immunization refresher training...

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Immunization Refresher Training

(Influenza)

EMERGENCY CONTACT

1-844-FLU-HELP

PassportHealthUSA.com

Immunization Training ObjectivesAT THE CONCLUSION OF THIS TRAINING SESSION, YOU WILL BE ABLE TO

EFFECTIVELY:

• Store vaccinations at proper temperatures

• Understand what is Influenza

• Understand the Vaccine Information Sheet

• Understand who should not receive the influenza vaccine

• Understand the client flow

• Understand preparations prior to your clinic and day of your clinic

• Vaccine preparation and selection of proper injection site(s) for influenza vaccine

• Administer immunizations utilizing proper technique, needle gauge and length

• Document immunizations by recording correct patient, time, dose, route and vaccine

given

• Passport Health Expectations: when to show up/what to wear/how to set up

• How to close your clinic

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Effective management procedures

Trained personnel

PROPER STORAGE

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What is Cold Chain Management?It is the system to keep and distribute temperature sensitive medical products

It starts at the manufacturing plant and includes all links in the distribution chain until it is administered to the client. At all links in the chain the product must be maintained at the proper storage temperature to be effective. There are 3 components to Cold Chain Management:

Transport and

storage

Vaccines must be stored, shipped and administer according to the manufacturer's instructions as outlined in the manufacturer’s package insert.

If cold chain is broken the vaccine is no longer usable and should not be administered. Never throw away spoiled vaccine, call your immediate supervisor for instructions.

1-844-FLU-HELP

SUMMARY OF STORAGE INSTRUCTIONS • Ensure vaccine is not exposed to excess heat/cold/light • Influenza must be kept cold at 35-46° F • DO NOT FREEZE• Use of refrigerated or frozen packs during shipping is

common and provided they are packed correctly, they will maintain cold chain during shipping.


What is Influenza?• Influenza “The Flu” is a contagious respiratory illness caused by influenza viruses that infect the

nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death.

• The best way to prevent the flu is by getting a flu vaccine each year.

• Easily spread by coughing, sneezing, or nasal secretions

• Everyone is susceptible

• Rates of infection higher among children

• Symptoms include fever, cough, sore throat, headache, chills, muscle aches and fatigue

• 226,000 hospitalized annually

• 36,000 die annually-mostly elderly

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220+ CLINICS NATIONWIDE


Vaccination Information Sheet (VIS)You will receive VIS sheets for your clinic. There are 2 this year

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They are for:

Live Flu

Inactivated Flu

You are required to hand this to the client prior to

the administration of the vaccine


Who Should Get Vaccinated This Season?

Everyone who is at least 6 months of age should get a flu vaccine this season.

While everyone should get a flu vaccine this season, it’s especially important for some people to get vaccinated.

Those people include the following:

• People who are at high risk of developing serious complications (like pneumonia) if they get sick with the flu.

– People who have certain medical conditions including asthma, diabetes, and chronic lung disease.

– Pregnant women.

– People younger than 5 years (and especially those younger than 2), and people 65 years and older.

• People who live with or care for others who are at high risk of developing serious complications

• Household contacts and caregivers of people with certain medical conditions including asthma, diabetes, and chronic lung disease.

– Household contacts and caregivers of infants less than 6 months old.

– Health care personnel.


INFLUENZA (INACTIVATED) VACCINE

DO NOT GIVE IF…..Any severe (life-threatening) allergies, including an allergy to eggs. If you ever had a life-threatening allergic reaction after a dose of flu vaccine, or have a severe allergy to any part of this vaccine, you may be advised not to get a dose.

Any history Guillain-Barré Syndrome (a severe paralyzing illness, also called GBS). Some people with a history of GBS should not get this vaccine.

If you are not feeling well. They might suggest waiting until you feel better. But you should come back.

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WHO SHOULD NOT GET VACCINATEDINFLUENZA (LIVE) VACCINE

DO NOT GIVE IF….Any severe (life-threatening) allergies, including an allergy to eggs. If you ever had a life-threatening allergic reaction after a dose of flu vaccine, or have a severe allergy to any part of this vaccine, you may be advised not to get a dose.

Any history Guillain-Barré Syndrome (a severe paralyzing illness, also called GBS). Some people with a history of GBS should not get this vaccine.

