TREATMENT OF ANAPHYLACTIC REACTION WITH EPINEPHRINE
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1 TREATMENT OF ANAPHYLACTIC REACTION WITH EPINEPHRINE FILE: JGCDC Background: The Bibb County School System recognizes the growing concern with severe life-threatening allergic reactions to food items, latex, medications, insect stings and bites, and environmental triggers. Alabama Law Act # allows public school systems to maintain a supply of premeasured, autoinjectable epinephrine that may be administered to school children in the event of an anaphylactic emergency. Administration will be performed by the school nurse or unlicensed school personnel who have completed an anaphylaxis training program. A local physician facilitator will issue the epinephrine standing order protocol. Pathophysiology and treatment: Anaphylaxis is a life-threatening allergic reaction that can affect almost any part of the body and cause various symptoms. Signs and Symptoms of Anaphylaxis may include: Mouth: Itching, Swelling of lips and/or tongue Lungs: Shortness of breath, coughing, wheezing Heart: Weak pulse, Dizziness, Passing out, Shock Skin: Itching, Hives, Redness, Swelling Throat: Itching, Tightness/closure, Coughing Stomach: Vomiting, Nausea, Diarrhea, Cramps Breathing difficulties and a drop in blood pressure (shock) can be potentially fatal. Medications to treat anaphylaxis include-epinephrine and Antihistamines Treatment of anaphylaxis is centered on treating the rapid progression of effects caused by the histamine release in the body. The allergen should also be removed immediately. Creating an Allergen-Safe Environment: The Bibb County School System supports the three levels of prevention through its methods of creating an allergen-safe environment. Primary prevention- promotes health and protects against threats before problems occur with allergy triggers and anaphylaxis awareness and training. Secondary prevention-detects and treats problems early, as in a first-time reaction at school with staff or students. Early treatment of anaphylaxis saves lives. Tertiary prevention-protecting a student from exposure to offending allergens is the most important way to prevent life-threatening anaphylaxis. Avoidance of exposure to allergens is the key to preventing a reaction. The risk of exposure to allergens for a student is reduced when school personnel, physician and parent/guardian work together to develop a management plan for the student. Educating the entire school community about life-threatening allergies is important in keeping students with life-threatening allergies safe. Identifying the School Team: School District administration-school administrators will support the Anaphylaxis Preparedness Program by assuring school staff is trained and that annual reviews are conducted. School Nurse-school nurses will be the Anaphylaxis Preparedness site coordinator for each campus. Each school nurse will work with the principal to ensure staff are trained and retrained as deemed necessary. The school nurses will also monitor the safety and security of the medication by checking the expiration date of the individual epinephrine auto-injector and inspecting the medication to insure that tampering has not occurred. Medication efficacy and availability, and Page 1 of 2
2 FILE: JGCDC (Continued) documentation of staff training will be maintained by the school nurse. The school nurse will respond to emergencies when possible and continue to function in the role as a school nurse with other duties. School Medical Director-A local physician will serve as the medical director providing authorization for this program and the standing order protocol for epinephrine. Teachers will be provided information each year on the school program, the signs and symptoms of anaphylaxis, the location of the medication, and the forms. Teachers will be offered training each year to recognize and respond to anaphylactic emergencies. Food Service Personnel will be provided information each year on the school program, the signs and symptoms of anaphylaxis, the location of the medication, and the forms. The food service personnel will be offered training each year to recognize and respond to anaphylactic emergencies. Each school nurse will remain in contact with food service personnel regarding students with known food allergies. Coaches, Athletic Directors, and After School Volunteers will be provided information each year on the school program, the signs and symptoms of anaphylaxis, the location of the medication, and the forms. Coaches will be offered training each year to recognize and respond to anaphylactic emergencies. Transportation Personnel will be provided information each year on the school program, the signs and symptoms of anaphylaxis, the location of the medication, and the forms. Bus drivers will be offered training each year to recognize and respond to