Get response ready for the anaphylactic moment

Drs. Mahr and Hernandez-Trujillo’s recent article in Contemporary Pediatrics, titled “AAP guidance: First-ever action plan for epinephrine and anaphylaxis,” provides excellent, detailed information on the assessment and management of children who present with subtle and more obvious symptoms of anaphylaxis. In addition, they provide a 1-page action plan that should be displayed in every pediatric practice setting, and specific guidance for the ordering and administering epinephrine.

Every nurse practitioner should review these guidelines and include an action plan in their practice. All providers should communicate information to all school, camp, and field nurses who are often the first to assess a child presenting with symptoms of anaphylaxis outside a medical facility. Providing instructions and a knowledge base for these nurses is especially critical based on a study cited by the authors that showed 31% of the children hospitalized and treated for anaphylaxis were discharged without referrals or follow-up plans.

When even moms don’t know

Knowledge deficit was a major concern identified by the authors. They cited several separate studies in which a large number of pediatricians and emergency medicine physicians lacked knowledge about administration of epinephrine. In another study cited in the article, emergency medical services providers did not provide epinephrine when a child showed evidence of anaphylaxis symptoms. Further, the authors reported the results of a study that examined the ability of mothers to administer the epinephrine to their child and found significant knowledge deficits. Clearly, it is time to critically reassess medical, nurse practitioner, and other healthcare providers’ grasp of anaphylaxis recognition and management so that they are best equipped to discharge instructions to parents and ensure their students are response ready.

Apply lab to life

I have taught management of anaphylaxis for the pediatric patient in the simulation laboratory for the past 10 years. Students are prepared for the experience prior to entering the simulation laboratory, and although they report feeling stressed during the training encounters, afterward they all express the feeling of being better prepared to handle this complex problem in the laboratory and in actual practice.

The latest educational strategies include flipped classrooms in which students assess and manage a simulated “patient mannequin” presenting with symptoms of anaphylaxis. These kinds of controlled, stressful scenarios provide individuals and small groups of students with the chance to confront and to critically think through an emergency situation, react, and then reflect on their performance under the guidance of expert educators and clinicians. Such mock emergency preparation can translate into lives saved when the anaphylactic moment hits.