Transcript True. - Lamorinda CERT

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July 11, 2016
Lamorinda CERT
Asthma and Anaphylaxis in Children: Education for
CERT
Mary Frazier, RN, MSN, AE-C
[email protected]
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Introduction
 What
is asthma
 What
are the signs and symptoms
 What
are the triggers that make it worse
 How
do we manage asthma in children
 What
to do in an emergency situation
 Anaphylaxis
and the treatment
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How common is asthma?
 During
2006-2008, an est. 7.8% US has asthma
 Current
asthma prevalence higher among
multiracial, Puerto Rican Hispanics, and nonHispanic blacks than non-Hispanic whites
 Higher
in children
 Higher
in females
 Higher
among the poor
-The CDC Health Disparities and Inequalities Report-United States, 2011
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Asthma in Alameda County
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Asthma in Contra Costa County
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The cost of treating asthma
 Health
Care System perspective:
 Doctor visits
 ER and Hospital stays
 Medication costs
 Family
perspective:
 Medication refills/copays
 Missed work
 Travel expenses/car maintenance
 Doctor/ER/Hosp visits
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What is the right way to diagnose and
treat asthma?
 National

Asthma Guidelines – Expert Panel Report
“EPR-3” or “guideline-based care”
 Guidelines
that describe how to diagnose and
treat patients with asthma
 http://www.nhlbi.nih.gov/health-
pro/guidelines/current/asthma-guidelines
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Two major goals of asthma therapy
 Reduce
the impairment
 Identifying asthma symptoms
 How asthma affects everyday living
 Reduce
risk of negative effects
 Finding appropriate asthma meds for each
patient with minimal side effects
 Finding ways to reduce risk of having future
asthma symptoms
 Keep kids in school!
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What is asthma?
A respiratory condition that involves airway
obstruction that is reversible.
Three major responses in the lungs:
 Muscles
around the airways contracting
 Inflammation
 Increased
(swelling) in the airways
mucus
+ Muscles Tighten; Redness and Inflammation
in Airway; Increased Mucus
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Key Asthma Symptoms
 Wheezing
 Coughing
 Chest
tightness
 Shortness
of breath
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What is asthma control?
 EPR-3
guidelines define asthma control as:
 Having symptoms < 2 days/week
 No nighttime awakenings due to asthma < 2
x/month
 No interference with normal activity
 Using rescue inhaler for symptoms < 2
days/week
 Fewer than 2 instances of oral corticosteroid use
in the past year
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Achieving Control
 Family
Education: the Asthma Action Plan
 Green
Zone: take daily medications as
prescribed
: something has changed and
symptoms are worse. Add or increase
medications
 Red Zone: take your rescue medication and call
for help
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Know and Remove Triggers
 Smoke
 Dust
 Pollens
 Exercise
 Pests
 Laughing, crying
 Pets
 Catching
 Perfumes, strong
odors
 Food
mites
sensitivities
 Pollution
 Stress
 Mold
 Allergies
and Mildew
a cold
vs Irritants
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Know Your Medications and Take
as Directed
 Quick
Relief –
albuterol
 Controller
- inhaled
steroid
 ProAir
 Flovent
 Ventolin
 Q-Var
 Proventil
 Pulmicort
 More
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Know Your Medications and Take
as Directed
 Combination
Medications
FOR QUICK
RELIEF
 Advair
 Dulera
 Breo
 Anticholinergics
for
COPD and irritant
triggers
 NOT
 Atrovent
 Spireva
 Combivent
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Know Your Medications and Take
as Directed
 Antihistamines
 Nasal
sprays
 Tablets
 Liquids
 Keep
Quick Relief
Medications with you
at all times
 Ask your provider to
Rx medications for
home, school, day
care, etc
 Be aware of doses
remaining and
expiration date
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Green Zone
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Yellow Zone
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Red Zone
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Emergency Care for Asthma
 What
to Look For
 Shortness
of Breath
 Coughing or Wheezing
 Chest Tightness
 Difficulty Walking, Talking or Breathing
 Tightly-pulled skin around neck or chest area
 Blue lips or nail beds
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Emergency Care for Asthma
 What
to do
 Offer Quick Relief medication if available
 Reassure the child
 Have them sit or take position of comfort
 If no improvement after 5 minutes call 911
 Offer Quick Relief again
 Notify family
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Resources

