Epipen and Anaphylaxis in Canada
The problem:
The occurrence of Anaphylaxis (life threatening systemic allergic reaction) have been increasing across the world. With the increase in patients with anaphylaxis it is more likely that you as a first aider may come across an individual presenting with an anaphylactic reaction. The correct identification of anaphylaxis and treatment are key to improving patient outcomes.
What is anaphylaxis:
Anaphylaxis is a full body reaction to an allergen. Allergens can vary with the most common causes of anaphylaxis being exposure to nuts and venom from insect stings such as bees and wasps, although there are a number of other possible allergens that can lead to anaphylaxis.
When a person with severe allergies is exposed to their allergen they can suffer from an anaphylactic reaction. This reaction can be sudden or may be delayed to hours after the exposure.
The best definition of anaphylaxis is as follows:
- Exposure to a known (previous history) or suspected (recent ingestion, sting, etc) allergen (example, nuts in food, insect sting) plus 2 or more of the following body systems reacting:
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- Circulatory system: increased pulse and decreased blood pressure, lightheadedness and dizziness, confusion
- Respiratory system: Difficulty breathing, increased breathing rate, wheezes, stridor (high pitched sound with breathing)
- Skin system: Raised red bumps or rash throughout body abdomen, back, arms, legs (commonly called hives), facial swelling lips, tongue
- Digestive System: Nausea (feeling sick to stomach), vomiting, diarrhea
What to do:
- Call 9-1-1 EMS and let them know you think your patient is having an anaphylactic reaction.
- Have the patient sit away from the possible allergen (remove the food or move away from possible insect that may have stung patient).
- Try to calm the patient and help them slow their breathing
- If an Epipen is available and you are comfortable in helping the patient administer you can assist the patient:
- Ideally the patient can self administer the medication
- If the patient is unable to self administer the Epipen you can administer the Epipen to them, follow the instructions on the label of the Epipen.
- Monitor and stay with the patient until the ambulance arrives. If available prepare a 2nd dose of Epinephrine (Epipen) in the case that the patient does not improve or condition worsens after 5 minutes of the 1st dose.
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- If the patient has not improved or worsens after 5 minutes of the 1st Epipen a 2nd Epipen can be given in the opposite leg.
How to use an Epipen:
- Check the Epipen:
- Check the expiry date on the Epipen label (if it is expired it may still work but may not be as effective).
- Check the clear window on the Epipen this shows the medication which should be clear. If the medication is yello/brown or has sediment in it it may not work for the patient.
- Check the dose of the Epipen. Epipen is available in 2 doses:
- Epipen 0.3mg for people weighing more than 30kg or 66lbs
- Epipen jr. 0.15mg for people weighing less than 30kg or 66lbs
2. Prepare the Epipen and the patient:
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- Have the patient sit or lie down whichever is more comfortable.
- Remove the Epipen from the clear case
3. Administering the Epipen:
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- If the patient is unable to self administer the Epipen you can administer the Epipen to them.
- Remove the blue safety cap from the end of the Epipen
- Hold the Epipen with your thumb off the ends and wrapped with your hand around the body of the Epipen.
- Find a place on the outside of the middle of the patients thigh that has minimal clothing ideally, remove any objects fromt he patients pocket and avoid seams and zippers.
- Place the Orange tip of the Epipen against the patients outer middle thigh and firmly press the Epipen into their leg until you hear a click.
- Once the Epipen clicks the needle has been activated and you need to hold the Epipen firmly into the leg for at least 3 seconds.
- After 3 seconds you can remove the Epipen, a cover will slide out over the exposed needle. Have the patient or yourself massage the area where the needle entered the body to help the medication distribute through the patient's body.
- Keep the Epipen and hand it off to the ambulance when they arrive.
Can I buy and use an Epipen in Canada?
You can legally purchase an Epipen without a prescription in Canada from any pharmacy. I purchased one yesterday from a local Rexall pharmacy for $132.
If you choose to use your Epipen to help a patient make sure you:
- See symptoms of anaphylaxis
- Call 9-1-1 EMS
- Aquire verbal consent from the patient to use the Epipen
- Follow the directions on the Epipen to administer
- Stay with the patient until the ambulance arrives
- Consult the 9-1-1 dispatcher if you are unsure if the Epipen should be given
Resources:
https://www.ccohs.ca/oshanswers/hsprograms/firstaid/firstaid_epinephrine.html
https://www.epipen.ca/en-ca/frequently-asked-questions
https://foodallergycanada.ca/increasing-access-to-epinephrine-through-advocacy/
https://www.ontario.ca/laws/statute/05s07
https://resources.allergyaware.ca/download/epinephrine-2021-a.pdf