Massachusetts Department of Public Health School Health Unit

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Massachusetts Department of Public Health -
School Health Unit

• Program for Unlicensed School Personnel to
  Administer Epinephrine by Autoinjector in
  Life-Threatening Situations

By Elizabeth Gartman, RN August, 2007
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Terms to Learn

• Allergen
• Immune system
• Epipen
• Autoinjector
• Anaphylaxis
• Epipen Jr
• Histamine
• Chemical mediators

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Common Causes of Allergic Emergencies

• Food
• Medication
• Latex
• Bee stings

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Allergic Response

• People with allergies have over-reactive immune
  systems that target otherwise harmless elements
  of our diet and environment. During an allergic
  reaction the immune system recognizes an allergen
  (food, medication, latex etc). This initiates a
  sequence of events in the cells of the immune
  system resulting in release of chemical mediators
  such as histamine . These chemicals trigger
  inflammatory reactions in the skin, the
  respiratory system, the gastrointestinal system,
  and the cardiovascular system.

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What Happens in an Allergic Response?
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What is Anaphylaxis ?

• Anaphylaxis is the widespread and systemic
  reaction of chemical mediators affecting the
  skin, respiratory, GI, and cardiovascular
  systems.
• This is a life-threatening emergency!!

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What are the Symptoms of Anaphylaxis ?

• Itching, tingling, swelling of lips, tongue
• Hives, itchy rash swelling of face or extremities
• Nausea, vomiting, abdominal cramps, diarrhea
• Tightening of throat, hoarseness, hacking cough
• Shortness of breath, wheezing
• Thready pulse, low blood pressure, fainting, pale

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Treatment of Anaphylaxis

• Anaphylaxis must be treated with an Epipen. This
  is injected into the thigh and works to constrict
  blood vessels and dilate or relax smooth muscles
  in the lungs to improve breathing, stimulates the
  heartbeat, and works to reduce the hives and
  swelling around the face and lips.

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Administration of Epinephrine

• Right patient
• Right medication
• Right dose
• Right route
• Right time

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Epinephrine Dosages

• Epinephrine is available in 2 strengths
• Epipen Jr 0.15 mg (use in children up to 60
  pounds).
• Epipen 0.30 mg over 60 pounds.

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How is Epinephrine Stored?

• Epinephrine is available in what is called an
  autoinjector. It is stored at room temperature
  and should not be subjected to any extremes in
  temperature. The solution is clear and colorless
  and should be replaced if it is not.

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How to Administer an Epipen

• Remove autoinjector from box or cylindrical
  container after making sure the name on the label
  is for the correct student.
• Pull off gray activation cap.
• Hold black tip near outer thigh.
• Swing and jab firmly into outer thigh until
  autoinjector mechanism functions.
• Hold in place and count to 10. Remove the
  Epipen and massage the injection area for 10
  seconds.

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Important Information

• After injecting the Epipen and removing from the
  student, carefully place the Epipen in its
  original container. If an accidental needle
  stick occurs, medical care should be sought.
• Send Epipen container to the hospital with the
  student.

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Remember

• If in doubt about the need to administer
  Epinephrine then go ahead and give it.
• Most deaths from allergic reactions occur because
  epinephrine was not administered!!!

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Protocol for Handling Life Threatening Emergency

• Observe student
• Recognize symptoms of anaphylaxis
• Administer Epipen
• Call 911
• Call parents
• Notify physician

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Field Trips

• All trips out of the school building, even those
  to schools within our district, must be reported
  to school nurse 2 weeks prior to the trip. If
  there is a student with an Epipen, the nurse will
  then send home a permission to delegate form to
  the students parent to sign. The nurse must be
  able to delegate to one person whose name will be
  on that form. The nurse can delegate to staff
  members only!!!

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Epipen Video

• To view a short video on treating an anaphylactic
  reaction with an Epipen go to
• www.epipen.com/howtouse.aspx