If you are not feeling well. They might suggest waiting until you feel better. But you should come back.

THE FOLLOWING SHOULD ONLY RECEIVE INACTIVATED INFLUENZA – DO NOT GIVE LIVE VACCINE

– are pregnant

– have a weakened immune system

– have certain long-term health problems

– are a young child with asthma or wheezing problems

– are a child or adolescent on long-term aspirin therapy

– have close contact with someone who needs special care for an extremely weakened immune system

– are younger than 2 or older than 49 years. (Children 6 months and older can get the flu shot. Children younger than 6 months can’t get either vaccine.)

– If you have gotten any other LIVE vaccines in the past 4 weeks.


Pregnant Women & Influenza• Flu is more likely to cause severe illness in pregnant women than in women who are not pregnant. Changes in the

immune system, heart, and lungs during pregnancy make pregnant women more prone to severe illness from flu as well

as hospitalizations and even death. Pregnant woman with flu also have a greater chance for serious problems for their

unborn baby, including premature labor and delivery.

• Flu shots will protect pregnant women, their unborn babies and even protect the baby after birth.

The Flu Shot is the Best Protection Against Flu

Getting a flu shot is the first and most important step in protecting against flu. The flu shot given during pregnancy has been

shown to protect both the mother and her baby (up to 6 months old) from flu. (The LIVE nasal spray vaccine should not be

given to women who are pregnant.)

The Flu Shot is Safe for Pregnant Women

Flu shots are a safe way to protect the mother and her unborn child from serious illness and complications of flu. The

flu shot has been given to millions of pregnant women over many years. Flu shots have not been shown to cause harm

to pregnant women or their babies. It is very important for pregnant women to get the flu shot.

NOTE: Many pregnant women may request preservative free flu vaccine. There are no contraindications with pregnancy and regular (non LIVE) flu vaccines per CDC. HOWEVER,

PPH’s practice is to provide all pregnant women and children with preservative free, inactivated flu vaccine.


Preservative in Flu Vaccines

What is thimerosal?

• It is a mercury-based preservative approved by the FDA and used for decades in the US

• It is in multi-dose vials (vials containing more than one dose)

• It is to prevent the growth of germs, bacteria and fungi, that can contaminate them.

Is thimerosal in vaccines safe? Yes. There is a large body of scientific evidence on the safety of thimerosal. Data from several studies show :

• Low doses of thimerosal in vaccines do NOT cause harm, and are only associated with minor

local injection site reactions like redness and swelling at the injection site.

• CDC, FDA and NIH found it to be a safe product to use in vaccines.

• The National Academy of Sciences’ Institute of Medicine, Advisory Committee on Immunization

Practices (ACIP), and the American Academy of Pediatrics (AAP)] also found thimerosal to be a safe

product to use in vaccines.

• The medical community supports the use of thimerosal in influenza vaccines to protect against

potential bacterial contamination of multi-dose vials.


INFLUENZA VACCINE• SELECT THE PROPER VACCINE FROM YOUR STOCK.

• CONFIRM VIAL IS THE SAME AS THE BOX.

• CHECK THE EXPIRATION DATE AND CHECK FOR SIGNS OF CONTAMINATION.

• RULE OF THUMB PREFILLED SYRINGE OR SINGLE DOSE VIAL = PRESERVATIVE FREE

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A Multi Dose Vial

All influenza vaccines you will receive will be one of the following presentations:

A pre-filled syringe

An intradermal

prefilled syringe

An intranasal prefilled syringe*LIVE

VACCINE*


DOSAGE & ROUTE DOSAGE

The influenza vaccination is a standard,

universal dose. There is no need to calculate a

dose based on the weight of the individual

receiving the vaccination.

• The influenza vaccine is NOT routinely given

to infants under the age of 6 months.

• For individuals 6-35 months of age the dose is

0.25 mL or cc.

• For individuals ≥ 3 years of age the dose is

0.5 ml or cc.

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Trade name Dose/RouteAge indications

Afluria® 0.5 mL IM ≥9 yrs.

Fluarix® 0.5 mL IM ≥3 yrs.

Flucelvax® 0.5 mL IM ≥18 yrs.

