Anaphylaxis Management: Administration Of Intramuscular Epinephrine

[Audio] Anaphylaxis Management: Administration of intramascular epinephrine.

[Audio] Remember 4 "R's"! 1. Realize the risk 2. Recognize the sign and symptoms 2. Respond calmly and quickly to the situation 3. Review the situation to prevent re-occurrence.

[Audio] Initial Exposure 1.An exposure to a substance (antigen) the immune system produces specific Ig antibodies in the lymph nodes. T cells help to enhance this process further. 2. These antibodies (IgE) bind to the membrane receptors located in mast cells and basophils but remain inactive. Subsequent Exposure In subsequent exposure when body re-encounters the antigen ,the IgE antibodies recognize the antigen as foreign and triggers the release of histamine and other chemical mediator, that causes symptoms of anaphylaxis. when body re-encounters the antigen ,the IgE antibodies recognize the antigen as foreign and triggers the release of histamine and other chemical mediator, that causes symptoms of anaphylaxis..

[Audio] Development of anaphylaxis Initial contact with allergen stimulates the production of allergen specific IgE antibodies by plasma cells in the susceptible individuals then allergen specific IgE attaches itself to the surface of mast cells in various tissues and basophils in the blood in a process known as sensitization. No symptoms occur during the sensitization phase but, once the phase is completed, the individual is primed to react to the offending allergen. when body re-encounters the antigen ,the IgE antibodies recognize the antigen as foreign and triggers the release of histamine and other chemical mediator, that causes symptoms of anaphylaxis..

[Audio] Risk factors for severe anaphylaxis: Anaphylaxis is a rare complication of immunization. Risk factors for increased severity of anaphylactic events include: very young or old age, pregnanacy, severe or uncontrolled asthma, chronic obstructive pulmonary disease, systemic mastosytosis, concurrent use of certain medications foe eg. angiotensin-converting enzyme [ACE] inhibitors and beta-blockers).

[Audio] How do I determine if it is anaphylaxis What are the sign aand symptoms of anaphylaxis. Prepared ahead when there is possibility for anaphylaxis. Where anaphylaxis can occur..

[Audio] Be Prepared: Prevention is extremely important. Please ask screening questions for all vaccines Has the vaccine recipient ever had a serious reaction (E.g., anaphylactic reaction) after receiving a vaccine or is the recipient aware of any allergies to components of the vaccine, or latex Additional screening questions if immunizing with live vaccines Does the vaccine recipient have any acute or chronic immunocompromising condition, or have they taken any medications in the past 3 months that cause immunosuppression, including corticosteroids? Review all allergies.

[Audio] Sign A-N-D Symptoms of Anaphylaxis: Respiratory Accessory muscles – use of Air entry – decreased Breathing increased rate increased work of shortness of breath Cough Drooling Grunting Hypoxemia Nasal flaring Sneezing Stridor Swallowing – difficulty Vocal changes Wheeze Cardiovascular Blood pressure – may be low Capillary refill time – poor Colour – cyanosis/pale/grey Conscious to unconscious Dizziness Ears – throbbing or ringing Headache Heart rate – rapid, weak Restlessness, irritability Uneasy, anxious – sense of impending doom Weakness Skin and Mucosa Colour – flushed Hives – generalized Itchiness Sweating Swelling – face, lips, tongue, and/or uvula Tingling sensation – tongue, mouth, or face – followed by a feeling of warmth Gastrointestinal Abdominal pain – cramping Diarrhea Incontinence Nausea Vomiting.

[Audio] When can anaphylaxis OCCUR Anaphylaxis can occur in the following ways: Symptoms usually start within minutes of exposure to an allergen. Sometimes, anaphylaxis can occur a half-hour or longer after exposure. In rare cases, it may be delayed for hours. Anaphylaxis can be uniphasic (all at once) or biphasic (a few hours later). Very rarely, it can last for days to weeks..

[Audio] Anaphylactic Treatment If you suspect anaphylaxis, a rapid response is critical. Steps 1,2,3,4 should be done promptly and simultaneously Step 1: Direct someone to call 911(where emergency) or emergency services Step 2: Assess airway, breathing and circulation Step 3: Place the individual on their back and elevate lower extremities Step 4: Inject Epinephrine intramuscularly into mid-anterolateral thigh (refer to epinephrine dosage table) Step 5: Repeat every 5 minutes if not improving Sep 4:.

