anaphylaxis
important since each AAI on the market has a slightly different method of administration. Administering high-flow oxygen – using a mask with an oxygen reservoir (greater than 10 litres min-1 to prevent reservoir collapse) – is also recommended. “If a first aider is trained in the use of oxygen, they can administer oxygen having undertaken an assessment and taken note of what else might be wrong with the person,” advises Quentin Sayer, regional medical affairs manager at BOC Healthcare.
The patient should be in the best position possible for administration. They should lie down with their feet elevated, or if they are having breathing difficulties, sit up slightly. It is important that they do not stand up or walk around, says Dr Julian Maitland, medical director of Meda Pharmaceuticals, “because there is a danger of their blood pressure dropping catastrophically”.
Ask for an ambulance and say ‘anaphylaxis’. The patient needs a blue light ambulance to the local emergency department
In the case of a patient being too unwell to administer their own adrenaline, then any member of staff who is familiar with AAI can do it for them by following the instructions on the pen’s label. All pens can be administered through a patient’s clothes to the front/side of the middle part of the thigh – not the arm or buttocks.
If a patient does not improve after the first injection, a second one can be administered after five or 10 minutes. “Many patients will carry two adrenaline auto injector pens, because sometimes the standard amount of adrenaline injected in the first pen is insufficient to start to relieve their symptoms,” says Dr Maitland. If the symptoms improve, don’t be hasty, warns Young: “Ensure the patient remains lying or sitting down and does not try to get up until they have been seen by the paramedics, even if they start feeling better.” Dr Maitland reminds: “The adrenaline
auto injectors are prescription-only medicines and therefore will have been prescribed to an individual. The patient should have their own adrenaline auto-injector and this should not be shared or given to other patients.” He continues: “All patients who have an anaphylactic reaction should go to hospital: adults will be observed for a period of time – 10 to 12 hours – children will be admitted.”
WHAT TO HAVE ON HAND Preparing for an emergency like this,
48 february 2013
from a practice manager point of view, is essential. Young recommends practices stock up on enough adrenaline for at least two IM injections while awaiting a blue light ambulance. “This can either be an emergency kit containing vials of adrenaline, needles and syringes, which a trained medical professional can draw up and administer,” he explains, adding that even for the best trained medical professional, it can be difficult to do it correctly in an emergency situation. Alternatively, he says, a practice could have two AAIs that both the medical and non-medical staff could be trained to administer. Practices should also have something to elevate the patient’s feet when they are lying down, an oxygen reservoir with mask, and, for patients with asthma, nebulised bronchodilators. “This is second line therapy,” Young says of nebulisers, “and absolutely must not delay administration of IM adrenaline or calling 999.”
TRAINING
In the rare case there are no medical staff on hand to deal with the emergency, practice staff can be trained to use the type of auto-injector available in the practice. “It is appropriate for any member of practice staff who normally receives basic life support training to also be trained to recognise anaphylaxis,” comments Young. “All the companies provide [a] trainer pen…that contain[s] no drug, and very often the doctors or practice nurse will have these available for you to try,” adds Dr Maitland. If staff are not trained, they can still help, however cursory. “At best, those that are not trained in the use of any particular product should not administer anything to a patient,” says Sayer, “like first-aiders, they are able to assist the patient.”
In short, if you’re faced with a patient going into anaphylactic shock, Young breaks it down like this: “Shout for help, help position the patient correctly, locate the practice supply of adrenaline auto-injectors and administer the injection or assist the patient to use their own if they know correct technique for that AAI, call 999, ask for an ambulance and say ‘anaphylaxis’, ensure the patient remains lying or sitting down and does not try to get up until reviewed by the paramedics.”
With thanks to ALK, BOC Healthcare and Meda Pharmaceuticals for medical advice
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