FluLaval® 0.5 mL IM ≥3 yrs

Fluvirin® 0.5 mL IM ≥4 yrs.

Fluzone®0.25 mL IM 6-35 mos.

0.5 mL IM ≥36 mos.

Fluzone® Intradermal 0.1 mL intradermal 18-64 yrs.

Fluzone® High-Dose 0.5 mL IM ≥65 yrs.

Fluarix® Quadrivalent 0.5 mL IM ≥3 yrs.

FluLaval® Quadrivalent 0.5 mL IM ≥3 yrs.

Fluzone® Quadrivalent0.25 mL IM 6-35 mos.

0.5 mL IM ≥36 mos.

FluBlok® 0.5 mL IM 18-49 yrs.

FluMist® Quadrivalent 0.2 mL intranasal 2-49 yrs.Cheat sheet


Intramuscular injection

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OVERVIEW OF ROUTESIntradermal injection

Intranasal


PREFERRED INJECTION SITES

• 6-12 months- anterolateral thigh muscle utilizing a 1" needle

• 1-2 yrs- anterolateral thigh muscle or deltoid muscle of arm utilizing a 1"-1 ¼"

needle and ⅝" – 1"needle respectively

• 3-18 yrs- deltoid muscle of arm or anterolateral thigh muscle utilizing a 1"

needle or 1" – 1 ¼" needle respectively

• Individuals ≥ 19 years of age by gender and weight:

• – Male/Female <130 lbs. deltoid of arm utilizing a 1" needle

• – Female (130-200 lbs) or Male (130-260 lbs) deltoid muscle of arm utilizing a

1”- 1 ½” needle

• – Female (200+ lbs) or Male (260+ lbs) deltoid muscle utilizing a 1 ½" needle

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Clinic PreparationPRIOR TO CLINIC DAY

• (1 week before) You should have received your Assignment Details via email

• The exact ADDRESS/DATE/TIME of where the clinic

• The PPH point of contact (POC) who will meet you on site(name/phone)

• Instruction on when and what you will receive via UPS for the clinic

• (1-2 days before) You will receive your FLU BOX via UPS

• Be sure to maintain cold chain and review the contents of the box.

• Be sure you have all the supplies you need. If not call 1-844-FLU-HELP.

• Review and understand your standing orders (call 1-844-FLU-HELP if you have questions)

• (Night before) You need to map your route and plan accordingly.

• Map the destination and print directions- ARRIVE 1 HOUR PRIOR TO START TIME

• Recheck to be sure you have everything you need!!!

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*includes but is not limited to:Vaccine Needles/SyringesSharps Container Gloves Alcohol wipes Band-AidsDisplay items Forms Emergency Kit Standing Orders


Clinic PreparationDay of Clinic

• Arrive at clinic 1 hour prior to start time – with positive attitude

• Upon arrival call the point of contact (POC)

• When entering the building introduce yourself to receptionist and ask them to direct you to

the person provided as the POC for the Clinic.

• Ask POC where they would like for you to set up

• Clock in / Mark your time sheet

• Verify you have the following: at least 1 table, 2 chairs, waste basket

WHAT TO WEAR

Clean Pressed matching blue scrubs with no deign and sneakers

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Clinic PreparationSetting your area up

• Wipe table with sanitizer wipes.

• Layout the tablecloth.

• Determine client flow to aid in a smooth process.

• Set up an area with clipboards, pens and consent forms.

• Ensure sign in sheet is visible.

• Arrange waste basket and sharps container for easy access.

• Set up supplies: gloves, alcohol pads, gauze, hand sanitizer, needles, syringes, band-aids, etc.

• Identify a location for emergency supplies so that they are out of the way but easily accessible

should you need them.

• Position the client’s chair where you would like for them to sit, place VIS directly in front of where

the client will be seated.

• Go to the bathroom and wash your hands utilizing proper hand hygiene technique. If no facility

available then use hand sanitizer.

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Client FlowClient must complete consent form – have client complete while in line to speed up process.

Client must sign the “sign in log”

Introduce yourself/ provide your qualifications. (Hello, my name is Nurse Jane Smith, I will be administering your flu vaccine today.)