[Audio] Please review the table to administer right dose of epinephrine ..

[Audio] Intramuscular (I-M---) epinephrine (using 1 milligrams/ml concentration ampule is first line treatment for anaphylaxis it shall be immediately administered when anaphylaxis is suspected.

[Audio] How much I give: If wrong dose is given or if epinephrine is administered by wrong route, it can cause serious negative outcomes Adult and Pediatric patients (12 years and older) Who weigh 46 kilograms or more promptly administer epinephrine 0.5 milligrams (0.5ml) from vial or 0.3 milligrams dose by autoinjector(EpiPen),deep Intramuscular to mid anterior lateral thigh(Vastus lateralis muscle) Monitor for continued signs and symptoms of anaphylaxis and repeat epinephrine dose every 5 minutes using a new anaphylaxis kit to maximum of 3 doses, if patient's condition does not improve. Use a new anaphylaxis kit for every required dose Failure to administer EPINEPHrine promptly may result in greater risk to the vaccinee with anaphylaxis than using EPINEPHrine improperly.

[Audio] Anaphylaxis Management Kits should contain A clear, concise summary of the anaphylaxis emergency management protocol. 1-1 ml ampule of epinephrine (1 milligrams/ml concentration)-flagged with "For IM use only" label: d A range of autoinjectors of epinephrine labelled by age and weight (optional) 1-1 ml syringe 1-25 grams, 1" safety glide needle 1-22 g" 1 ½ inch safety glide needle 1-18 gauge 1 1/2" Blunt fill needle-filter 2 alcohol swabs Storage of anaphylactic kits: should be stored: In a cool dark place at room temperature, between 15-30 degrees celsius, but not refrigerated, as temperatures below 15 degrees celsius may damage the injector mechanism..

[Audio] Non-pharmacologic interventions Positioning Supine position with lower extremities elevated or position of comfort if unable to lie on the back due to Respiratory Distress sit up, sit forward, or in a position of comfort. Elevate leg if tolerated Unconscious or risk for vomiting – Recovery position Keep the patient supine with legs elevated or position of comfort until their cardiovascular system has stabilized. Oxygenation Administer oxygen and monitor oxygen . Airway and Ventilation Patient's airway should be monitored and maintained due to the potential for rapid development of upper airway edema resulting in obstruction.

[Audio] Monitoring and Assessing Continue to monitor until E-M-S arrives and care is transferred. Check vitals signs every 5 minutes Biphasic Reaction: Anaphylaxis that resolves after the epinephrine, but patient becomes symptomatic up to 72 hours later without additional exposure to allergen Protracted anaphylactic reactions: It is rare when symptoms persists for up to 48 hours without completely resolving, despite treatment..

[Audio] Documentation Document administration of all emergency medications in E-M-A-R. Document vital signs and other relevant clinical information and all adverse events in the Resident's medical record. Notify the Physician . A-E-F-I Reporting The Public Health Act: immunization Regulation (Alberta) requires health professional to report adverse effects following immunization(A-E-F-I-) to A-H-S--. If anaphylaxis is experienced by staff or a resident following immunization , health care professional must report this to A-E-F-I team by email aefi@ahs.ca or phone 1-855-44-2324, as soon as possible or with in 24 hours ,after managing the emergency event..

[Audio] Patient Education Anaphylactic Reaction: Care instructions Instruct patient to : Avoid known or suspected triggers and implement preventative measures to potentially minimize the risk of anaphylaxis..

Periodic table of elements. Reference. Ellis, A. K. (2021). Anaphylaxis: Confirming the diagnosis and determining the cause(s). In: UpToDate, Kelso, J. M. (Ed.). Cardona, V., et al. (2020). World Allergy Organization anaphylaxis guidance 2020. The World Allergy Organization Journal, 13(10), 100472. Retrieved June 2024 from https://doi-org.ahs.idm.oclc.org/10.1016/j.waojou.2020.100472 (Level VII) Public Health Agency of Canada. Anaphylaxis and other acute reactions following immunization: Canadian Immunization Guide: Part 2 – Vaccine Safety. Ottawa (ON): PHAC; 2020. Table 4 Dosage of intramuscular EPINEPHrine 1:1000 (1 mg/mL) solution, by age or weight. Government of Canada https://www.aafp.org/pubs/afp/issues/2020/0915/p355.html https://www-wolterskluwer-com.ahs.idm.oclc.org/en/know/clinical-effectiveness-terms. 2024.