www.nhlbi.nih.gov/health/health.../asthma

http://www.lung.org
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https://www.healthinfotranslations.org/pdfDocs/Asthma_SP.
pdf
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http://www.pamf.org/asthma/education/handouts.html

http://www.sehac.org/
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Anaphylaxis
 Anaphylaxis
(an-a-fi-LAK-sis) is a serious,
life-threatening allergic reaction. The most
common anaphylactic reactions are to
foods, insect stings, medications and latex.
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1. Question
 Symptoms
of anaphylaxis can occur:
 Shortly
after coming in contact with an
allergen
 Hours
after coming in contact with an
allergen
 Either
of the above
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1. Answer
 Either.
While anaphylaxis typically occurs within
minutes or even seconds after exposure to an
allergen, it is possible for symptoms to be
delayed an hour or more. There are also
cases where symptoms go away only to
return a few hours later.
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2. Question
 An
anaphylactic reaction can be as simple
as developing a rash after exposure to an
allergen.
 True
 False
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2. Answer

False. Anaphylaxis typically involves more than one
symptom in more than one part of the body at the same time.
For instance, a serious reaction could involve developing a
rash and vomiting or diarrhea after being exposed to an
allergen. Other warning signs of a serious reaction include:

Swollen throat

Wheezing

Passing out

Chest tightness

Stomach cramps

Feeling of impending doom
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Continued
 The
most dangerous symptoms are low
blood pressure, breathing difficulty and
loss of consciousness, all of which can be
fatal.
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3. Question
 Anaphylaxis
can occur from eating common
foods such as milk, eggs or shellfish.
 True
 False
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3. Answer
 True.
 These
common foods may be harmless
substances for most people, but having an
allergy to these or any other foods can
trigger an allergic reaction. Foods that cause
the majority of life-threatening reactions are
peanuts, tree nuts (such as walnut, cashew,
Brazil nut), shellfish, fish, milk and eggs.
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4. Question
 Which
of these are not likely to cause
anaphylaxis:
 Medications
 Pollen
 Latex
 Exercise
 Stinging
Insects
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4. Answer
 Pollen.
 Out
of this group, pollen is not known to
cause life-threatening reactions.
Medications, foods, latex and stinging
insects are allergens most likely to cause
anaphylaxis. While rare, there is a chance
of experiencing a serious reaction after
exercising.
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5. Question
 If
you had a mild allergic reaction to an
allergen in the past, then you are not at risk
for a life-threatening reaction in the future.
 True
 False
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5. Answer
 False.
 While
having previous mild reactions to an
allergen is a strong predictor regarding the
intensity of future reactions, a mild reaction
does not guarantee that your next reaction
won't be more serious.
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6. Question
 Epinephrine
should be given early in
symptoms of anaphylaxis.
 True
 False
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6. Answer
 True.
 Autoinjectable
epinephrine (adrenaline)
should be given early to help stop or slow
down the reaction from getting worse. People
with a severe allergy or a history of
anaphylaxis should carry epinephrine with
them at all times. Remember to refill your
prescription if your epinephrine has expired.
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7. Question
 Epinephrine
 Arm
 Thigh
 Buttocks
should be injected into the:
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7. Answer
 Thigh.
 Evidence
shows that epinephrine should be
given in the anterior lateral thigh muscle.
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8. Question
 Antihistamines
and corticosteroids are
good substitutes for epinephrine in treating
anaphylaxis.
 True
 False
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8. Answer
 False.
 Antihistamines
and corticosteroids can
sometimes used in addition to epinephrine,
but these medications are not a substitute for
epinephrine.
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9. Question
 Anaphylaxis
treatment.
 True
 False
always requires medical
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9. Answer
 True.
 Anaphylaxis
requires immediate treatment.
First with an injection of epinephrine,
followed by a trip to a hospital emergency
room. If it isn't treated properly, anaphylaxis
can be fatal. Sometimes symptoms go away,
and then return a few hours later, so if you
have taken epinephrine and are feeling
better, go to the hospital anyway to make
certain your reaction is under control
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10. Question
 If
you are at risk for anaphylaxis, the best way to
manage your condition is:
Avoid allergens that trigger symptoms
 Carry autoinjectable epinephrine
 Know how to use epinephrine
 Develop an anaphylaxis action plan
 All of the above