Ask them to have a seat:

1. Hand them VIS

2. Verify log and consent complete

3. Review consent for contraindications- ask clarifying questions about any consent questions with a Yes response.

4. Explain the vaccination process to the client. Example: We are administering the inactivated or killed influenza vaccine today. It is given by intramuscular injection to the deltoid muscle. The risk of

serious problems from the vaccine is very rare, but for safety I ask that you remain in the general area for at least 15 minutes after the vaccination

so that I may monitor you for any reactions. If mild problems occur such as fever, aches, headache, fatigue etc. they usually only last 1-2 days.

You can expect some soreness at the injection site but again that should only last 1-2 days.

5. Give the client an opportunity to ask any questions they may have

6. Follow Vaccine Administration Process – see following slides

7. Chart in the For Clinic Use Only section of the consent form

8. Thank the client.

9. Set Clients paperwork aside and refill clip board.

10. Place clipboard back with the others and invite the next client back.

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PREPARING VACCINATIONS

• Check Allergies & Contraindications & Standing Orders

• Ensure that you have selected the proper vaccination from your stock

• Check the expiration date

• Select the proper syringe (one which will allow you to draw up an accurate dose)

• Select the appropriate gauge and length needle based on the age and size of the person

being vaccinated

• Select the proper site for the injection

• Check Allergies & Contraindications

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Administration of Vaccine

Where do I give an intramuscular/intradermal

injection?• Completely expose the upper arm.

• You will give the injection in the center of an upside down triangle.

• Feel for the acromion process. The bottom of it will form the base of the triangle.

• The point of the triangle is directly below the middle of the base at about the level of the armpit.

• The correct area to give an injection is in the center of the triangle, 1 to 2 inches below the

acromion process.

• This site should not be used if the person is very thin or the muscle is very small.

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• Wash/Hand Sanitize Hands.

• Don Gloves for each client – this is a requirement for all Nurses – NO EXCEPTIONS

• Alcohol wipe area where injection will occur, using an outward circular motion. Let the area dry. Do not touch this

area until you give the injection.

• Hold the skin around where you will give the injection: With your free hand, gently press on and pull the skin so that it

is slightly tight.

• Insert the needle into the muscle: Hold the syringe barrel tightly and use your wrist to inject the needle through the

skin and into the muscle at a 90 degree angle.

• Check the needle: Let go of the skin with your other hand. Hold the syringe so it stays pointed straight in.

• Inject the vaccine: Push down on the plunger to inject the vaccine. Do not force the vaccine by pushing hard. Some

vaccines hurt. You can inject the vaccine slowly to reduce the pain.

• Remove the needle: Once the vaccine is injected, remove the needle at the

same angle as it went in. Place gauze over the area where you gave the injection.

• Chart the administration of vaccine as well as the site of the administration.

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Administration of Vaccine How do I give an intramuscular injection?

http://www.drugs.com/cg/how-to-give-an-intramuscular-injection.html


• Wash/Hand Sanitize Hands.

• Don Gloves for each client – this is a requirement for all Nurses – NO EXCEPTIONS

• Alcohol wipe area where injection will occur, using an outward circular motion. Let the area dry. Do not touch this

area until you give the injection.

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Administration of Vaccine How do I give an intradermal injection?

ID is administered in the same location as IM !

Don’t Forget!Chart the administration of vaccine as well as the site of the administration.


Administration of Vaccine How do I give intranasal vaccine?

Chart the administration of vaccine as well as the site of the administration.


Follow these guidelines when you work with sharps:

• Do not uncover or unwrap the sharp object until it is time to use it.

• Keep the object pointed away from you at all times.

• Never recap or bend a sharp object.

• Keep your fingers away from the tip of the object.

• Never hand a sharp object to someone else or put it on a tray for another person to

pick up.

• Never put your fingers into the sharps container.

• Sharps containers should be at eye level and within your reach.

• If a needle is sticking out of the container, NEVER push it in with your hands.

• If you find an uncovered sharp object outside of a disposal container, it is safe to pick it up only if you can grasp

the non-sharp end. If you cannot, use tongs to pick it up and dispose of it.

ALL USED NEEDLES AND SYRINGES MUST BE PLACED IN THE SHARPS CONTAINERS PROVIDED.

