Anaphylaxis and Epinephrine

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Anaphylaxis and Epinephrine

• The Role of the EMT-Basic

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Goals

• Review the signs symptoms types of allergic
  reactions
• Review of emergency care of a patient
  experiencing an anaphylactic reaction
• Develop a basic knowledge of epinephrine its
  administration
• Identify situations when epinephrine may be
  indicated

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What Is Medical Control?

• Off-Line / Standing Orders
• Online Medical Control
• contact with an emergency department physician at
  the receiving facility

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Common Causes of Allergic Reactions
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Mild Allergic Reactions
A mild, local reaction caused by a bee sting
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Severe Allergic Reaction

• A Clear History of Allergen Exposure AND Signs
  and Symptoms including
• Shock (hypoperfusion)
• Respiratory distress
• Wheezing, stridor, cough, hoarseness
• Chest / throat tightness

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Severe Allergic Reaction

• Itching, skin flushing
• Urticaria (hives) (look at the torso!) and /or
  swelling (Especially the face and the extremities)

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Severe Allergic Reaction

• Increased Pulse
• Decreased Blood Pressure
• Nausea Vomiting
• Altered Mental Status
• Sense of impending doom especially with history
  of anaphylaxis

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Epinephrine

• Generic Name
• Epinephrine
• Trade Name
• EpiPen
• EpiPen Jr.
• Adrenalin

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EpinephrineActions

• Dilates bronchioles
• Constricts blood vessels
• Increases heart rate
• Increases cardiac output

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EpinephrineIndications

• Signs and symptoms of severe allergic reaction

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EpinephrineContraindications

• None when dealing with anaphylaxis!

BUT MUST FOLLOW NH PATIENT CARE PROTOCOLS!
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EpinephrineDosage

• Adult
• 1 adult Epi-pen auto-injector (0.3 mg)
• Child
• Child greater than 10 kg and fit on a pediatric
  length based resuscitation tape (Broselow tape).
• Epi-pen Jr. auto-injector (0.15 mg)

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EpinephrineRoute

• Deep Intramuscular Injection
• Lateral thigh, midway between waist and knee

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Epinephrine Side Effects

• Increased pulse rate
• Pallor
• Dizziness
• Chest Pain
• Headache

• Nausea
• Vomiting
• Excitability / nervousness
• Anxiety
• Syncope

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Epi auto-injector Administration

• Remove safety cap from auto-injector
• Hold auto-injector from center
• (Do Not place thumb over either end!)
• Place against patients thigh
• Lateral portion, midway between waist and knee

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Epi auto-injector Administration

• Push until auto-injector activates
• Hold until medication injected (10 seconds).
• Record Time
• Record Response to Medication

• Dispose of auto-injector in biohazard sharps
  container.

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Patient Assessment

• Routine Patient Care
• Scene Size-up
• Initial Assessment (watch the airway!)

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Focused Physical Assessment

• Reassess ABCs
• Breath Sounds
• Baseline Vital Signs
• O2 Saturation

• Assess respiratory system
• Assess cardiovascular system

? Assess for Signs Symptoms of Anaphylaxis
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• Call ALS
• Administer oxygen
• Assess respiratory status
• Assess cardiac status
• Vital signs
• If patient has signs / symptoms of an allergic
  reaction (hives, itch, anxiety) but is otherwise
  hemodynamically stable, contact medical control
  for further direction.
• If trained to do so, administer Epi-Pen 0.3 mg or
  Epi-Pen Jr 0.15 mg IM for patient with signs /
  symptoms of anaphylaxis.
• Do not delay transport, except for epinephrine
  administration.
• Consider ALS intercept

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Ongoing assessment

• Monitor A-B-Cs
• Reassess vital signs
• Oxygen!
• Watch for changes in patient condition

OXYGENATE
OXYGENATE
OXYGENATE
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Ongoing Assessment

• If the patient deteriorates...
• Oxygenate
• Contact Medical Control for order for second dose
• Prepare for resuscitation
• Oxygenate
• Treat for shock

OXYGENATE
OXYGENATE
OXYGENATE
Did we mention Oxygenate?
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Ongoing Assessment

• Contacted Medical Control to administer a second
  auto-injector.
• Be prepared to perform CPR if patient
  deteriorates.

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Communication

• What?
• Assessment Finding
• Treatments
• Result of Treatment
• Who?
• Other EMS providers
• Receiving Facility personnel

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Questions?