9.3.4.2.1: Anaphylactic Shock

Anaphylactic shock, also known as anaphylaxis, is a severe and life-threatening allergic reaction that occurs rapidly after exposure to an allergen. This reaction can affect various systems in the body and lead to a range of symptoms, including difficulty breathing, swelling, a drop in blood pressure, and loss of consciousness. Anaphylactic shock requires immediate medical attention and intervention to prevent severe complications or death.

Symptoms of anaphylactic shock include difficulty breathing, swelling of the face, lips, tongue, or throat, rapid and weak pulse, drop in blood pressure, hives or widespread skin rash, nausea, vomiting, or diarrhea, confusion or altered mental state, and loss of consciousness or coma. Common triggers of anaphylactic shock include foods, insect bites, medications, and latex.

The primary treatment for anaphylactic shock is epinephrine (adrenaline), administered through an autoinjector (e.g., EpiPen). Other measures may include administering antihistamines and corticosteroids to reduce allergic symptoms. Patients may require intravenous fluids and medications to support blood pressure and open airways in severe cases.

It is crucial to recognize the signs of anaphylactic shock because timely treatment with epinephrine can be lifesaving. The MA should know where the Epi-pens are stored and how to use them before they are in an emergency. The MA should also check the expiration dates on EpiPens regularly to ensure that an expired EpiPen isn’t used during an emergency.

To safely administer an EpiPen, follow these steps:

1. When the pharmacy stock order is received, read EpiPen insert.
2. Practice administering the EpiPen with the trainer found in the EpiPen package.
3. Check expiration dates of EpiPens on a routine basis.
4. Report signs of severe allergic reaction to the provider, which includes swelling, which can lead to difficulty breathing or swallowing, shortness of breath or wheezing, abdominal pain, chest tightness, dizziness, vomiting, confusion, hypotension, and severe hives or rash.
5. Ask or help the patient to lie down (if not lying down already).
6. Collect the EpiPen from emergency medication storage upon the provider's verbal order.
7. Call out loudly for another staff member to call 911.
8. Flip the yellow cap and remove the EpiPen from the carrier tube.
9. State loudly, “I am preparing the EpiPen.”
10. Hold the Epi-pen in your fist with the orange tip facing downward and the blue tip facing upward.
11. Remove the blue safety cap.
12. Place the orange safety tip against the middle of the outer thigh. Hold the leg firmly in place. Note: The autoinjector is designed to be injected through clothing.
13. Firmly and loudly state, “I am giving the EpiPen now.” Note the time that the EpiPen is being administered. Listen for any instructions from the provider.
14. Using a slight swing, jab the autoinjector into the thigh at a 90-degree angle until you hear the device make a click sound.
15. Hold the pen firmly in place for three full seconds. State loudly, “The EpiPen has been administered.”
16. Remove the autoinjector from the thigh. Check to ensure the window in the autoinjector has been obscured (this means the EpiPen has been discharged).
17. Massage the injection site for 10 seconds.
18. Check the patient’s vital signs and responsiveness.
19. Prepare a second EpiPen if instructed by the provider.
20. Continue to monitor the patient until their condition improves or emergency personnel arrive.
21. Remind the provider to document the order for EpiPen.
22. Document the procedure, patient vital signs, patient response, patient education, and patient disposition.