Anaphylaxis and Epinephrine The Role of the EMT-Basic N.H. Patient Care Protocols N.H. Department of...
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Transcript of Anaphylaxis and Epinephrine The Role of the EMT-Basic N.H. Patient Care Protocols N.H. Department of...
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Anaphylaxis and Anaphylaxis and Epinephrine Epinephrine
The Role of the EMT-Basic
N.H. Patient Care Protocols
N.H. Department of Safety Division of Fire Standards & Training
andEmergency Medical Services
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• Overview of General Pharmacology• 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 & it’s
administration • Identify situations when epinephrine may be
indicated• Understand NH Patient Care Protocol - Anaphylaxis
GoalsGoals
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General PharmacologyGeneral Pharmacology• For every medication you may
administer, you must thoroughly understand the following:
•Actions
•Indications
•Contraindications
•Dosage
•Route
•Side effects
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General PharmacologyGeneral Pharmacology
• Generic name– Original chemical name
• Trade name– Brand name given by manufacturer
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General PharmacologyGeneral PharmacologyMedication Forms
• Solutions – Liquid mixture of one or more
substances
• Other forms– tablets, suspensions, vaporized, gels,
etc.
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General PharmacologyGeneral Pharmacology• Right Patient• Right Drug• Right Dose• Right Time• Right Route• Right Documentation
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What Is Medical Control?What Is Medical Control?Off-Line / Standing Orders Online Medical Control
• contact with an emergency department physician at the receiving facility
NH Patient Care Protocols• “Minimum” menu - Saf-C 5900• “Maximum” menu - Medical
Control Board• Scope of Education v. Scope of
Practice
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Allergic ReactionsAllergic Reactions
• Very Common
• Range from mild and local to severe and systemic.
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Common Causes of Allergic Common Causes of Allergic ReactionsReactions
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Mild Allergic ReactionsMild Allergic Reactions
– Mild reactions usually affect only one area of the body
– Slow onset, and minor symptoms (i.e. localized redness, swelling, itching)
– NO respiratory or cardiac signs or symptoms
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Mild Allergic ReactionsMild Allergic Reactions
A mild, local reaction
caused by a bee sting
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Severe Allergic ReactionSevere 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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• Itching, skin flushing
• Urticaria (hives) (look at the torso!) and /or swelling (Especially the face and the extremities)
Severe Allergic ReactionSevere Allergic Reaction
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Severe Allergic ReactionSevere Allergic Reaction
• Increased Pulse• Decreased Blood Pressure• Nausea & Vomiting• Altered Mental Status• Sense of impending doomsure with
history of anaphylaxis
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AnaphylaxisAnaphylaxis• An exaggerated immune
response to an allergen• Sudden, rapid onset• Systemic involvement • Severe allergic reaction
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EpinephrineEpinephrine• Generic Name
– Epinephrine
• Trade Name– EpiPen– EpiPen Jr.– Adrenalin
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EpinephrineEpinephrineActionsActions
• Dilates bronchioles
• Constricts blood vessels
• Increases heart rate
• Increases cardiac output
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EpinephrineEpinephrineIndicationsIndications
• Signs and symptoms of severe allergic reaction
• Compliance with the NH Patient Care Protocols
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EpinephrineEpinephrineContraindicationsContraindications
None when dealing with anaphylaxis!
BUT MUST FOLLOW NH BUT MUST FOLLOW NH PATIENT CARE PATIENT CARE PROTOCOLS!PROTOCOLS!
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EpinephrineEpinephrineDosageDosage
• 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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EpinephrineEpinephrineRouteRoute
– Deep Intramuscular Injection
– Lateral thigh, midway between waist and knee
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EpinephrineEpinephrine Side EffectsSide Effects
– Increased pulse rate
– Pallor– Dizziness– Chest Pain– Headache
• Nausea• Vomiting• Excitability /
nervousness• Anxiety • Syncope
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Epi auto-injector Epi auto-injector AdministrationAdministration
• Remove safety cap from auto-injector• Hold auto-injector from center
(Do Not place thumb over either end!)• Place against patient’s thigh
– Lateral portion, midway between waist and knee
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Epi auto-injectorEpi auto-injector AdministrationAdministration
• Push until auto-injector activates
• Hold until medication injected (10 seconds).
• Record Time• Record Response to
Medication
•Dispose of auto-injector in biohazard Dispose of auto-injector in biohazard “sharps” container.“sharps” container.
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Emergency Medical CareEmergency Medical Care
Allergic Reaction/Anaphylaxis
Patient Care ProtocolJanuary 2005
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Patient AssessmentPatient Assessment•Routine Patient Care•Scene Size-up•Initial Assessment (watch
the airway!)
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Focused HistoryFocused History• Determine SAMPLE Hx and Hx of
Present Illness (HPI) :– Hx of allergies– What was patient exposed to now & then?– How was patient exposed? Now? Past?
– Past & Current Signs and Symptoms? – Time of onset?– Progression?– Treatments already performed?
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Focused Focused Physical AssessmentPhysical 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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ANAPHYLAXISANAPHYLAXIS
• Summer of 2002, the NH Medical Control Board (MCB) and Seacoast Food and Allergy Group worked on the development of a protocol to allow EMT-Basic to administer Epipens and Epipen Jr.s supplied on EMS Units.
• Adopted by MCB for 2003 Local Option Protocols
• Standing Orders adopted by MCB 2005
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NH Patient Care AnaphylaxisNH Patient Care AnaphylaxisProtocolProtocol
• Call ALS• Administer oxygen• Assess respiratory status• Assess cardiac status• Vital signs
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NH Patient Care AnaphylaxisNH Patient Care AnaphylaxisProtocol(cont.)Protocol(cont.)
• Caution needed when administering epinephrine to patients with history of CAD, HTN, etc.
• If patient has signs / symptoms of an allergic reaction (hives, itch, anxiety) but is otherwise hemodynamically stable, contact medical control for further direction.
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NH Patient Care AnaphylaxisNH Patient Care AnaphylaxisProtocol(cont.)Protocol(cont.)
• 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 assessmentOngoing assessment
• Monitor A-B-Cs• Reassess vital signs• Oxygen!• Watch for changes in
patient condition
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Ongoing AssessmentOngoing Assessment
If the patient deteriorates...• Oxygenate• Contact Medical Control for order for
second dose• Prepare for resuscitation• Oxygenate• Treat for shock
Did we mention Oxygenate?
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Ongoing AssessmentOngoing Assessment
– Contacted Medical Control to administer a second auto-injector.
– Be prepared to perform CPR if patient deteriorates.
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CommunicationCommunication
• What?– Assessment Finding– Treatments– Result of Treatment
• Who?– Other EMS providers– Receiving Facility personnel
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DocumentationDocumentation• What?
– Assessment Finding– Treatments – Result of Treatment
• Where?– PCR– Performance Improvement / Quality
Improvement
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Goals Review!Goals Review!• Overview of General Pharmacology• 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 &
it’s administration • Identify situations when epinephrine may be
indicated• Understand NH Patient Care Protocol -
Anaphylaxis
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Questions?Questions?