Administering epinephrine for acute anaphylactic type allergic reactions Training for first aiders People known to be allergic (1.5 hours) MAJ 2012-3
2 Objectives of the training Understand the legal context of responding to an anaphylactic reaction Know the roles and responsibilities of first aiders and organizations Understand the causes and mechanisms of anaphylaxis Know the signs and symptoms of an anaphylactic reaction Know the protocol for administering epinephrine to a person who is known to be allergic Know the mechanisms of action and side-effects of epinephrine Know how to determine the right dose based on weight Know how to use the auto-injector
3 Legal context Section 3 of the Regulation respecting Professional activities that may be engaged in within the framework of pre-hospital emergency services, sets out the conditions for the intra-muscular administration of epinephrine (with an auto-injection device) in an emergency, notably in schools: In the absence of a first responder or ambulance technician, any person having received training in the administration of adrenalin approved by the regional or national medical director of pre-hospital emergency services may administer adrenalin with an auto-injection device to a person in the case of an acute anaphylactic allergic reaction.
4 Code des professions 39.8. Notwithstanding any inconsistent provision, a person working for an intermediate or family-type resource referred to in section 39.7 or under a home care program provided by an institution operating a local community service centre, or a person working in a school or another temporary alternative environment for children, may administer prescribed ready-to-administer medications by oral, topical, transdermal, ophthalmic, otic, rectal or vaginal route or by inhalation, and administer insulin by subcutaneous route.
5 Training for first aiders: person known to be allergic A plus: training in CPR with exposure to AED Condition: follow and successfully complete this training: Hand in the pre-test at the beginning of the training Length of certification: three years
6 Roles and responsibilities of first aiders Role: Help reduce anaphylaxis-related mortality Responsibilities: Comply with the clinical protocol Keep skills and knowledge up to date Depending on the setting, the organization must make clear who is responsible for ensuring that the auto-injectors are always available (employer, employee, CPE, parent, etc.).
7 Definition: anaphylaxis Allergic reaction in which the immune system reacts in an exaggerated and disproportionate way to contact with an allergenic substance (antigen) Generally multiple body systems affected Generally very rapid after contact
8 Common allergens Causal agents Foods Venom insects Medications Intensity depends on the amount of allergen.
9 Allergens - Foods Peanuts Tree nuts Seafood Eggs Dairy products Fruits Sesame seeds, wheat and soy + often = respiratory distress
10 Stinging and biting insects Bees Wasps Ants + often = shock
11 Allergens - Pharmaceuticals Antibiotics: Penicillin Sulfas ASA and anti-inflammatories: Aspirin NSAIDS numerous Iodine: Intravenous contrast Others
12 Signs and symptoms - Systems Respiratory: Difficulty, distress, respiratory arrest Cardiovascular: Shock, cardiopulmonary arrest (CPA) Gastro-intestinal: Nausea, vomiting, diarrhoea, abdominal pain Skin: Urticaria, angioedema (swelling), redness Other: Anxiety, feeling of imminent death
13 Presence of signs and symptoms No sign or symptom is always present during an anaphylactic reaction. During the reaction, a number of substances enter into play, including histamine. These substances cause: Narrowing of the bronchioles Dilation of blood vessels Skin lesions
Source: http://www.4- men.org/images/hives.jpg 14 Urticaria Generally raised Migratory
Angioedema 15
16 Angioedema More worrying: Upper respiratory tract affected More visible: Around eyes Lips
17 Epinephrine - Effects Opposite of the anaphylactic reaction Dilates the bronchioles Increases blood pressure Increases the heart rate palpitations Anxiety, trembling, nausea and vomiting Effects of short duration
18 Inclusion criteria (known allergy) Recent contact with causal agent: < 12 hours + First signs of an allergic reaction: Difficulty breathing Weakness, fainting Urticaria, itching
19 Exclusion criteria None, in the case of an anaphylactic type reaction.
20 General protocol Evaluate safety: Potential dangers? / Wear gloves. Primary examination: Call 911 at the same time if two first aiders are present. Inclusion criteria? If present, administer prescribed epinephrine. Monitoring and first aid: Call 911 now if first aider is alone. 2nd dose, after 15 minutes if needed. Take to hospital Always.
21 Special situations Repeat the dose every 15 minutes if the inclusion criteria are still present. There is no maximum number of doses. When in doubt, administer to children. Administer even if expired (past expiration date). For adults known to have a heart disease, be more careful.
22 Auto-injectors Intramuscular injection Automatic Automatic dose: Adults = 0.30 mg Paediatric = 0.15 mg > 25 kg < 25 kg
The second dose of the Twinject cannot be administered because the Twinject is not an auto-injector. 23 Administering using auto-injectors Demonstrations:
24 Risks related to auto-injectors Accidental injection soiled: Squeeze to force bleeding. Clean with soap + water or disinfectant without water. Immediately go to emergency room. Accidental injection sterile, in a finger Apply hot compresses. Place pointing down. Immediately go to emergency room.
25 Summary Anaphylaxis: disproportionate allergic reaction First-line treatment: epinephrine Doses: Adult: 0.30 mg Paediatric (under 25 kg): 0.15 mg Repeat: every 15 minutes as needed Always take to hospital
26 Acknowledgements AQAA Saint John Ambulance Canadian Red Cross CSST Heart and Stroke Foundation of Québec Canadian Ski Patrol OIIQ Lifesaving Society Table des directeurs médicaux régionaux des services préhospitaliers d urgence EPIPEN TWINJECT
27 Questions? Thank you for your attention. Version - CSST and others MAJ-2012-3