EpiPen Administration. by Jolene Hatcher, LPN
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- Phoebe Snow
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1 EpiPen Administration by Jolene Hatcher, LPN
2 EpiPen Administration! This program has been designed for the school staff member who is willing to administer an EpiPen in the event that a student has a life-threatening allergic reaction.
3 You may feel like this now
4 But after this program, you ll feel like this
5 Your objectives are:! Accurately recognize student-specific warning signs of allergic emergency! Accurately identify student for whom epinephrine is prescribed! Accurately read and interpret the student s Individual Health Care Plan (IHP)! Correctly follow directions on the student s IHP
6 Objectives continued! Accurately read the epinephrine (EpiPen) label and follow directions from the label! Administer epinephrine by auto-injector! Safely handle epinephrine in auto-injector! Accurately describe the school s plan for responding to life-threatening allergic emergencies! Access resources appropriately, including emergency medical services, school nurse, physician, and parents
7 Epinephrine is the treatment of choice for allergic reactions
8 Epinephrine! It quickly constricts blood vessels, raising blood pressure! It relaxes smooth muscles in the lungs to improve breathing
9 Epinephrine continued! It stimulates the heart beat! It works to reverse the hives and swelling around the face and lips
10 How is epinephrine stored?! Stable at room temperature until the marked expiration date Do not freeze, refrigerate, or expose to extreme heat or sunlight it will cause it to oxidize and go bad..and turn brown.
11 How is epinephrine handled?! Before using, make sure solution is clear and colorless! Accidental injection into the hands or feet may result in loss of blood flow to the affected area and will require immediate treatment in the Emergency Department (ED)
12 How is epinephrine handled?! After using epinephrine, the autoinjector should be placed in an impermeable container and given to EMS personnel to take to the ED.
13 The 5 RIGHTS of epinephrine administration! Right student! Right medication! Right dose! Right route! Right time
14 Right student! Identify the student with the known allergy. Use the photo on the IHP Introduce yourself personally to the student prior to allergen exposure Explain to the student that you will assist him/her with an EpiPen in the event of an allergen exposure.! The student should be able to identify you as a resource in the event of allergen exposure.
15 Right medication! Epinephrine is available in an auto injector called an EpiPen
16 Right dose! An EpiPen comes in TWO different doses: EpiPen 0.3 mg (over approx.66 lbs.) EpiPen Jr mg (under approx 66 lbs.)
17 Right route! The EpiPen is administered into the large outer thigh muscles
18 Right time! Based on student s symptoms and IHP e.g., hives spreading over the body, wheezing, difficulty swallowing or breathing, swelling in face or neck, tingling or swelling of tongue, vomiting, signs of shock, such as extreme paleness/gray color, clammy skin, loss of consciousness, or any other child-specific known symptom.
19 Steps in EpiPen administration Breathe Call for HELP! 911! Have student lie down! Look at the directions on the EpiPen! It states: 1. Form fist around autoinjector (black tip down) 2. With your other hand, pull off gray cap. 3. Hold black tip near outer thigh 4. Swing and jab firmly into outer thigh so auto-injector is perpendicular (at 90 degree angle) to thigh. 5. Hold firmly in thigh for several seconds.
20 A quick review! Case study! You are the teacher in charge of a class you have just taken outside for a math problem. It s spring and the flowers are blooming and the bees, unbeknownst to you, are buzzing. You have a child with a known bee allergy requiring immediate EpiPen administration if stung. You ve made it a point, because you are an proactive teacher, to see the nurse to review your student s IHP and secure his EpiPen before going outside. The unthinkable happens
21 ! What are the steps you would take? Have student lie down and administer the EpiPen immediately Dispatch 2 students to the Nurse s office with the name of the student and code word allergy Keep student warm, reassured, and away from allergen
22 Emergency Protocol for management of anaphylactic reactions in students with Epi- Pens Signs and Symptoms of Anaphylactic Reaction: - Generalized itching - Redness - Hives - Swelling of lips, face, or throat - Wheezing - Shortness of breath - Shock - Abdominal cramping - Cardiovascular Collapse
23 Treatment * Call for nurse: Stay with child. Be prepared to start CPR * If nurse unavailable or will be delayed: Send adult for EPI-PEN located in nurse s office; administer immediately. Have an adult call 911. Stay with child * Stay with the child until nurse or EMS arrives Perform CPR if necessary Keep student flat on back unless he/she is having difficulty breathing. If breathing is difficult, student s head may be elevated if not unconscious Make sure parents have been contacted.
