Dr Rida Javaid Iqbal Pediatric Resident Texas Tech University of Health Sciences Anaphylaxis Lifethreatening allergic reaction that may involve multiple body systems Medical emergency Immediate intervention and treatment ID: 538838
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Slide1
Use of EPI-pen
Dr Rida
Javaid
Iqbal
Pediatric Resident
Texas Tech University of Health SciencesSlide2Slide3
Anaphylaxis
Life-threatening allergic reaction that may involve multiple body systems.
Medical emergency
Immediate intervention and treatmentSlide4
Food Allergy Management Education:
Challenges
• Limited education time
– Not enough time to become competent or confident in food allergy
management
– Large Volume of Information
– Significant Lifestyle Changes
– Train the trainer
• Studies of parental knowledge demonstrate
clear deficits in
– Competency in epinephrine administration
– Allergen avoidance
– Information provisionSlide5
Who is at risk?
Risk Factors
• Delayed administration of epinephrine.
• Reliance on oral antihistamines alone to treat
symptoms.
• Consuming alcohol and the food allergen
at the same time.
Groups at Higher Risk
• Adolescents and young adults.
• Children with a known food allergy.
• Children with a prior history of anaphylaxis.
• Children with asthma, particularly those with
poorly controlled asthma. Slide6
Food Allergy Fatal and Near Fatal Anaphylaxis
• Most away from the
home
•
Unintentional ingestion with known food allergy
•
Majority are peanut & tree nut
•
Asthma is a significant risk factor
•
Adolescents and young adults are at greatest risk ‐ 70% of mortalities between ages 12 and 21
•
Delayed or lack of administration of epinephrine – 88% of fatalitiesSlide7
How do you know?
“my tongue feels funny”, “There’s a frog in my throat”, “There’s
sth
stuck in my throat”
S&S
Swelling eyes, lips, itchiness, flushing, hives, NVD, cramping, congestion, sneezing, wheezing, deep breathing, chest feels tight, hoarseness, pallor, cyanosis, dizziness, sense of ‘impending doom’
Takes 1 to 2hrs after exposureSlide8
Pillars of Food Allergy Management
These must be applied at all times and in all settings:
Prevention Emergency
PreparednessSlide9
Prevention
Routes of Food Allergen Exposure
Oral
Inhalation
Skin ContactSlide10
Cross contact
Allergens can be transferred by objects, saliva, and food
• Exposure to small amounts of allergen is enough to cause
a serious allergic reaction
• Allergens withstand heating and drying
• Routine training for all caregivers about sources of cross‐
contact and prevention of exposure is essential
• Saliva and pets can be a source of cross contact
• Be aware of the developmental level and capabilities of
the child
• Different issues with different age groupsSlide11
Cleaning to Prevent Cross‐Contact
•
Establish a cleaning protocol to avoid cross‐contact
What Works: Soap and water,
commercial hand wipes, commercial cleaners,
What Doesn’t: Hand sanitizersSlide12
In short..
Read Labels
Prevent Cross-contact
Avoid Hidden IngredientsSlide13
Emergency preparedness
Must be applied at all times and places
Identify children with food allergies
Develop a plan to manage and reduce risk of food allergies
Help students manage their own food allergiesSlide14
Implementation of SB 66
The Texas Legislature passed SB 66 in the 2015 Legislative Session.
This bill allows for the stocking of epinephrine auto-injectors in Texas public schools and publicly funded charter schools to be used in case of emergency, and gives legal liability protection to those involved.Slide15
What is an emergency care plan?
This form should be kept in each child’s school health record, and it may include the following:
° A recent photo of the child.
° Info about the food allergen, + a confirmed written
dx
from the doctor
° Info about S&S of the child’s possible reactions to known allergens.
° Info about the possible severity reactions, + any
hx
of anaphylaxis
° A Rx plan for responding to allergy reaction or emergency, including whether an epinephrine auto-injector should be used.
° Info about other conditions, such as asthma that might affect food allergy management.
° Contact info for parents and doctors, including alternate phone numbers for notification in case of emergency.
Slide16
Food Allergy and Anaphylaxis Emergency Care Plan
• Simplified criteria to identify potential allergic emergencies for use by patients, families, caregivers and school staff
• Accessible and understandable
• Strongly encourage submission to school/daycare
• Train families to use
ECPsSlide17
Food Allergy and Anaphylaxis Emergency Care Plan
Clearly Convey the Critical Role
of Epinephrine
Auto‐injector Trainers
Call 911 for Suspected AnaphylaxisSlide18
This is what auto injectors look like Slide19
What do they contain?
Epinephrine AKA adrenaline
Improves all symptoms immediately
But is short actingSlide20
What to do..
Follow the anaphylaxis protocol
Administer the epinephrine (always have 2 injectors ready)
Call EMS
Place patient on back with legs up
Notify guardian
Place AED, portable O2,
ambu
bag, pulse ox, nebulizer kit,
albuterol
, close to pt
Vitals
q
5
mins
Bronchospasm
? Give
albuterol
neb!
Notify Health services, to reorder epinephrine
DocumentSlide21
The biphasic reaction
Food-induced anaphylaxis is SERIOUS
Can cause death due
t
cardiopul
compromise in 30mins to 2hrs of exposure
20% of the time, even if the initial symptoms are successfully treated, the anaphylaxis recurs within 4 to 8hrs.
They might need additional emergency care.Slide22
Bust A Myth
Myth
Food allergy? Give antihistamine first
Fact
Epinephrine is the treatment of choice for anaphylaxisSlide23
Bust A Myth
Myth
Call an ambulance because epinephrine is dangerous
Fact
Call an ambulance because the reaction was bad enough to need epinephrine and might need additional treatmentSlide24
Bust A Myth
Myth
The needle for
epi
pen is HUGE
Fact
The needle is shorter than the width of a dimeSlide25
Bust A Myth
Myth
All anaphylactic reactions have skin reactions
Fact
10 to 20% of anaphylactic reactions have NO skin problemsSlide26
In short..
Know how and when to give epinephrine
Always have 2 epinephrine doses available
Call 911 for anaphylaxisSlide27
video
https://youtu.be/EN83hen4D-YSlide28
Sources
Texas Allergy Asthma and Immunology Society
Epipen.com
CDC guidelines