When To Use Epipen
If you have been prescribed EpiPen®, you should carry it with you at all times… and use it immediately at the first signs and symptoms of a severe allergic reaction.
In a severe allergic emergency, quick symptom recognition and immediate treatment are vital.
The symptoms of a severe allergic reaction occur suddenly within minutes or several hours after exposure to an allergy trigger:
Patient History And Waveform Capnography Help Identify Asthma Attacks
Asthma attacks can mimic other respiratory conditions. Wheezing from the lower airways can be difficult to distinguish from sounds caused by upper airway inflammation. Anxiety can trigger an asthma attack, but it can also cause hyperventilation with no bronchospasm. The sound of air passing, sometimes referred to as cardiac wheezes, through fluid-filled alveoli from pulmonary edema, can be made worse if misdiagnosed and treated as an asthma attack.
Not all asthma attacks cause wheezing. Cough may be the only sign of an asthma attack, especially in exercise-induced and nocturnal attacks . Breath sounds may be diminished or absent in severe asthma attacks, which an ominous sign of decreased air movement through the lower airways.
Waveform capnography is a valuable tool to differentiate an asthma attack from other causes of respiratory distress. The waveform represents air movement throughout the respiratory cycle, and is normally rectangular shaped. Bronchoconstriction causes air to be released unevenly from the alveoli, which makes the capnography waveform appear rounded, similar to a shark fin .
The length of the waveform also represents the exhalation phase, which is prolonged during an asthma attack. The more severe the bronchoconstriction, the more pronounced the shark fin and length of the waveform. This can be seen even if the patient has diminished breath sounds and is not wheezing.
Be Prepared For Severe Allergic Reactions
If you are at risk of a severe allergic reaction, make sure you:
- Carry a mobile phone to call for help when needed.
- Carry an adrenaline injector to treat a severe allergic reaction.
- Wear medical identification jewellery this increases the likelihood that adrenaline will be administered in an emergency.
- Avoid medication that may increase the severity of an allergic reaction or complicate its treatment such as beta blockers.
- Avoid the known allergen where possible.
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What Can I Do To Prevent Anaphylaxis
- Know your allergens. An accurate diagnosis is important. An allergist can help you create a plan to keep you safe.
- Avoid your allergens.
- If you have a drug allergy, be familiar with both the generic name and brand names of medicines that cause you to have a severe allergic reaction. And be aware of ingredients in a combination product. Become familiar with medicines that might cause a cross-reaction. Read drug information carefully.
- If you have a food allergy, be careful about everything you eat. Check ingredients on all food labels. Wash hands, and use clean surfaces and utensils to prepare food. Ask restaurant staff how they prepare foods.
- If you react to insect stings or exercise, talk to your doctor about how to avoid these reactions.
- Carry your epinephrine auto-injectors with you at all times. This is very important and can save your life or the life of a loved one.
- Prepare with a plan. Have your doctor help you create an anaphylaxis action plan.
- Talk to your doctor and caregivers. Make sure they know the names of any medications you are allergic to and what symptoms you had when you took them. Give them a list of every drug you take. Some common medicines, like beta-blockers, can worsen anaphylaxis.
- Wear a medical ID bracelet or necklace. It lets others know of your allergy in an emergency. Also, keep a card in your wallet or purse that explains your allergy.
Asthma And Peak Flow Meters
Learning how to monitor your asthma will help you know when to seek asthma emergency treatment. Taking regular peak flow meter readings is often the foundation of good asthma control. You can do this at home. A peak flow meter is a simple handheld device. By breathing into it, you get a reading of your lung function.
When you are first diagnosed with asthma, your doctor will probably tell you to take peak flow meter readings every day for two to three weeks. The highest number you record is called your “personal best.”
Many asthma action plans are based on peak flow readings. Depending on your readings, you will take a different course of action.
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Is Asthma Stress Related
Strong Emotions, Stress and Depression Can Trigger Asthma. Strong emotions and stress are well known triggers of asthma. There is evidence of a link between asthma, anxiety and depression, though the outcomes are sometimes not consistent. Anxiety and depression may be associated with poor asthma control.
What Is An Adrenaline Autoinjector
Adrenaline autoinjectors are used to treat severe allergic reactions in an emergency. They are designed to administer a single, fixed dose of adrenaline and can be given by anyone, including people who are not medically trained.
There are two different brands of adrenaline autoinjector available in Australia EpiPen and Anapen. Both brands have an autoinjector for adults and one, which contains a lower dose of adrenaline, for children who weigh between 15kg and 30kg.