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10. Answer

All of the above.

The risk of you or your child suffering a lifethreatening allergic reaction is frightening. Being
prepared for an emergency can help. Work with your
allergist / immunologist to identify allergens that
trigger symptoms so that you can avoid these
allergens. Your physician can help you develop an
action plan for emergency situations. Know how to
administer epinephrine and teach others who are in
close contact with you or your child. Last, but not least,
keep epinephrine close by at all times for emergency
use.
To use an EpiPen auto-injector:
Form a fist around the auto-injector with the
black tip pointing down. Pull off the safety cap.
 Place the black tip against the fleshy portion of
your outer thigh. ...
With a quick motion, push the auto-injector
firmly against your thigh. ...
Remove the auto-injector from your thigh.
• Always call 9-1-1 after using
epinephrine. The medicine starts to
wear off in 20 to 30 minutes. The
reaction may come back. Repeat the
dose in 5 to 10 minutes if your child is
not better. Inhalers, like albuterol and
antihistamines (Benadryl®), are not
usually enough to treat severe allergic
reactions. You can give them after
epinephrine is used.
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Do not store the injector in a
refrigerator or a hot car. Keep it at
room temperature. The liquid
medicine in the injector should be
clear. If it is discolored or has floating
specks, get a new pen.
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How to Use the Epi-Pen
 The
following slides show the patient using an EpiPen trainer.
 The
trainer has an orange tip
 The
real Epi-pen will have a black tip
 Keep
the real pen with you, never take the trainer
Avoid placing
your finger over
either end to avoid
accidentally
triggering the
device.
•
Pull off the blue
activation cap
(opposite end
from the black tip
that holds the
needle).
•
•
Hold the EpiPen
firmly with your fist in
the middle. Do not put
any part of your hand
over either end to
avoid an accidental
trigger. An EpiPen is a
single-use device;
once it is triggered it
cannot be re-used.
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•
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Inject into the mid-outer-thigh.
Place the black tip against the thigh
and push firmly. There should be a
click once the needle has entered
the thigh.
Hold for several seconds.
Do not inject in any other place
than the thigh. Accidental
intravenous injections of adrenaline
can lead to death
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Remove the EpiPen. Remove
the unit and massage the
injection area for 10 seconds.
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Check the tip. The black
needle cover should
automatically cover the
injection needle once the
EpiPen is removed from the
thigh.
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Prepare for possible side effects. When you give a person an
EpiPen, it may cause them to feel panicked or paranoid, and
can also cause their body to shake uncontrollably. This is NOT
a seizure.
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The shaking will subside over the next few minutes or hours.
Don't freak out; just try to be calm and reassuring. Your calm
will help to settle the person.
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Go to the hospital immediately. 20% of acute anaphylaxis
episodes are quickly followed by another crisis, called
biphasic anaphylaxis. Once you have administered or
received the EpiPen, you should be seen by a doctor without
delay. The second episode might be mild or severe. If not
treated, it can lead to a fatality.
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The second crisis happens when patients seem to have
recovered. It’s important to go to the hospital even if you feel
fine.
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Thank you!

Resources:

http://www.wikihow.com/Use-an-Epipen

www.epipen.com/

www.youtube.com/watch?v=EN83hen4D-Y

http://www.allergy.org.au/health-professionals/anaphylaxisresources/how-to-give-epipen-in-english-and-other-languages