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Safe Sharps Disposal


POST IMMUNIZATION• If 1st time receiving vaccine, have patient wait approx. 15 minutes prior to

allowing them to leave.

• Be prepared to handle the patient if they develops anaphylaxis.

• ALWAYS HAVE YOUR EMERGENCY KIT – Prior to your clinic you must review the standing order and contents.

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Closing your ClinicAfter last Client

• Verify with POC that there are no further employees requiring vaccination.

• Total vaccines administered & provide POC opportunity to make copies of documentation for their

employees (If required). DO NOT GIVE ORIGINALS

• Complete On-site Vaccine Clinic Form

• Clean up administration area; repack all supplies and vaccine according to proper protocols.

• Be sure to repack vaccines to maintain cold chain.

• Gather trash and ask POC where you can dispose of it. DO NOT LEAVE A MESS

• Thank POC again for allowing Passport Health to provide care to their employees

• Load up supplies in vehicle. Return Flu box to home office or UPS to home office

– Be sure to include On-Site Vaccine Clinic Form, Event Sign in Log, and any Credit Card

Authorization forms in the UPS envelope sent with your supplies.

• Call 1-844-FLU-HELP with final head count/vaccine doses provided during the clinic and a brief

summary of how the clinic went.

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FAQs

Can I pre-fill syringes for a flu shot clinic? If so, how long before the clinic can I pre-fill the syringes?

CDC does not recommend pre-filling syringes because of the potential for administration errors. The same person who

draws vaccine should ideally be the person who administers it. Once the needle is placed on the syringe it should be used

immediately. Any syringes except those filled by the manufacturer should be discarded at the end of the clinic day.

Do I need to wear or change gloves for every Patient?

Yes! This is PPH’s policy. No exceptions.

Do I need to give everyone a Band-Aid?

YES! Many clients have no need for a Band-Aid after administration, however due to client request, it is our policy to

provide all clients with a Band-Aid post administration.

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All vaccines have the potential to cause an adverse reaction. In order to minimize adverse reactions, patients

should be carefully screened for precautions and contraindications before vaccine is administered.

Even with careful screening, reactions may occur. These reactions can vary from trivial and inconvenient (e.g.,

soreness, itching) to severe and life threatening (e.g., anaphylaxis). If reactions occur, staff should be prepared with

procedures for their management.

In every flu box there is an emergency kit with standing orders.

Be sure to review the contents of this kit prior to your clinic.

Management of Vaccine Reactions


Management of Vaccine ReactionsREACTION SYMPTOMS MANAGEMENTLocalized Soreness, redness, itching or

swelling at injection siteApply a cold compress to the injection site.Consider OTC analgesic or antipyretic medication and/or hydrocortisone cream

Slight bleeding Apply an adhesive compress over the injection site.

Continuous bleeding Lay thick layer of gauze pads over site and maintain direct and firm pressure; raise the bleeding injection site (e.g., arm) above the level of the patient’s heart.

Psychological fright and syncope (fainting)

Fright before injection is given Have patient sit or lie down for the vaccination.

Fall, without loss of consciousness Examine the patient to determine if injury is present before attempting to move the patient. Place patient flat on back with feet elevated.

Loss of consciousness Check the patient to determine if injury is present before attempting to move the patient. Place patient flat on back with feet elevated.Call 911 if patient does not recover immediately.

Anaphylaxis Sudden or gradual onset of generalized itching, erythema (redness), or urticaria (hives);angioedema (swelling of the lips, face, or throat); severe bronchospasm (wheezing);shortness of breath; shock; abdominal cramping; or cardiovascular collapse.

See “Emergency Medical Protocol” – for full detail :1. If symptoms are generalized, call 911 (EMS)2. Administer (1:1000) aqueous epinephrine SC, 0.01 mL/kg/dose, 0.3 to 0.5 mL

(maximum single dose is 0.5 ml). In addition, for systemic anaphylaxis, administer diphenhydramine 50–100 mg IM (1–2 mg/kg, 50 mg maximum single dose).

3. Monitor the patient closely until EMS arrives. Perform cardiopulmonary resuscitation (CPR), if necessary, and maintain airway. Keep patient in supine position unless he or she is having breathing difficulty. If breathing is difficult, patient’s head may be elevated, provided BP is adequate to prevent loss of consciousness. If BP is low, elevate legs. Monitor BP and pulse every 5 minutes.

