Anaphylaxis at a School Picnic
You are a teacher supervising a school picnic. A 9-year-old student with a known peanut allergy accidentally eats a cookie containing peanut butter. Within minutes, the child complains of throat tightness, has hives on the face and neck, and is wheezing. The child is anxious and breathing rapidly. The school nurse is off-site, and the child's epinephrine auto-injector is in the nurse's office, about a 5-minute walk away. You have a first aid kit with no medications. The child is conscious and able to speak in short sentences. Another teacher is calling 911. You are the only one with first aid training.
1. What are your immediate priorities and actions?
Read the worked answer
Recognize anaphylaxis: rapid onset of throat tightness, hives, and wheezing after exposure to a known allergen. This is a life-threatening emergency. Call 911 (already called) and send someone to retrieve the epinephrine auto-injector immediately. Keep the child calm and in a comfortable position (sitting up if breathing is difficult). Do not give anything by mouth. Monitor breathing and be prepared to start CPR if the child becomes unresponsive and stops breathing. If the auto-injector arrives, help the child use it (or administer it if trained and permitted) into the outer thigh. Note the time. Even if symptoms improve, the child must be evaluated by EMS because reactions can recur.
2. The child's condition worsens: the wheezing becomes quieter, the child is struggling to breathe, and becomes drowsy. The auto-injector has not arrived yet. What do you do?
Read the worked answer
The child is showing signs of severe respiratory distress and impending respiratory failure (quiet wheeze may indicate poor air movement, drowsiness indicates hypoxia). Ensure 911 has been called and update them on the worsening condition. Continue to keep the child calm and positioned for comfort; if unconscious but breathing, place in a recovery position. Monitor breathing continuously. If the child stops breathing, begin CPR immediately (30 compressions to 2 breaths for one rescuer, or 15:2 if two rescuers). Do not delay CPR to wait for the auto-injector. When the auto-injector arrives, if the child is still conscious and showing signs of anaphylaxis, administer it without delay. Be prepared to use a second dose if symptoms persist after 5-15 minutes and EMS has not arrived, if permitted by protocol.