Epipen action plan pdf

Discovering that a child suffers from a lifethreatening allergy is a troubling event for any parent. By doing this, parents help to keep their children safe. Wisconsin department of public instruction medication. Give medication as ordered on health care provider form 42a c. The action plans have been developed following an extensive consultation period with health professionals, support organisations, parents of foodallergic children and teachers. This plan is provided to people with allergies who have been prescribed any brand of adrenaline autoinjectors. Action plan for anaphylaxis patients name date of birth expiration date for action plan health care provider providers phone number responsible person i. This plan is provided to people with allergies who have been prescribed epipen adrenaline autoinjectors. An action plan is intended to provide an easy to read aide memoire in the event of an emergency, not a comprehensive set of instructions.

How to use an epipen epinephrine injection, usp auto. I give my permission for information to be sent to the school. Grasp the autoinjector in your fist with the orange tip needle end pointing downward. Focus on creating, enforcing, and distributing an anaphylaxis action plan ahead of time.

Plan to stay for observation at the emergency room for at least 4 hours. Medications specified on this plan to be administered according to the plan. Dr signed date anaphylaxis action plan for stay with person and call for help. The most common anaphylactic reactions are to foods, insect stings, or medications. The plans are medical documents, and should be completed by a childs health professional and not by parents or teachers, for example. Selection of the appropriate dosage strength is determined according to patient body weight. Oversee or assist child in injecting the epinephrine in 4. Personal plan for individuals prescribed epipen personal plan for individuals prescribed jext. Anaphylaxis anafilaksis is a serious, lifethreatening allergic reaction. Retrieve epinephrine autoinjector which will be located here. Action plan for anaphylaxis a useful takehome reminder about your epipen adrenaline autoinjector or epipen jr adrenaline autoinjector and the steps to take if you believe you have come into contact with your allergen. I, the parent or guardian of the above named student, request this emergency action plan be used to guide allergy care for my child. Below are links to downloadable plans and cards for allergic emergencies anaphylaxis. Shortness of breath, wheezing, or coughing skin color is pale or has a bluish color.

Plans can be completed electronically and then printed and saved, or filled in by hand. I have read and understand springboro community city schools medication policy. Epinephrine autoinjector emergency action plan campus, department name effective date. Get to know this document, the cornerstone of personalized treatment for anyone with a food allergy. A kit must accompany the student if heshe is off school grounds i. Springboro community city school health services place. Action plan for anaphylaxis australasian society of. Ascia action plan for anaphylaxis red 2020 generic. Severe allergic reaction anaphylaxis medication administrationepinephrine autoinjector. B care giver allergy to yes no yes no medication dosages.

Action plan for au an ap h y l axis how to give epipen for use. For use with epipen adrenaline epinephrine autoinjectors if adrenaline is accidentally injected e. I hereby authorise medications specified on this plan to be administered according to the plan. Continue to follow this action plan for the person with the allergic reaction. How to give epipen action plan for anaphylaxis for use with epipen. Wisconsin department of public instruction medication administration. Ci yes higher risk for a severe reaction cl no place students picture here extremely reactive to the following foods. Rash especially hives with redness and swelling especially on face, lips and tongue shortness of breath, cough, wheeze. Identify symptoms of a severe allergic reaction as indi cated on the emergency action plan, if possible. Anaphylaxis action plan for au 1 form fist around epipen and pull off blue safety release hold leg still and place orange end against outer midthigh with or without clothing push down hard until a click is heard or felt and hold in place for 3 seconds remove epipen how to give epipen. Student anaphylaxis action plan and authorization for. Emergency action steps do not hesitate to give epinephrine.

Anaphylaxis action plan for for insect allergy, flick out sting if visible. Locate epipen or epipen jr adrenaline autoinjector. National jewish health food allergy action plan name d. For severe allergy and anaphylaxis what to look for if child has any of these severe symptoms after eating the food or having a sting, give epinephrine. Anaphylaxis card from asthma and allergy foundation of america anaphylaxis emergency action plan asthma action plan from asthma and allergy foundation of america asthma action plan. Only a healthcare professional should give additional doses of epinephrine if you need more than two. There are 4 plans available click on the link to download the relevant plan. C if checked, give epinephrine immediately for any symptoms if the allergen was likely eaten. Allergy and anaphylaxis emergency plan childs name.

Anaphylaxis action plan for those requiring emergency epinephrine treatment anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. Epipen or allerject at the first sign of a known or suspected anaphylactic reaction. Anaphylaxis is a potentially lifethreating, severe allergic reaction. For children with multiple food allergies, consider providing separate action plans for different foods. Evidence that action plans improve the outcome from anaphylaxis is. This form is adapted from the food allergy anaphylaxis network, food allergy action plan by the alaska asthma coalition. Contact responsible person or other emergency contacts listed above.