Lesson 5 – Anaphylaxis Management And Epinephrine Administration: Life-Saving Interventions In Severe Allergic Reactions

Lesson 5 Overview

Managing anaphylaxis and epinephrine use is vital. Learn to recognize anaphylaxis, know when/how to give epinephrine, and manage critical patients effectively.

Recognizing Anaphylaxis

Rapid onset (minutes to hours), involves 2+ body systems: skin (hives/swelling, may be absent in repeats), respiratory distress, cardiovascular signs (hypotension), severe GI symptoms. Treat if suspected.

When to Give Epinephrine

Indicated for airway swelling/stridor, severe wheezing, shock signs (low BP, altered mental status), or rapidly worsening symptoms. Early administration better than delay, especially with prior severe reactions.

Using an EpiPen

Remove blue cap; press orange tip firmly against lateral thigh (through clothing if needed); hold 3-5 sec. Adult dose 0.3mg, pediatric 0.15mg. Help patient lie down or sit if breathing hard; never let stand/walk. Call 000 immediately. Follow ASCIA plan.

Assisting Patient with Auto-Injector

Confirm prescription and expiry. Encourage self-use; assist if unable. Inject lateral thigh, hold 3-5 sec. Document med, dose, time, injection site for hospital.

EMT Epinephrine Administration

Scope varies: assist patient’s injector or administer EMS supply (auto-injector or vial). For vials (1:1000), remove dust cover, inject air equal to withdraw volume, withdraw dose, remove bubbles, inject IM/subcutaneous lateral thigh. Ampules require gauze snap, draw medication horizontally, remove bubbles, inject dose, discard sharps properly. Know all methods.

Dosing

Adults & kids >30kg: 0.3mg IM. Kids 15-30kg: 0.15mg IM. Smaller kids: medical control. Repeat every 5-15 min if no improvement; max 2-3 doses without medical control. Auto-injectors preset dose.

Post-Epi Monitoring

Request ALS for cardiac & airway monitoring. Check vitals every 2-5 min. Monitor breathing for improvement/deterioration. Watch for side effects (tachycardia, hypertension, anxiety) — not reason to withhold epi but monitor.

Additional Treatment

High-flow O2 essential. Position supine with legs elevated to support BP; patient comfort priority (sitting if breathing difficult). Use bronchodilators if wheezing & protocol allows. Antihistamines/steroids usually ALS interventions but good to know.

Transport

Transport urgently; consider ALS intercept or air evac if remote. Notify hospital early with “anaphylaxis.” Monitor closely en route, repeat epi if needed. Patient position comfortable (often sitting).

Special Considerations

Pregnant patients should receive epi if needed; benefits outweigh risks. Elderly may be sensitive—monitor closely. Beta-blocker patients may have reduced response. Heart disease patients at risk but treat true anaphylaxis. Contact medical control if unsure.

Scenario

45yo bee sting, breathing difficulty, low BP. Rapid assessment, epi admin, airway support, ALS request, repeated dosing if needed, urgent transport. Minutes count; reassess frequently. Next lesson: special considerations.