Anaphylaxis at the Concession Stand
You are a lifeguard at a community pool. A 12-year-old girl comes to the concession stand and tells you she ate a peanut butter cookie and is having an allergic reaction. She has a known peanut allergy and carries an epinephrine auto-injector. She is conscious but appears anxious. Her face is flushed, and she has hives on her arms. She complains of a tight throat and difficulty breathing. You can hear wheezing. She has her epinephrine auto-injector in her bag. The pool is not busy, and another lifeguard is available. You have a first aid kit and an AED nearby. You have been trained to assist with epinephrine auto-injectors.
1. What are the signs and symptoms of anaphylaxis in this situation, and what should you do first?
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The girl is showing signs of anaphylaxis: hives, flushing, difficulty breathing, tight throat, wheezing, and anxiety after exposure to an allergen (peanut). Anaphylaxis is a severe, life-threatening allergic reaction. The first priority is to call 911 immediately. Then, if the girl has a prescribed epinephrine auto-injector, you should assist her in using it or administer it if she is unable to do so. Epinephrine is the first-line treatment for anaphylaxis. You should help her into a comfortable position, usually sitting up to ease breathing. Monitor her breathing and consciousness. If she has a second dose, be prepared to administer it if symptoms do not improve after 5-15 minutes or if they recur. Do not delay epinephrine administration while waiting for EMS. Keep her calm and reassure her.
2. How should you administer the epinephrine auto-injector, and what precautions should you take?
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To administer the epinephrine auto-injector, first check the expiration date and ensure it is the correct prescription for the girl. Then, follow the steps: remove the safety cap, place the tip against the outer thigh (mid-outer thigh, can be given through clothing), and push firmly until it clicks. Hold it in place for the recommended time (usually 10 seconds for many devices, but follow the device instructions). Remove the injector and massage the area for a few seconds. Note the time of administration. Precautions: ensure the needle is not exposed after use, dispose of the device properly, and be aware that the girl may have a rapid heartbeat or tremors as side effects. Do not inject into the buttocks or other areas. If she is unable to use it herself, you may administer it if you are trained and authorized. After administration, monitor her closely and be prepared to start CPR if she becomes unresponsive and stops breathing.