anaphylactic emergencies. Epinephrine Auto-Injector As funding is available, maintenance of stock supplies of life saving emergency medications (epinephrine auto injector, EpiPen) will be housed in all schools for use in anaphylaxis emergencies, following the Epinephrine Standing Order Protocol. If epinephrine is administered local Emergency Medical Services (911/Ambulance) will be contacted/summonsed as soon as possible. Each school principal, along with the school nurse, will decide the location to store the epinephrine auto-injector(s) and ensure that all staff is aware of the location. SOURCE: Bibb County Board of Education, Centreville, AL ADOPTED: July 13, 2017 LEGAL REF: National Association of School Nurses (2013)Food allergy and anaphylaxis Mylan, (2017); Alabama State Department of Education, ACT # Page 2 of 2
3 FILE: JGCDC -F1 Epinephrine Auto-Injector Delivery Verification School Name: Date: Label number: Lot number: Expiration Date: Label number: Lot number: Expiration Date: Label number: Lot number: Expiration Date: Location to be stored: Administrator: Print Name: Signature: Date: School Nurse: Print Name: Signature: Date:
4 FILE: JGCDC F2 Skills Checklist Epinephrine Auto-Injector Name of Trainee: 1. Positions student into lying position 2. Identifies possible problems and appropriate actions 3. Knows to call 911 when auto-injector is used Identifies supplies 1. Gloves 2. Right medication Procedure 1. Applies gloves 2. Removes end cap from autoinjector 3. Places tip of autoinjector on either side of outer thigh 4. Presses hard into thigh until the mechanism injects 5. Hold firm pressure for 10 seconds 6. Removes autoinjector with caution to avoid accidental needle stick 7. Massages injection site for 10 seconds to help absorption 8. Elevate feet of victim and monitor breathing 9. Note time of injection Follow up 1. Contact parent and school nurse 2. Give 911 empty auto injector 3. Discards used supplies 4. Document the incident and give report to school nurse Signature of Trainee: Date: Signature of School Nurse: Date:
5 FILE: JGCDC-F3 Student Demographics and Health History 1. School District: Bibb County Board of Education 2. Name of School: 3. Age: 4. Type of Person: Student Staff Visitor Gender: Male Female 5. Race: 6. History of allergy: If known, specify type of allergy: If yes, was allergy action plan available? History of anaphylaxis: Previous epinephrine use: person have a diagnosis of asthma? Does this School Plans and Medical Orders 7. Management Plan Individual Health Care Plan (IHCP) in place? 8. Written school district policy on management of life threatening allergies in place? 9. Does the student have a student specific order for epinephrine? 10. Expiration date of epinephrine: Epinephrine Administration Incident Reporting 11. Date/Time of occurrence: Vital signs: T- P- R- BP- O2 sat- 12. If known, specify trigger that precipitated this allergic episode: Please check: Ingested Touched Inhaled Other 13. Did reaction begin prior to school? 14. Location where symptoms developed: Classroom Cafeteria Bus Playground Other: 15. Details about how exposure occurred: 16. Signs and Symptoms: (Check all that apply) Respiratory GI Skin Cardiac/Vascular Other Cough Abd Discomfort Angioedema Chest discomfort Irritability Difficulty breathing Diarrhea Flushing Cyanosis Loss of consciousness Hoarse voice Difficulty General pruritus Dizziness C/o metallic taste Swallowing Nasal congestion Oral Pruritus General rash Faint/Weak Pulse Red eyes Rhinorrhea Nausea Hives Headache Uterine cramping Swollen throat Vomiting Lips swelling Hypotension SOB Localized Rash Tachycardia Sneezing Stridor Chest tightness Wheezing Pallor Diaphoresis Page 1 of 2
6 FILE: JGCDC-F3 (Continued) 17. Location where epinephrine administered: 18. Location of epinephrine storage: 19. Epinephrine administered by: Was this person formally trained? List date of Training 20. Time elapsed between onset of symptoms and communication of symptoms minutes. 21. Parents notified of epinephrine administration (time): 22. Was a second dose of epinephrine required? If yes, was that dose administered at the school prior to arrival of EMS? Biphasic reaction: Yes No Unknown Disposition 23. EMS notified at (time); Transferred to ER: Yes No If yes, transferred via: ambulance Parent/Guardian Other: Parent: At School Will come to school Will meet student at hospital Name of hospital: 24. Student/Staff/Visitor outcome: Form completed by: Date: Signature: Title: ****Copy of this form should be sent to Lead School Nurse Approvals Title Printed Name Signature Date Superintendent Lead School Nurse SOURCE: Bibb County Board of Education, Centreville, AL ADOPTED: July 13, 2017 LEGAL REF: National Association of School Nurses (2013)Food allergy and anaphylaxis Mylan, (2017); Alabama State Department of Education, ACT # Page 2 of 2
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