4. If EMS has not arrived and symptoms are still present, repeat dose of epinephrine every 10–20 minutes for up to 3 doses, depending on patient’s response.


Localized reactions:REACTION SYMPTOMS MANAGEMENT

Localized Soreness, redness, itching or swelling at injection site

A mild local reaction resolving by itself within a few minutes does not require special observation. Apply a cold compress to the injection site.Consider OTC analgesic or antipyretic medication and/or hydrocortisone creamIf swelling and hives occur at the injection site(s):• Keep the client under direct observation for at least 30 minutes to ensure the reaction remains localized • Observe for any deterioration in condition • If hives or swelling disappears, or there is no evidence of any progression to other parts of the body or any other symptoms within the 30-minute observation period, no further observation is necessary. Release the client from observation. • If any other symptoms arise, even if considered mild (e.g., sneezing, nasal congestion, tearing, coughing, facial flushing) or if there is evidence of any progression of the hives or swelling to other parts of the body, administer epinephrine. • There is little risk to the precautionary use of epinephrine, whereas delay in its administration (when

required) may result in difficulty to treat anaphylaxis and eventual death

Slight bleeding Apply an adhesive compress over the injection site.

Continuous bleeding

Lay thick layer of gauze pads over site and maintain direct and firm pressure; raise the bleeding injection site (e.g., arm) above the level of the patient’s heart.


Psychological fright & vasovagal syncope All clients must sit down to receive a vaccination. If you think your client

may have fright or syncope have them lie down during administration if

you are able.

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Fright before injection is givenClients experiencing an anxiety reaction may appear fearful, pale and diaphoretic and complain of lightheadedness, dizziness and numbness, as well as tingling of the face and extremities. Hyperventilation is usually evident.

Have patient sit or lie down for the vaccination. If a client appears anxious, it may be helpful to have him or her re-breathe into a paper bag until symptoms subside. This technique must be used with caution and should be a last resort option to address anxiety-related hyperventilation since an anaphylactic reaction misdiagnosed as anxiety could worsen the associated hypoxia by the use of paper bag re-breathing.

Fall, without loss of consciousness Examine the patient to determine if injury is present before attempting to move the patient. Place patient flat on back with feet elevated.

Loss of consciousness Check the patient to determine if injury is present before attempting to move the patient. Place patient flat on back with feet elevated.Call 911 if patient does not recover immediately.

If a client experiences a loss of consciousness you must safely ambulate the client to the floor protecting them from injury


Fainting (vasovagal syncope)

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During a vasovagal reaction, the client suddenly becomes pale, feels dizzy and may lose consciousness and collapse. Fainting is sometimes accompanied by brief clonic seizure activity (i.e., rhythmic jerking of the limbs), but this generally requires no specific treatment or investigation. The client should be place in a recumbent position, turned on his/her side, with slight pronation. This will help prevent aspiration and keep the airway open while the client is unconscious, especially if seizure activity is present.

Recovery of consciousness occurs within a minute or two, but clients may remain pale, diaphoretic and mildly hypotensive for several more minutes. If unconsciousness persists for more than two to three minutes, call 911/ambulance and proceed as per emergency treatment for anaphylaxis. Unconsciousness may reflect hypoxia.

The lack of hives, a slow, steady pulse rate and cool pale skin distinguish a vasovagal episode from anaphylaxis. Prior to immunization, ask the client about the history of fainting with previous immunizations.

To reduce the likelihood of fainting (and the possibility of injuries), consider the following measures to lower stress in those awaiting immunization:

• seat every client prior to immunization • maintain a comfortably cool room temperature and, if possible, with plenty of fresh air • avoid long line-ups in mass immunization clinics • prepare vaccine(s) out of view of recipients • provide privacy during vaccination • if the client is anxious and pale but remains conscious: have him or her lie down with legs slightly elevated, reassure,

and apply cold wet cloth to face. If the client was lying down, have him or her sit for a few minutes before standing.


Fall without loss of consciousness

Elevate feet

Cool cloth to neck and forehead

Check BP

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Examine the patient to determine if injury is present before attempting to move the patient. Place patient flat on back with feet elevated.


