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Speaker 1: Can I have a piece? Speaker 2: Mm-hm. Try it. It's really good. Speaker 1: Hey, Anthony, can you go get help? Speaker 2: Mm-hm. Speaker 3: In all my years as a licensed paramedic, working on the street, not many acute illnesses are as scary as a severe allergic reaction. We have a fancy word to call that. It's called "anaphylaxis," which is the body's reaction to something that is causing them to have a number of different symptoms that could lead to a life-threatening emergency. In this scenario, we're going to teach you what anaphylaxis is, what it's doing in the body, and then how we maybe able to treat them until emergency medical services arrive. So what anaphylaxis? Anaphylaxis is an allergic reaction, where the body does different things at the same exact time. While the blood vessels are dilating and becoming leaky, allowing fluid to leak out into the tissues of the body, decreasing the blood pressure, something else is tightening. And it's the airways. The bronchioles, the alveoli sacs, are filling with mucus and fluids, and basically we have these two mechanisms working together to create a serious life-threatening problem. So the signs that this person might be showing is not only the itchy, the hives, the scratchy, the itchy throat, the swollen tongue, the swollen lips. Those are kind of superficial as far as the outside of the body. But what is happening inside is what we hear, most of the time. And that's difficultly breathing, wheezing, gasping for breath, and not being able to get it in. This is caused by those bronchoconstrictions, as well as well as the fact that she might be headed into looking pale, because her heart rate is trying to increase and she's also losing blood pressure. So, these are some things that we're going to be ware of as we're dealing with this anaphyatic patient. Now, in this scenario though, she was wise. She understands that she's having a problem and she told somebody who was a bystander to get help. In this training scenario, she's already been prescribed epinephrine for these types of emergencies. But in the case, didn't know she had a food allergy. So her brother shared the candy bar with her, it might have had an allergen in it, obviously it did. And now she's reacting to it. So, as soon as we could, we got to her EpiPen. A few points to think about here is we need to make sure that the date is still within the expiration range so that it, it's good. We're going to pull the cap off, the safety cap, and it's important to remember that we grip it firmly in our hand. But, we do not put a thumb over the needle area, or over the back of the EpiPen. Now that this has been readied, I'm going to hand it to this victim, whose now going to auto-inject. She puts it into her big muscle in her thigh, and holds it there for three seconds. She now takes it out of her leg and lays it beside her. While she does that, she massages the leg and tries to get the, the medicine to absorb into that deep inner muscular injection. This training is based on the EpiPen brand, so if you use a different brand, make sure you follow that manufacturer's directions. Now, while we're letting that get into the system, if we have not already called 911, we should be. So, if you have a phone, dial 911, and get emergency medical services on the way. If you don't have a phone, send somebody to go call 911 immediately. If there's a delay in emergency medical services of greater than 5 to 10 minutes, and the patient actually has a second auto-injector available, we can actually deliver a second auto-injector if the signs and symptoms of her anaphylaxis have not improved. Now, we're always going to be monitoring this patient for an increased problem. Maybe a loss of consciousness, increased difficulty of breathing, or respiratory arrest, and then eventually cardiac arrest. And we're going to treat them accordingly while we wait for EMS to arrive.
There's nothing as scary as a severe and sudden allergic reaction (called anaphylaxis), as the body reacts to a foreign substance that produces a number of different symptoms simultaneously, and usually within mere minutes of the allergen coming into contact with the body. Anaphylactic shock will cause death if not treated.
Epinephrine is the first line of defense when it comes to treating anaphylaxis. And the sooner it's administered, the less severe the allergic reaction.
In this lesson, we'll cover what anaphylactic shock is, what it does to the body, and how we can help someone who's having a severe allergic reaction until advanced medical personnel arrive.
Anaphylaxis Effects on the Body
During a severe allergic reaction, there are two biological mechanisms working together, albeit while moving in opposite directions.
- Blood vessels relax and dilate. As this happens, blood and other fluids leak into the body's tissues, which decreases blood pressure and will eventually starve vital organs of oxygen.
