Transcript document

Epinephrine auto injectors
Anaphylactic Reaction
Protocol Changes
Aaron J. Katz, AEMT-P, CIC
Overview
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Not just “Any allergic reaction”!
Once you see it – you’ll never forget it!
Reactions tend to worsen with each
“exposure”
You have a responsibility to educate
patients and families
Some interesting cases
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Post Dental Visit
Bee Sting (2 cases)
Cookies with hidden nuts
Milk – 6 month old
Milk – 2 year old
Touched the fish
Penicillin shots
Allergy injections
The cheese danish
Neighborhood “X”
Introduction
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Anaphylactic shock is a potentially life
threatening emergency
This condition has a high mortality rate
when not recognized and treated early
With allergies increasing, mortality has
also increased
We don’t know why allergies are
increasing
Introduction Cont.
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Hatzoloh responds to approximately 400 calls
per year for anaphylaxis of which 15% are of
patients with true anaphylactic shock
Patients in anaphylactic shock are those that
benefit from epinephrine injections
ALS units are not always readily available
More of a problem for FDNY/EMS?
Introduction
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Many studies have shown that the use
of an EPI- PEN can be safely
administered by an EMT
The EMT must be appropriately
trained
Goals
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Early recognition of anaphylaxis
Early BLS intervention
Early ALS intervention
Administration of Epinephrine using the
Epi-Pen Auto injector
Anaphylaxis
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Allergic reaction – immune response to
any substance.
Reaction can be localized or severe and
life threatening (anaphylaxis)
Allergen – substance that causes the
immune response
Common allergens
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Insects – bees, wasps
Food – nuts, fish, milk, chocolate
Plants – poison ivy, oak
Medications – antibiotics
Other – outdoor allergens, fragrances
Latex
Patient Assessment
Skin
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Swelling to face, neck, hands, feet, tongue
and periorbitally
Urticaria – hives
Itching
Erythema – redness
Flushed skin
Warm tingling feeling to face, mouth, chest,
feet and hands
Respiratory system
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Tightness to throat and chest
Cough
Tachypnea
Labored breathing
Hoarseness
Noisy breathing – stridor or wheezing
bronchoconstriction
Cardiovascular system
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Tachycardia
Vasodilation
Hypotension
 Poor cardiac output!
Other systems
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Itchy, watery eyes
Headache
Sense of impending doom
Runny nose, nasal congestion
Decreased mental status
Abdominal distress
Critical Point
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Findings that reveal hypoperfusion
(shock), or respiratory distress (upper
airway obstruction, lower airway
disease, severe bronchospasm ) may
indicate the presence of a severe
allergic reaction (anaphylaxis)
Past Treatment Protocol
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Perform initial assessment
Perform focused history and physical exam,
including:
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History of allergies
What was patient exposed to
How were they exposed
Effects
Time of onset
Progression
interventions
Past Treatment Cont.
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Assess baseline vital signs and SAMPLE
history
Administer high concentration oxygen
Monitor breathing for adequacy
Request ALS assistance
Assist the patient with self-administration of
their own prescribed Epinephrine
Loosen restrictive clothing or jewelry
Assess for shock and treat if appropriate
New Treatment Protocol
patients over age 9 or weighing over 30
kilos
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Determine that patients history includes past
history of anaphylaxis, severe allergic
reactions, and/or recent exposure to an
allergen
Administer high concentration oxygen
Request ALS assistance
Assess the cardiac and respiratory status of
the patient
Continued
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If both the cardiac & respiratory status
of the patient are normal, initiate
transport
If either the cardiac or respiratory
status of the patient is abnormal,
proceed as follows:
Continued
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If the patient has severe respiratory distress
or shock and has a prescribed Epi-Pen assist
the patient in administration
If the auto injector is not available or expired
and the EMS agency carries one, administer
(0.3 mg.) as authorized by the agency
medical directors
If the patient does not have a prescribed EpiPen, begin transport and contact medical
control for authorization to administer 0.3 mg
via auto injector
Note
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If unable to make contact with online medical control and the
patient is under 35 years old, you
may administer 0.3 mg
epinephrine via an auto-injector if
indicated.
The incident should be reported to
medical control or your medical
director as soon as possible
Protocol cont.
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Contact medical control for
authorization to administer a second
dose if needed
Refer to other protocols as needed
(resp distress/failure, obstructed airway,
shock)
If patient arrests treat as per the nontraumatic cardiac arrest protocol
Pediatric differences
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The age for pediatrics in this protocol is
patients under 9 years old or weighing
less than 30 kg (66 lbs)
The dose of epinephrine is 0.15 mg
It can not be given without medical
control authorization
Pharmacology - Epinephrine
Medication name:
Generic
Trade
– Epinephrine
– Adrenalin
Pharmacology – Epinephrine
cont
Properties
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Bronchodilation
Vasoconstriction
Indications
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Must meet the following three
criteria
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Patient must exhibit findings of severe
allergic reaction (anaphylaxis)
Medication is prescribed for this patient by
their physician, direction by medical
control, or inability to contact medical
control and epinephrine is indicated
Administration of medication is authorized
by REMAC or a physician
Contraindications
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None when used to treat anaphylaxis
Medication form
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Liquid contained in an auto injector
needle and syringe system
Dosage
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Adult- one adult auto injector (0.3 mg)
Infant and Child- one auto injector
(infant/child) 0.15 mg
Administration
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Obtain order from medical control either
on line or as per protocol
Obtain patients prescribed unit if
available
Ensure prescription is written for patient
Ensure medication is not discolored
Remove safety cap from device
Administration cont.
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Place tip of device against the patients thigh:
Use lateral portion of thigh midway between the
waist and knee
Push firmly until the injector activates
 Keep in contact for 10-15 seconds
Record activity and time
Dispose of injector in appropriate container
Can be administered through patients clothes
Actions
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Dilates the bronchioles
Constricts blood vessels
Side effects
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Increased heart rate
Pallor
Dizziness
Chest pain/ sudden death
Headache
Nausea/ vomiting
Excitability, anxiousness
Reassessment
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Continually assess ABC’S for signs of
worsening patient condition such as:
Mental status change
Increased respiratory rate
Decreasing B/P
Reassessment
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Be prepared to initiate BCLS measures if
indicated including: CPR, AED, ALS
intercept
Treat for shock
As the drug lasts in the system 10-20
minutes, be prepared for a potential
return of the anaphylactic reaction
Reassessment
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As many as 25% of those having an
anaphylactic reaction will have a
recurrence of life threatening symptoms
within hours of the first attack
Transportation Decision
• Any patient who received
Epinephrine should be transported to
an Emergency Room for evaluation
• On-Line Medical Control must be
contacted for any patient refusing
treatment or transportation after
treatment with Epi.
Special Consideration
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A BLS crew may encourage an authorized layperson
to administer an Epi-Pen to a patient if all of the
following conditions are met:
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The BLS unit is not equipped with an Epi-Pen
The Patient is having an anaphylactic reaction where Epi-Pen
is indicated
ALS assistance is not readily available
An authorized layperson is present with an Epi-Pen and in
the clinical judgment of the EMTs it is in the best interests of
the patient to allow the authorized layperson to administer
the Epi-Pen