SHEFFIELD CLINICAL IMMUNOLOGY AND ALLERGY SERVICE



SHEFFIELD CLINICAL IMMUNOLOGY AND ALLERGY SERVICE | |

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|These constitute guidelines for the diagnosis/management of the condition stated, for use by immunology doctors and nurses |

|within the Sheffield Clinical Immunology and Allergy Service. |

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|Clinical judgement supersedes these guidelines whenever necessary. |

|GUIDELINES FOR: |

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|PATIENT INFORMATION SHEET; HOW AND WHEN TO USE THE ADRENALINE AUTOINJECTOR |

|Gone to medical illustration |

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|Index No: |AL 78 |Version No: |AL 78.04 |

| |Name, |Date |Signed |

| |Designation | | |

| | | | |

|Approved for local use at this |Dr Egner/ Dr Shrimpton/ Dr | | |

|centre by: |Sargur | | |

| |Consultant Immunologists | | |

|Date operational: |NOVEMBER 2012 |

|Date for review: |NOVEMBER 2014 |

|Filename: | |

|Status: |Operational /Controlled |

|Location of copies on this site: |Copy 1: Immunology Office CIAU |

| |Copy 2: Shared Drive Limited Access |

| |Copy 3: Nursing Station CIAU |

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|This is copy number: | |

|Summary of changes compared to previous version: | |

| |This is the fourth version |

HOW, AND WHEN, TO GIVE ADRENALINE USING AN AUTOINJECTOR FOR ALLERGIC REACTIONS

Anaphylaxis is an acute severe reaction needing immediate medical attention. You may feel as if you cannot breath or are about to collapse. The treatment is injected adrenaline [see treatment plan].

Minor or Moderate allergic reactions can have some of the same symptoms but are much less severe and may be treated with antihistamines, salbutamol, inhaled adrenaline or corticosteroids as required [see treatment plan]. Adrenaline is not needed for minor or moderate reactions.

When someone develops an acute allergic reaction the onset is usually rapid (usually less than one hour after exposure, often within minutes.)

MINOR symptoms may include:

➢ Itching

➢ Strange or metallic taste in the mouth.

➢ Urticaria (Hives, Nettle Rash) anywhere on the body. [Urticarial rash is pale pink, raised and intensely itchy].

➢ Swollen lips, tongue or face.

MODERATE TO SEVERE symptoms may include:

Difficulty in swallowing due to swollen throat or tongue

➢ Mild or moderate difficulty in breathing due to a swollen tongue, or because of wheezing/asthma.

➢ Abdominal pain, cramps or diarrhoea.

SEVERE symptoms may include:

➢ Rapid onset of severe difficulty in breathing due to wheeze or throat swelling

and/or a sudden feeling of

o Severe faintness

o Actual collapse

o Loss of consciousness

o Low blood pressure

For further information contact:

Sr. Fran Ashworth, EN, RGN, ONC, BA [Hons], DCHCP

Tel 01142 266964 or 01142 434343 Bleep 2918.

DIRECTIONS FOR USING AN ADRENALINE AUTOINJECTOR

(e.g. JEXTtm or EPIPENTM)

If you experience symptoms suggesting a severe reaction you should take the following actions IMMEDIATELY.

1. Send someone to call an Ambulance.

Say the problem is “ANNA-PHIL-AXIS”

2. Lie down if you feel faint. If someone else has collapsed then position them on their side in Recovery position. Never sit upright until medically assessed, leave others lying down.

3. Place the black tip of the adrenaline autoinjector (the pointy bit) against the big muscle on the front or side of the patient’s thigh, holding the autoinjector at right angles to the leg.

4. Remove the grey or yellow safety cap.

5. Press hard and steadily into the thigh until the autoinjector mechanism functions; [you will hear a click] - hold in place for 10-15 seconds.

6. Remove the autoinjector from the thigh, massage the injection site for several seconds. Note the time.

7. Elevate the legs; Do not sit the patient up (even if they feel better)

8. If someone else has collapsed check their pulse and breathing. If necessary perform Cardio Pulmonary Resuscitation [CPR] immediately and continue to do so until the ambulance arrives or the patient recovers.

9. Check the Ambulance has been called.

10. Stay with and reassure the patient if recovering or continue CPR until help arrives if the patient is not recovering and consider giving a second autoinjector (if available) after 5-15 minutes if there is no sign of recovery. This is rarely needed.

Side effects of adrenaline may include:

Palpitations, tachycardia [rapid pulse], sweating, nausea, and vomiting, pallor,

dizziness, nervousness and anxiety.

In people with ischaemic heart disease [IHD] adrenaline may induce angina or rarely a heart attack. Adrenaline should be reserved for severe reactions in these patients.

IF IN DOUBT AND FACED WITH SIGNIFICANT DIFFICULTY IN BREATHING, OR IMMINENT COLLAPSE DUE TO ALLERGY - USE THE ADRENALINE AUTOINJECTOR.

1. Remove autoinjector from its carton.

2. Place black tip onto the thigh at right angle to the leg

3. Remove grey or yellow safety cap and press hard into thigh until autoinjector mechanism functions. Hold in place for 10 seconds.

4. The autoinjector should be removed and discarded safely

5. Massage the area for several seconds.

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NB ONCE USED, THE AUTOINJECTOR NEEDS TO BE DISCARDED IN A SAFE MANNER. IT IS ADVISED TO GIVE THEM TO AMBULANCE OR HOSPITAL STAFF WHO WILL DISCARD THEM FOR YOU.

NEVER SIT THE PATIENT UP, EVEN IF THEY FEEL BETTER, UNTIL ASSESSED BY A PARAMEDIC OR DOCTOR. THIS CAN BE DANGEROUS.

IF BLOOD PRESSURE APPEARS LOW, ELEVATE (LIFT UP) THE LEGS.

For further information please consult the appropriate website:

epipen.co.uk

jext.co.uk

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DIRECTIONS FOR USING AN ADRENALINE AUTOINJECTOR

Grey or yellow safety cap

Black tip

Safety cap

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