Appendix D Emergency Management of <strong>Anaphylaxis</strong> Symptoms of anaphylaxis generally <strong>in</strong>clude two or more of the follow<strong>in</strong>g body systems: sk<strong>in</strong>, respiratory, gastro<strong>in</strong>test<strong>in</strong>al and/or cardiovascular. However, low blood pressure alone (i.e. cardiovascular system), <strong>in</strong> the absence of other symptoms, can also represent anaphylaxis. Breath<strong>in</strong>g difficulties and low blood pressure are the most dangerous symptoms and both can lead to death if untreated. • Sk<strong>in</strong>: hives, swell<strong>in</strong>g (face, lips, tongue), itch<strong>in</strong>g, warmth, redness • Respiratory (breath<strong>in</strong>g): cough<strong>in</strong>g, wheez<strong>in</strong>g, shortness of breath, chest pa<strong>in</strong> or tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneez<strong>in</strong>g), trouble swallow<strong>in</strong>g • Gastro<strong>in</strong>test<strong>in</strong>al (stomach): nausea, pa<strong>in</strong> or cramps, vomit<strong>in</strong>g, diarrhea • Cardiovascular (heart): paler than normal sk<strong>in</strong> colour/blue colour, weak pulse, pass<strong>in</strong>g out, dizz<strong>in</strong>ess or lightheadedness, shock • Other: anxiety, sense of doom (the feel<strong>in</strong>g that someth<strong>in</strong>g bad is about to happen), headache, uter<strong>in</strong>e cramps, metallic taste Individual displays signs/symptoms of a potentially life-threaten<strong>in</strong>g allergic reaction (anaphylaxis). Immediately proceed with five steps of the Emergency Protocol: 1. Give ep<strong>in</strong>ephr<strong>in</strong>e auto-<strong>in</strong>jector (e.g. EpiPen ® or Allerject) at the first sign of a known or suspected anaphylactic reaction. 2. Call 9-1-1 or local emergency medical services. Tell them someone is hav<strong>in</strong>g a life-threaten<strong>in</strong>g allergic reaction. 3. Give a second dose of ep<strong>in</strong>ephr<strong>in</strong>e <strong>in</strong> 5 to 15 m<strong>in</strong>utes IF the reaction cont<strong>in</strong>ues or worsens. 4. Go to the nearest hospital immediately (ideally by ambulance), even if symptoms are mild or have stopped. The reaction could worsen or come back, even after proper treatment. Stay <strong>in</strong> the hospital for an appropriate period of observation as decided by the emergency department physician (generally about 4-6 hours). 5. Call emergency contact person (e.g. parent, guardian). Upon discharge from hospital, the patient should: • Obta<strong>in</strong> an ep<strong>in</strong>ephr<strong>in</strong>e auto-<strong>in</strong>jector prescription and immediately fill it. • Schedule a follow up appo<strong>in</strong>tment with his or her physician. If not already under the care of an allergist, the patient should obta<strong>in</strong> a referral. 36 <strong>Anaphylaxis</strong> <strong>in</strong> <strong>Schools</strong> & Other Sett<strong>in</strong>gs Copyright © 2005-2014 Canadian Society of Allergy and Cl<strong>in</strong>ical Immunology
Th<strong>in</strong>k F.A.S.T. Appendix E <strong>Anaphylaxis</strong> <strong>in</strong> <strong>Schools</strong> & Other Sett<strong>in</strong>gs Copyright © 2005-2014 Canadian Society of Allergy and Cl<strong>in</strong>ical Immunology 37
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