5185 - Anaphylaxis

Policy 5185 Anaphylaxis title box

The Boards of Directors of the Southwest Vermont Supervisory, Bennington School District, Inc., Mount Anthony Union School District, North Bennington Graded School District, Pownal School District, Shaftsbury School District, and Woodford School District recognize that anaphylaxis is a life threatening allergic reaction that usually occurs within seconds or minutes of exposure to an allergen. Reaction ranges from mild self-limited symptoms to rapid death (peripheral vascular collapse). Anaphylaxis can occur in those with known or unknown hypersensitivity to a food, insect venom, a drug, latex or other allergen.

It is the policy of the board that immediate and appropriate intervention shall be provided to assure the most successful management of an anaphylactic episode. Intervention includes the following:
  1. Prompt recognition of signs and symptoms
  2. Administration of appropriate medication
  3. Rapid transport to an emergency facility
In the case of an UNKNOWN hypersensitivity anaphylaxis, the nurse will manage the intervention as described above. Medication as prescribed by the school medical advisor will be administered by the nurse as outlined in the attached administrative rules. If the nurse is not available, the rescue squad and parent will be called, or the person will be transported by two staff members and local law enforcement may be called for assistance.

In the case of a KNOWN hypersensitivity anaphylaxis the appropriate doctor's order and epinephrine will be supplied by the allergic person. Willing staff shall be instructed by the school nurse in how to administer the epinephrine.

Medical information will be requested from parents.

Parents (or those designated by parents) will always be notified immediately after medication is given and emergency transport is initiated.

Policy 5185 warning and adoption dates

ADMINISTRATIVE REGULATIONS

Anaphylactic reaction is characterized by some or all of the following symptoms and signs. The sooner symptoms develop after the initiating stimulus, the more intense the reaction.

SYMPTOMS:

  1. tingling sensation around mouth or face followed by a feeling of warmth
  2. tightness of the throat and chest
  3. difficulty in swallowing
  4. itching
  5. dizziness, feeling of faintness
  6. wheezing, shortness of breath
  7. palpitations
  8. swelling
  9. feeling of nervousness

SIGNS:

  1. severe anxiety
  2. generalized flush
  3. Urticaria (hives)
  4. Cyanosis
  5. Vomiting, abdominal cramps
  6. Wheezing, paroxysmal coughing, dyspnea
  7. angioedema with various degrees of hoarseness, inspiratory stridor, dysphagia, nasal congestion, itching of the eyes
  8. edema
  9. loss of consciousness
a. hypotension
b. feeble heart sound, may have an arhythmia
c. cardiopulmonary arrest

UNKNOWN HYPERSENSITIVITIES:

For insect stings, a local reaction only (small or large) is NOT anaphylaxis. For local reactions after an insect sting, wash area and apply ice. Benadryl (Diphenhydramine) may be given if student is complaining of discomfort or itching at the sight of the sting only.

PLAN:

  1. Observe for any signs or symptoms.
  2. If any signs or symptoms (other than local only), call for help. DO NOT LEAVE THE PERSON ALONE.
  3. Maintain airway
  4. Start CPR if necessary
  5. If nurse is not available, call rescue and the parent: or take the person to the nearest emergency facility (with the help of another person and police).

  6. MEDICATION/DOSAGE:

    EPIPEN JR. <45 LBS.
    EPIPEN SR. >45 LBS.

    If Epipen is not available, dose as follows:
    Epinephrine 1:1000 aqueous solution IM or SC in the opposite arm of the insect sting
    approx. 22 lbs.        0.1 ml
                33 lbs.        0.15 ml
                44 lbs.        0.2 ml
                55 lbs.         0.25 ml
                70 lbs. & >  0.3 ml

    A SECOND DOSE MAY BE GIVEN IF THERE IS NO IMPROVEMENT IN 15 MINUTES

  7. Diphenhydramine (Benadryl) should be given immediately after any doses of epinephrine for all conscious persons (without specific allergies to the drug).
    Liquid (12.5 mg/5 ml) is preferred due to rapid absorption (anaphylaxis significantly slows gut absorption of pills).

  8. DOSAGE: Diphenhydramine liquid (12.5mg/5ml) at approx. 1.2 mg/kg of body weight
    22 to 32 lbs. -- 12.5 mg = 5 ml ==1 tsp
    33 too 46 lbs. -- 18.0 mg = 7.5 ml = 1.5 tsp
    >46 lbs. -- 25 mg = 10ml = 2 tsp

  9. All persons with anaphylaxis from previously undiagnosed hypersensitivities must be transported to the nearest emergency facility for more evaluation and treatment.

KNOWN HYPERSENSITIVITIES:

  1. All persons with known hypersensitivities should have their own physician prescription kit and signed Anaphylaxis Plan available at the school.
  2. The School Nurse will teach willing staff members how to use the kit.
  3. Use the physician prescription kit according to instructions, for persons with known anaphylaxis to stings, food, etc. Epinephrine should be given immediately followed by Benadryl (Diphenhydramine) per directions/dosage listed above. Benadryl is given without need for specific physician orders.
  4. The parent and physician should be contacted immediately after medication is given. It is recommended that the person be taken to the nearest emergency facility (contact rescue squad or police) for observation due to the potential for a biphasic anaphylactic reaction (reoccurrence of symptoms/signs after initial resolution of anaphylaxis).

EDUCATION:

  1. Parents shall provide appropriate medications and signed Anaphylaxis Plan.
  2. Encourage person with known hypersensitivities to wear alert bracelet or necklace.
  3. Inform necessary staff of allergies of students and staff members.
  4. Inservice programs for designated staff should be offered to help them recognize and respond to this situation. This education for designated staff should include CPR instruction.