Adrenaline treats the very low blood pressure and poor circulation that occur when someone is having a severe allergic reaction. It also relaxes the lungs to help breathing, and reduces swelling, skin rashes and itching.
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How Should I Use Epinephrine Inhalation
Use exactly as directed on the label, or as prescribed by your doctor.
Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.
Before using this medicine for the first time, shake the inhaler and prime it with 4 test sprays into the air, away from your face.
Also shake the inhaler just before each use and prime it with 1 spray.
Each dose is 1 to 2 inhalations. After the first inhalation, wait 1 minute. Then use a second inhalation if your symptoms have not improved.
Wait at least 4 hours between doses. Do not use more than 8 inhalations in 24 hours.
Seek medical attention if your breathing problems do not improve after 20 minutes, or if they get worse quickly.
Tell your doctor if you have more than 2 asthma attacks in 1 week.
Do not share this medicine with another person, even if they have the same symptoms you have.
Store at room temperature away from moisture and heat. Keep away from open flame or high heat. The canister may explode if it gets too hot. Do not puncture or burn an empty inhaler canister.
Wash the inhaler after each day of use by running water through the mouthpiece for 30 seconds.
What Allergies Require An Epipen
Any severe allergic reaction, also known as anaphylaxis, can be treated with an EpiPen. This can include food allergies like a peanut allergy, allergic reactions to insect stings and bites, and allergies to medications. Epinephrine can even be used to treat exercise-induced anaphylaxis, which is a rare form of anaphylaxis that may include symptoms like itching, hives, and wheezing.
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What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the package it came in, away from light, tightly closed, and out of reach of children. Store omalizumab injection in the refrigerator, but do not freeze it. Discard any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
Before Taking This Medicine
Do not use epinephrine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.
epinephrine inhalation is for use only in people who have been diagnosed with asthma. Do not use epinephrine inhalation to treat any condition that has not been checked by your doctor.
Ask a doctor or pharmacist if this medicine is safe to use if you have ever had:
urination problems caused by an enlarged prostate.
Ask a doctor before using this medicine if you are pregnant or breastfeeding.
Epinephrine is not approved for use by anyone younger than 12 years old.
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Is Asthma Worse When You Lay Down
The exact reason that asthma is worse during sleep are not known, but there are explanations that include increased exposure to allergens cooling of the airways being in a reclining position and hormone secretions that follow a circadian pattern. Sleep itself may even cause changes in bronchial function.
What Does Epinephrine Do For Anaphylaxis
When you come in contact with something you’re allergic to, your immune system overreacts. It sends out an antibody called immunoglobulin E, and in turn, the antibody triggers a large number of chemicals in its war against the allergen. For most people, the response to the battle between their body and the allergen results in sneezing, itching, coughing, hives and some other unpleasant yet not dangerous symptoms. However, for some people, allergies can be life-threatening: These people may go into anaphylactic shock.
Signs that indicate the onset of anaphylaxis include a sudden and drastic drop in blood pressure, hives or rash, constricted airways that make breathing difficult, a rapid pulse, dizziness, nausea and even loss of consciousness. A person who’s familiar with these signs knows that the first way to handle anaphylaxis is to give himself an epinephrine injection. The next step is to get immediate medical care. If you don’t have epinephrine, call for emergency help right away paramedics carry epinephrine with them.
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Changes In Your Health
If at any time during the course of your immunotherapy you develop a new medical condition, you become pregnant, or you start a new medication, please tell the nurse. In particular, high blood pressure or heart medications and certain antidepressants cannot be taken with allergy shots. You should not get your allergy shot if you are have a fever, rash, asthma symptoms, or increased allergy symptoms.
Reactions To Allergy Shots
Reactions to allergy shots are common. Most reactions are local . Rarely, reactions can affect your entire body. This is referred to as a systemic reaction, and it can be dangerous. For this reason you must stay in our office for 30 minutes following every shot appointment. Additionally, you should not exercise for 2 hours after your shots.
If you are having asthma symptoms when you are scheduled for an allergy shot it is important to tell your nurse. Allergy shots can worsen asthma symptoms.
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Have An Action Plan For Anaphylaxis
If you are at risk of having an allergic reaction, it is important to have an action plan. This is a short, easy to follow one-page document that sets out how to treat anaphylaxis in an emergency. Your anaphylaxis action plan is filled out and signed by a health professional, such as a doctor or nurse.
You can find out more about anaphylaxis action plans on the Australasian Society of Clinical Immunology and Allergy website.
