1. Epi-Pen Anaphylaxis Protocol for Emergency Treatment of Allergic Reactions Pre-service Training For CCHD Nursing & MD Staff Edition: April 2006

2. Definition of Anaphylaxis • “An allergic hypersensitivity reaction to a foreign protein or drug • Affects the respiratory and circulatory system and can result in shock • May cause increased irritability, shortness of breath, blue color to the skin and sometimes convulsions, unconsciousness and death” (Taber’s)

3. Agents • Insect Stings • Bees, wasps, hornets, yellow jackets, fire ants, others • Foods • Peanuts, nuts, milk, eggs, shellfish, whitefish, food additives • 1/80 persons have nut allergy

4. Other Agents • Medications • Antibiotics (most commonly penicillin), as well as seizure medications, muscle relaxants, aspirin, non-steroidal anti-inflammatory agents • Radio-opaque contrast dyes • Exercise

5. Signs and Symptoms • Symptoms occur quickly after exposure • Rebound any time within 24 hours • Shortness of breath • Localized skin redness • Rash (Hive like wheals) • Itching • Apprehension (“something’s wrong”)

6. Other Signs & Symptoms • Sneezing • Runny nose • Coughing • Tightness in chest • Wheezing • Swelling around face • Labored breathing

7. Further Signs & Symptoms • Decreased level of consciousness, due to: • lowered oxygen content in blood • lowered blood pressure • Seizure • Cardiac Arrest • Death

8. Emergency Treatment • CALL 911! • Maintain open airway, assist ventilation, place victim in position of comfort • Treat for shock • Initiate CPR if necessary • Check expiration date and color of EpiPen (do not use if expired or liquid is brown color) • Inject Epi-Pen (adult or peds) as appropriate

9. Using the EpiPen • Inject epinephrine into upper outer side of the front thigh muscle– NOT INTO BUTTOCK OR INTRAVENOUSLY • Repeat injections if possible: • every 5 minutes if worse, for total 3 doses • or every 15 minutes if better, for total of 3 doses, while awaiting emergency transport

10. Initiate Evacuation • Even if the person responds to the initial injection, symptoms may re-occur • The antigenic substance is still in the body (we have treated only the immediate effects) • The person MUST get emergency attention as soon as possible

11. How to Use the Epi-Pen • Pull off the gray safety cap • Place black tip on the outer thigh • Push Epi-Pen against the thigh (into muscle, not fat) until a click is heard • Hold in place for 10-15 seconds as vial is emptied • Can be administered through clothes • Discard unit (not reusable)

12. How to Use the Epi-Pen • Do not store Epi-Pen in refrigerator or in extreme heat (not in cars or sunlight) • Do not use if brown or date has expired

13. Pharmacology • Actions: • Epinephrine is adrenaline • Improves breathing by reducing the swelling of the airways • Stimulates heartbeat and circulation • Works to reverse hives and swelling around the face and lips (angioedema) • Works quickly but short duration of action

14. Pharmacology • Dosing: • ADULT & OLDER CHILDREN (over 33 lbs): Yellow Epi-Pen, 0.3 mg epinephrine 1:1000. • PEDIATRIC (younger children under 33 lbs): White Epi-Pen-Jr., 0.15 mg epinephrine 1:2000. • Both may be repeated every 5-15 minutes for maximum 3 doses

15. Personal Liability • Florida Statute 768.13 FS (Good Samaritan Act): • “Any person who gratuitously and in good faith renders emergency care or treatment at the scene of an emergency… without the objection of the injured victim shall not be held liable for any civil damages… where the person acts as an ordinary reasonably prudent man would have acted under the same, or similar circumstances.”

16. Certification • Persons attending an approved training meet the requirements of law to administer the Epi-Pen. • Biennial re-certification (every 2 years) • Child Specific orientation is needed for each child prescribed with an Epi-Pen.

17. Employee Statement • I (print name), _________________________, have read through this training material. I will use the Epi-Pen as detailed in this presentation, as needed for emergency treatment of allergic reactions during work activities assigned by my supervisor of the Collier County Health Dept. • (Employee Signature & Date) ______________________________________ (Supervisor Signature & Date) ______________________________________