24 How a Child Might Describe a Reaction Children have unique ways of describing their experiences and perceptions, and allergic reactions are no exception. Precious time is lost when adults do not immediately recognize that a reaction is occurring or don t understand what the child is telling them. Some children, especially very young ones, put their hands in their mouths or pull or scratch at their tongues in response to a reaction. Also, children s voices may change (e.g. become hoarse or squeaky), and they may slur their words. The following are examples of the words a child might use to describe a reaction: - This food is too spicy - There s something stuck in my My tongue is hot (or burning). throat. - It feels like someone is poking my tongue. - My tongue feels full (or heavy). - My tongue (or mouth) is tingling (or burning). - My lips feel tight. - My tongue (or mouth) itches - It feels like there are bugs in there. - It (my tongue) feels like there is hair on it. - It (my throat) feels thick. - My mouth feels funny - It feels like a bump is on the back of - There s a frog in my throat. my tongue (throat). - My tongue feels like it is vibrating.
25 The EpiPen buys you 15 minutes of time! Activating emergency services via 911 immediately is critical! Know who the CPR trained staff are in your building so that persons trained in life support can be dispatched to your location
26 After EpiPen administration you must remember to! Document the time of administration.! Have someone notify the student s doctor (on emergency card) regarding incident and where student is being transported.! Notify parent/guardian regarding incident, student s condition, and hospital destination.
27 What about field trips?! Being the ever-prepared teacher you are, you will see the nurse at least 2 days prior to leaving to review the student s IHP and answer any questions you may have.! You will meet with the allergic student, explaining that you will have his/her EpiPen and you will be readily available to the student throughout the trip. This includes on student s bus and at lunchtime.! Student buddy
28 Field trips cont.! You must have telephone access to call 911 at all times while off school property with students
29 Can I be sued if I make a mistake?! If you volunteer to do this for a student, you will have been delegated by the parent/ guardian in writing to administer this medication in the event of an emergency. In addition, you will have been trained by the parent/guardian(or the school nurse) about the student s specific IHP.
30 You are now prepared to administer an EpiPen in a lifethreatening allergic emergency!
31 One more thing: I thought I was done! You must pass the EpiPen post test and demonstrate competency by being evaluated on the EpiPen trainer by your school nurse.! This training is good for one year only and must be repeated annually in order to remain current.
32 Basic Seizure First Aid! 1. Notify nurse.! 2. Stay Calm! 3. Keep Child Safe.! 4. Do not restrain.! 5. Do not put anything in their mouth.! 6. Stay with the child until fully conscious,! 7. Record seizure in log.! 8. Notify Parent or emergency contact.
33 For Grand-Mal (Tonic-Clonic) Seizures! Protect head.! Keep airway open/watch breathing! Turn the child on their side.
34 A seizure is generally considered an emergency when:! 1. Convulsive (tonic-clonic) seizure lasts longer than 5 minutes.! 2. Student has repeated seizures without regaining consciousness.! 3. Student is injured, or has diabetes.! 4. Student has a first time seizure.! 5. Student has breathing difficulties.! 6. Student has a seizure in the water.
35 Hypoglycemia (Low Blood Glucose)! Causes: Too little food or skipping a meal; too much insulin or diabetes pills; more active than usual.! Onset: Often sudden
36 Hypoglycemia Symptoms! Shaky! Fast Heartbeat! Sweating! Dizzy! Anxious! Hungry! Blurry Vision! Weakness or Fatigue! Headache! Irritable If low blood glucose is left untreated, the student may pass out and need immediate medical help. In that case contact the office with the name of the student and the code word diabetes, then the office will know that the nurse needs to be come immediately. If the student is unconscious DON T try to make them drink or eat.
37 What can you do?! If you are a bus driver radio the office and have them call the parents of the student to let them know to check on the student when they get home.! Check their blood glucose, right away. If you can t check, treat anyway.! Treat by feeding them 3-4 glucose tablets or 3-5 hard candies you can chew quickly (such as peppermints), or by drinking 4 ounces of fruit juice, or ½ can of regular soda.! Check their blood glucose again after 15 min. If it is still low, treat again. If symptoms don t stop send to the nurse.
38 Hyperglycemia (High Blood Glucose)! Causes: Too much food, too little insulin or diabetes pills, illness, or stress! Onset: Often starts slowly
39 Hyperglycemia Symptoms! Extreme Thirst! Need to urinate often! Dry skin! Hungry! Blurry vision! Drowsy! Slow healing wounds
40 What can you do?! Check blood glucose! If their blood glucose levels are higher than their goal for 3 days and they don t know why contact the nurse. The nurse will contact the parent.! Refer to the Diabetes Medical Orders from the physician.
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