Anything Else Youd Like People To Know
If you have any questions or concerns, speak with your allergist to discuss your options for epinephrine coverage. Having generic options have helped a lot of people who previously had cost concerns. Regardless of your choice of epinephrine device, work together with your board-certified allergist to devise an anaphylaxis plan that you prepared to follow in the event of an emergency.
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Emergency First Aid For Asthma Attacks
If you have asthma, your doctor will prescribe medication and help you to develop a plan to manage your asthma and an action plan for asthma attacks.
Asthma can be well controlled with medication in most people.
If you, or someone you know, are having an asthma attack, follow the asthma action plan. In case of emergency, call triple zero and ask for an ambulance. Tell the operator that someone is having an asthma attack.
Move Away From Triggers
The presence of asthma triggers wont only cause an attack, they can also make your symptoms worse. Be sure to try to get away from things that may be triggering your asthma attack.
For example, if youre in an area where people are smoking cigarettes, you should move away promptly.
Its also important to know your triggers. Common triggers include:
- allergens, such as pet dander, pollen, or certain foods
You should always be sure to seek immediate emergency medical treatment if you experience any of the following symptoms during an asthma attack:
- your symptoms continue to get worse even after treatment
- you cant speak except in short words or phrases
- youre straining your chest muscles in an effort to breathe
- your shortness of breath or wheezing is severe, particularly in the early morning or late-night hours
- you begin to feel drowsy or tired
- your lips or face appear blue when youre not coughing
Symptoms that indicate that you could be experiencing an asthma attack include:
- severe shortness of breath
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Assess Capnography Work Of Breathing Lung Sounds And Pulse
EMS is often called when asthma attacks are worse than ones a patient normally experiences, when a patient is not compliant with their treatment plan, or they do not get better after treatment at home. Ask patients if their current asthma attack is worse than any they have had in the past, if they have ever been intubated for an asthma attack, and if they have used any inhalers or breathing treatments before calling. This helps predict which EMS interventions will be effective and whether assisted ventilation will be needed.
Patients having mild asthma attacks are able to speak in full sentences. Wheezing may be heard at the end of exhalation. In moderate to severe attacks, patients may be seated upright in a tripod position, get winded with speaking, use accessory muscles to breathe, and have supraclavicular and subcostal retractions. Wheezing may be heard throughout exhalation. Also expect the patient to have altered mental status, such as awake and anxious during a moderate attack.
Patients having a severe attack may have difficulty holding their head up from respiratory muscle fatigue and hypoxia, and only speak in short phrases. Wheezing may be heard on inhalation and exhalation, or breath sounds may be diminished or absent. Decreased level of consciousness is another sign of the seriousness of a severe asthma attack.
What Is Uncontrolled Asthma
Daily symptoms, such as chest tightness, shortness of breath, coughing and wheezing, are signs of uncontrolled asthma and may require the use of quick-relief medication a few times a week or even daily. In addition, you may commonly experience nighttime flare-ups and may even have to visit the emergency room.
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Student Rights To Self
All 50 states now have laws protecting students rights to carry and use prescribed asthma and anaphylaxis medications.
Why is it important to allow students the right to self-carry their asthma and anaphylaxis medications?
Every school year students have died because they were unable to get to their asthma or anaphylaxis medications on time. The medications were locked in a nurses cabinet or stowed away in a place too far to get to when the student needed them. Minutes count when asthma or anaphylaxis strikes. Students need to carry these medications on them, know when and how to use them and then do it.
What if my childs school doesnt allow my child to self-carry asthma and anaphylaxis medications?
Parents, teachers, school nurses contact local schools and make sure they know these laws exist and what they mean. If you need the text of the law for your state, please contact us.
What was the Networks role in passing these self-carry laws?
We spearheaded a Breathe: Its the Law is an awareness campaign to make sure students in every state had the right to carry and self-administer their life-saving asthma and anaphylaxis medications. We played worked with volunteers and legislators in every state to get these laws passed in all 50 states.
Who Is At Risk For Anaphylaxis
- People who have experienced anaphylaxis before
- People with allergies to foods, insect stings, medicine and other triggers
If you are at-risk:
- Keep your epinephrine auto-injectors on-hand at all times and be ready to use them if an emergency occurs.
- Talk with your doctor about your triggers and your symptoms. Your doctor may tell you to see an allergist. An allergist can help you identify your allergies and learn to manage your risk of severe reactions.
- Ask your doctor for an anaphylaxis action plan. This will help you know what to do if you experience anaphylaxis.
Medical Review October 2015, updated February 2017.
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