by Amanda Painter, South Chapter Coordinator
Last month a study was published in Annals of Emergency Medicine identifying 25 cases of epinephrine auto-injector related injuries. The majority of these injuries were lacerations to the thigh. The media has picked up on this study, and in typical media-fashion, some of the headlines are a bit dramatic.
If reading this study or the media reports scares you, take a moment to examine why.
Are you afraid you may injure your child?
Are you concerned because you never knew you might need to restrain the child and immobilize his or her leg?
Don’t let fear be what you take away from this study. We should never fear life-saving medication or the device that delivers it. We must be confident on how to properly use it.
Let this study be your motivation to practice with your auto-injector trainers. Practice restraint techniques. Don’t keep this information to yourself. Share this information with those who care for your child or any child with food allergies.
If you have ever been present for a child receiving a shot in the doctor’s office, you know that the nurse will ask the parent or guardian to help restrain the child. Administering an epinephrine auto-injector isn’t different. If anything, it is likely to be more stressful for the child and parent. Anxiety will be running high and you may not have another adult to help you.
The more confident you are about how to use the device properly, the less anxious you will be. This will help the child be calmer too.
Also, we need to educate children with food allergies to not be afraid of their auto-injector. Don’t talk to them about big scary needles, whether it is their auto-injector or a shot at the doctor’s office. Be honest that it may hurt, just for a minute, but if they are still and cooperate it will be over quickly. The main focus needs to be on how this will help them feel better, very quickly. You cannot predict how a child will react emotionally during a reaction, but you can be prepared to handle the unexpected.
FACET’s Medical Advisor, Dr. Singer had this to say about the study.
"The injuries, although undoubtedly painful, will heal, maybe with a scar. But the scar from not using epinephrine when needed is much larger.
As always, discussing injector technique and device type with your physician is appropriate. Not giving epinephrine when needed is not."
You can read the rest of his thoughts on the study here.
In response to this study being released Dr. Julie Brown (lead doctor in the study) and some of her ED colleagues demonstrated some options for restraint of a resistant young child. They are pictured below. (Thank you Dr. Brown for the examples!)
I cannot stress enough the importance of being familiar with your auto-injector. Know how it works and how to properly care for it. Understand that you can never use the same device more than once. This and many other reasons are why you should always carry 2 (see image below for more information on Why 2). Read more here about being confident on how and when to use your auto-injector.
I urge you to use this study to create a positive. Don’t be fearful. Use this as an educational moment to make your emergency preparedness stronger.
Now is a good time to practice.
As always, consult a medical professional if you have questions about your medication.
Fellow food allergy advocate Gina Mennett Lee created a “Beyond Awareness Educational Campaign” for 2015. One part of this is the focus on Do You Know Your EPI? Gina with the help of other star food-allergy bloggers, Caroline Moassessi (Grateful Foodie) & Sharon Wong (Nut Free Wok), are asking for help from other bloggers to assist in spreading the word. Here is the FACET Advocate take on it:
Food allergy diagnosis – check
Allergen avoidance – check
Epinephrine auto-injector on hand at all times - check
You are prepared for an emergency.
But are you confident about how to use an epinephrine auto-injector?
A recent study from the University of Texas Medical Branch at Galveston (UTMB) shows the misuse of epinephrine auto-injectors. 102 patients with prescribed epinephrine participated in the study. Of these, 16% properly demonstrated how to use the epinephrine auto-injector. That means the remaining 84% did not know how to use the device correctly. 84%!!!
You cannot save your own life or the life of someone you care for during an anaphylactic reaction if you do not know how to properly use an epinephrine auto-injector. I cannot stress this point enough. An auto-injector is useless unless you know how to use it.
Most cases of anaphylaxis that result in death are due to delayed epinephrine administration or not using epinephrine at all.
An anaphylactic reaction is going to be terrifying and emotional.
Your hands may shake.
You may fumble while finding the auto-injector.
You may second-guess if you truly need to use it.
Your heart will be racing.
You may have to restrain the child before administering.
You may panic.
Despite all of this, you MUST be able to properly administer the epinephrine. A life will depend on it.
Practice. Practice. Practice.
It’s important to know that there are multiple brands of auto-injectors on the market. All manufacturers of epinephrine auto-injectors have videos on their website demonstrating how to use their product. Be sure you are familiar with the brand that you will need to use in case of anaphylaxis.
In addition to knowing how to use it, you have to know when to use it. When to use epinephrine should be specifically documented in an Emergency Care Plan by your allergist. In my opinion, an Emergency Care Plan is the single most important piece of paper a person with food allergies should have. If you do not have a care plan, work with your allergist to create one specific to your/your child’s unique diagnosis.
While we’re talking about auto-injectors, a few items to know:
Successful treatment of anaphylaxis depends on 3 things:
Are you confident? If not, now is the time to speak up.
by Amanda Painter, South Chapter Coordinator
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