Fall with loss of consciousness

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Check the patient to determine if injury is present before attempting to move the patient. Place patient flat on back with feet elevated.

Assess airway.Call 911 if patient does not recover immediately.

CPR if needed.


Anaphylaxis

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• It is a severe allergic reaction to a foreign substance occurring rapidly and may be fatal in some cases.

• Extremely rare, however, every immunization there is risk of anaphylactic reaction.

• Signs and symptoms within minutes of exposure; most instances begin within 30 minutes after administration, but some reactions might develop later.

• Fatalities during anaphylaxis usually result from delay in the administration of epinephrine and from severe respiratory complications, cardiovascular complications, or both.

• It is important to recognize the first signs and symptoms of anaphylaxis quickly so that treatment can be administered without delay.


Anaphylaxis-Clinical presentation

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Urticaria

Angioedema


Emergency Medical Protocol for Adults/Teens

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1. If itching and swelling confined to the injection site, observe patient closely for development of generalized symptoms.

2. If symptoms are generalized, activate the emergency medical system (EMS; call 911).

3. Administer (1:1000) aqueous epinephrine SC, 0.01 mL/kg/dose, 0.3 to 0.5 mL (maximum single dose is 0.5 ml)

4. In addition, for systemic anaphylaxis, administer diphenhydramine 50–100 mg IM (1–2 mg/kg, 50 mg max single dose).

5. Monitor the patient closely until EMS arrives. Perform cardiopulmonary resuscitation (CPR), if necessary, and maintain airway. Keep patient in supine position unless he or she is having breathing difficulty. If breathing is difficult, patient’s head may be elevated, provided BP is adequate to prevent loss of consciousness. If BP is low, elevate legs. Monitor BP and pulse every 5 minutes.


7. Record all vital signs, medications administered to the patient, including the time, dosage, response, and the name of the medical personnel who administered the medication, and other relevant clinical information.

8. Notify the patient’s primary care physician if applicable.

Age Weight kg Epinephrine 1mg/ml (1:1000) aqueous epinephrine, 0.01 mL/kg/dose) Route: SC

Benadryl 50mg/ml IM 50–100 mg (1–2 mg/kg)Route: IM

11-12 yrs 77lbs -99 lbs 35 kg-44 kg 0.35-0.4ml 30mg

13+ yrs 100+ lbs 45+ kg 0.5ml 50 mg


Emergency Protocol for Infants/Children

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1. If itching and swelling confined to the injection site, observe patient closely for development of generalized symptoms.

2. If symptoms are generalized, activate the emergency medical system (EMS; call 911).

3. Administer (1:1000) aqueous epinephrine SC, 0.01 mL/kg/dose, 0.3 to 0.5 mL (max single dose is 0.5 ml)

4. In addition, for systemic anaphylaxis, administer diphenhydramine 50–100 mg IM (1–2 mg/kg, 50 mg max single dose).

5. Monitor the patient closely until EMS arrives. Perform CPR, if necessary, and maintain airway. Keep patient in supine position unless there is breathing difficulty. If breathing is difficult, patient’s head may be elevated, provided BP is adequate to prevent loss of consciousness. If BP is low, elevate legs. Monitor BP and pulse every 5 minutes.


7. Record all vital signs, medications administered to the patient, including the time, dosage, response, and the name of the medical personnel who administered the medication, and other relevant clinical information.

8. Notify the patient’s primary care physician if applicable.

Age Weight kg Epinephrine 1mg/ml (1:1000) aqueous epinephrine, 0.01 mL/kg/dose) Route: SC

Benadryl 50mg/ml IM 50–100 mg(1–2 mg/kg) Route: IM

1-6 mo 9-19 lb 4-9kg 0.05ml none

7-36 mo 20-32 lb 10-14 0.1ml 10-20mg

37-59 mo 33-39 lb 15-17 0.15ml 15-30mg

5-7 yrs 40-56 lb 18-24 0.2-0.25ml 20-30mg

8-10 yrs 57-76 lb 25-33 0.25-0.3ml 30mg

11-12 yrs 77-99 lb 34-45 0.35-0.4ml 30mg

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