- At the same time, the airway begins to tighten. The bronchioles and alveoli sacs are filling with mucus and other fluids and breathing becomes more and more difficult.
People with a history of allergic reactions should always carry an epinephrine pen. Pens are single dose, pre-filled, automatic injection devices, also known as epi-pens.
The following instructions are specifically for Epi-Pen brand. If you're using a different brand of epi-pen, be sure to follow the manufacturer's instructions.
How to Provide Care
Before we get into how to use an epi-pen, let's look at some common signs and symptoms of an allergic reaction, which include:
- Hives
- Itchiness
- Swollen tongue
- Scratchy throat
- Pale
- Lightheaded
- Difficulty breathing
Pro Tip #1: Any time an epi-pen is used, be sure to call 911 and activate EMS. The person, even if feeling better, must seek further medical attention after a severe allergic reaction. Especially if this is their first allergic reaction.
- Make sure the epi-pen isn't expired.
- Remove the pen's safety cap.
- Grip the pen in your hand with the tip pointing down.
Warning: Never put your thumb, fingers, or hand over the tip of the pen (or the back); you may accidentally inject yourself while treating the victim.
- Firmly push the tip of the pen into the victim's outer thigh at a 90-degree angle and until you hear the pen click. Needles can penetrate clothing.
- Keep the auto-injector firmly pressed against the patient's thigh; hold for a minimum of three seconds.
- Pull the epi-pen straight out.
Warning: Make sure you don't pull the pen out at an angle. This can cause a lot of pain and bleeding. And if blood comes out of the leg (along with some epinephrine), there's a good chance the effectiveness of the shot will be reduced.
- Rub the area for 10 seconds, as this will increase absorption of the epinephrine within the leg muscle.
Pro Tip #2: A second epi-pen may be used if symptoms persist or recur and if EMS has been delayed for more than 5 to 10 minutes.
Usually the patient will notice some airway relief pretty quickly, as the tightness in the throat begins to dissipate. There are, however, some unfortunate side effects that some patients may experience, including:
- Rapid heartbeat
- Shakiness
- Feelings of anxiety
- Dizziness
- Headache
A Few Common Questions About Anaphylaxis
Should I administer the epinephrine, or should I let the victim do it?
Let the victim handle the epi-pen if they're able to. If dealing with a small child or someone who's unable to do it themselves, assist as needed. If you do have to assist, try and get permission to do so for reasons of liability. The American Heart Association recommends helping in the following scenarios:
Only assist if/when:
- The patient has a previous diagnosis of anaphylaxis and has been prescribed an epinephrine auto-injector
- The patient is having signs and symptoms of anaphylaxis
- The patient requests your help using an auto-injector
- Your state laws permit giving assistance
What if there are complications while waiting for EMS to arrive?
It's always a good idea to monitor for other issues while waiting for paramedics to arrive, like loss of consciousness, an increase in breathing difficulties, respiratory arrest, and cardiac arrest.
If the person stops breathing but still has a pulse, perform rescue breathing. If the victim stops breathing and loses his or her pulse, begin full CPR.
Pro Tip #3: Remember, you can always call 911 and put the phone on speaker. Dispatch can help walk you through any first aid scenarios you may not be comfortable with. Also, it's important to understand that once a person loses consciousness and a pulse, they're technically already dead. And there's no way to make that situation any worse.
If the victim begins showing signs of shock – cool, pale, sweaty skin and a rapid pulse – cover him or her with a sheet, coat, or blanket and keep them as warm and comfortable as possible while waiting for EMS to arrive.
Are there different doses of epinephrine?
Yes. Epinephrine devices are available in different doses, as the dose of epinephrine is based on weight – 0.15 mg for children weighing between 33 and 66 pounds, and 0.3 mg for children and adults weighing more than 66 pounds. People with a known history of anaphylaxis would be wise to carry an anaphylaxis kit containing at least two doses of epinephrine with them at all times.