thigh muscle Children between 15kg and 30kg - the usual dose for self-administered adrenaline in allergic emergencies is 150 micrograms of adrenaline for injection into the outer thigh muscle Remember: the correct dose of Jext depends on bodyweight. The dose will need to be increased as your child develops. What should I tell family, friends and colleagues? Make sure that you tell family, friends and colleagues what to do if you were to experience anaphylaxis. They should know how to recognise the signs and symptoms and how to administer your Jext if required. A Jext Simulator may be of assistance in teaching others who may be available to help if you experience anaphylaxis. There is an air bubble in my Jext, is it still OK to use? The bubble is perfectly normal to find in Jext. You can confidently use your Jext as the bubble will not affect either the medication or the mechanism. When should I use my Jext? You should be trained by your doctor or nurse as to when and how to use your Jext. If you are at all unsure about when to use your Jext, ask to have the instructions repeated by your doctor or nurse. Copyright ProTrainings Europe Ltd all rights reserved 21

22 How can I remember to replace my Jext when it is due to expire? You can register online at the Jext website for an automatic expiry alert. You can also register by mobile phone for an SMS text alert or . I have noticed that my Jext is out-of-date, what do I do? Contact your doctor to arrange to replace your Jext by the expiry date stated on the label and printed on the box. The expiry date refers to the last day of the month. After the expiry date, the adrenaline may not work effectively. What should I do if the liquid visible through the inspection window is no longer clear and colourless Contact your doctor to arrange to replace your Jext if the adrenaline solution visible through the inspection window becomes discoloured or contains particles. How should I store my Jext? Jext should be stored within the flip-top case provided. Do not freeze. Are there any precautions I should take with my Jext when I go on holiday? Make sure that you have sufficient Jext auto-injectors with you. Check with your holiday company or airline whether a letter from your GP will be required permitting you to carry your Jext on-board the aircraft. When travelling abroad, it is important that you take the same level of care as you would at home, if not more. I am travelling to a very different climate to the UK and I wondered if my Jext would still work properly? When travelling, you should take the same care of your Jext as you would in the UK. Store your Jext within the flip-top case. Do not freeze. I have accidently removed the yellow cap but do not need to use my Jext, what should I do? When the yellow cap is removed the Jext is armed to fire. Remember; never touch the black tip, as this is where the needle fires from when the yellow cap is removed from the opposite end. The yellow cap can be carefully replaced if the Jext has not been used. The Jext can then be safely returned to the flip-top case to be used in the future. Copyright ProTrainings Europe Ltd all rights reserved 22

23 Information on the EpiPen An adrenaline auto-injector (AAI) is a prescription-only medicine (POM), designed to allow patients to self-administer a precise dose of adrenaline to during an acute allergic emergency. It contains a concealed needle which, when activated, delivers a rapid, single dose of adrenaline to individuals experiencing potentially life threatening anaphylaxis. How does adrenaline work? Adrenaline is the treatment of choice for anaphylaxis because it quickly reverses the symptoms of a severe allergic reaction. Adrenaline works by rapidly constricting blood vessels, causing a rise in blood pressure, relaxing smooth muscle in the lungs and throat to improve breathing, stimulating the heart beat and reducing swelling around the lips and face. What is the difference between EpiPen (adrenaline) Auto-Injector and EpiPen Jr (adrenaline) Auto-Injector? EpiPen (adrenaline) Auto-Injector is designed to deliver the correct dose of adrenaline to reverse an allergic emergency in adults and children over 30kg. EpiPen Jr (adrenaline) Auto- Injector is for people who weigh between 15kg and 30kg. Your doctor will have taken this and other factors into account when choosing which is the right EpiPen (adrenaline) Auto-Injector for you. How should I use EpiPen or EpiPen Jr? The device contains a concealed needle, which should be pressed into your outer thigh, through clothes if necessary. You should practice regularly with a training device. How will I know that my EpiPen or EpiPen Jr. has worked and that I have received the adrenaline I need? When you jab the EpiPen (adrenaline) Auto-Injector into your thigh, you will hear a distinct click, and afterwards you will be able to see the needle which will be left exposed. There will still be a significant proportion of the medication in the auto-injector; this is perfectly normal. Remember EpiPen (adrenaline) Auto-Injector can only be used once. Can EpiPen or EpiPen Jr. be used through clothing? Yes, the EpiPen Auto-Injector is specifically designed to operate through clothing, even jeans. Take care not to obstruct the needle with anything in your pockets. Copyright ProTrainings Europe Ltd all rights reserved 23

24 After using EpiPen or EpiPen Jr., what should I do? You should always seek medical attention after using an EpiPen. After injection, dial 999 or ask someone to do it for you. You should give the used EpiPen (adrenaline) Auto-Injector to the ambulance or hospital staff who treat you. Remember, you will need to get a replacement EpiPen (adrenaline) Auto-Injector. How do I dispose of an out-of-date EpiPen or EpiPen Jr. which has not been used? You should contact your GP surgery or your pharmacist, who will be able to advise you of how to dispose of an out-of-date EpiPen or EpiPen Jr. What should I tell family, friends and colleagues? You should make your family, friends and colleagues aware of what might happen if you were to experience anaphylaxis; it could make the difference in a life-threatening allergic emergency. Teach them the signs and symptoms, where you keep your EpiPen (adrenaline) Auto-Injector and how to administer your EpiPen if required. There is an air bubble in my EpiPen, is it still OK to use? The bubble is, in fact, nitrogen and is perfectly normal to find in EpiPen. You can confidently use your EpiPen as the bubble will not affect either the medication or the mechanism. When should I use my EpiPen or EpiPen Jr.? You should be trained by your doctor or nurse to recognise the signs and symptoms of anaphylaxis. You should not delay using your EpiPen (adrenaline) Auto-Injector when you get these symptoms, as it could be very dangerous. When you have used your EpiPen (adrenaline) Auto-Injector, you should immediately call 999 and state ANAPHYLAXIS and get professional help to you as soon as possible. How can I remember to replace my EpiPen or EpiPen Jr. when it is due to expire? If you register your expiry date on a expiry date reminder service, they will send you SMS text and/or reminders to ensure you can visit your doctor in time to replace your EpiPen prior to the expiry date. I have noticed that my EpiPen or EpiPen Jr. is out of date. The EpiPen contains adrenaline. After the expiry date printed on the box and auto-injector, the adrenaline may not work as effectively. It is recommended that you contact your GP to arrange replacement of your EpiPen. How should I store my EpiPen or EpiPen Jr.? Adrenaline can be affected by heat and direct sunlight. For this reason, always store away from any extremes of temperature in the tube provided. Copyright ProTrainings Europe Ltd all rights reserved 24

25 Summary If you have completed our online course, you will be able to download and print your completion certificate online as soon as you have passed the test. If you completed a classroom course, you will receive a ProTrainings wall certificate and wallet card, as shown below, in the post after the course. For more information on first aid and medical issues register free at for the latest news and details of how you can view on itunes, Reku, YouTube and many other formats. If you require any further assistance or would like information on this or any ProTrainings course, support@protrainings.eu or call ProTrainings Europe Ltd 650 The Crescent Colchester Business Park Colchester Essex CO4 9YQ support@protrainings.eu Web Phone Copyright ProTrainings Europe Ltd all rights reserved 25