Nebraska Administrative Code › Topic - EDUCATION, DEPARTMENT OF › Title 92 - NEBRASKA DEPARTMENT OF EDUCATION › Chapter 59 - REGULATIONS FOR SCHOOL HEALTH AND SAFETY › Appendix A - EMERGENCY RESPONSE TO LIFE-THREATENING ASTHMA OR SYSTEMIC ALLERGIC REACTIONS (ANAPHYLAXIS)

Current through June 17, 2024
DEFINITION:
Life-threatening asthma consists of
				  an acute episode of worsening airflow obstruction. Immediate action and
				  monitoring are necessary.
A systemic allergic reaction (anaphylaxis) is a severe
				  response resulting in cardiovascular collapse (shock) after the injection of an
				  antigen (e.g. bee or other insect sting), ingestion of a food or
medication,
or exposure to other allergens, such as animal
				  fur, chemical irritants, pollens or molds, among others. The blood pressure
				  falls, the pulse becomes weak,
AND DEATH CAN OCCUR.
Immediate
				  allergic reactions may require emergency treatment and medications.
LIFE-THREATENING ASTHMA SYMPTOMS:
Any of these
				  symptoms may occur:
Chest tightness
									Wheezing
									Severe shortness of breath
									Retractions (chest or neck "sucked in")
									Cyanosis (lips and nail beds exhibit a grayish or
					 bluish color)
									Change in mental status, such as agitation, anxiety, or
					 lethargy
									A hunched-over position
									Breathlessness causing speech in one-to-two word
					 phrases or complete inability to speak
ANAPHYLACTIC SYMPTOMS OF BODY SYSTEM:
Any of the
				  symptoms may occur within seconds. The more immediate the reaction, the more
				  severe the reaction may become. Any of the symptoms present require several
				  hours of monitoring.
Skin: warmth, itching, and/or tingling of
					 underarms/groin, flushing, hives
									Abdominal: pain, nausea and vomiting,
					 diarrhea
									Oral/Respiratory: sneezing, swelling of face (lips,
					 mouth, tongue, throat), lump or tightness in the throat, hoarseness, difficulty
					 inhaling, shortness of breath, decrease in peak flow meter reading, wheezing
					 reaction
									Cardiovascular: headache, low blood pressure (shock),
					 lightheadedness, fainting, loss of consciousness, rapid heart rate, ventricular
					 fibrillation (no pulse)
									Mental status: apprehension, anxiety, restlessness,
					 irritability
EMERGENCY PROTOCOL:
1. CALL 911.
2. Summon school nurse if available. If not, summon
				  designated trained, non-medical staff to implement an emergency
				  protocol.
3. Check airway patency, breathing, respiratory rate, and
				  pulse.
4. Administer medications (epinephrine auto injector and
				  nebulized albuterol) per standing order.
5. Determine cause as quickly as possible.
6. Monitor vital signs (pulse, respiration, etc.).
7. Contact parents immediately and prescribing health care
				  practitioner as soon as possible.
8. Any individual treated for symptoms with epinephrine at a
				  school will be transferred to a medical facility.
STANDING ORDERS FOR RESPONSE TO LIFE-THREATENING ASTHMA OR
				  ANAPHYLAXIS:
Administer epinephrine auto injector junior for any
					 child less than 60 pounds or adult epinephrine auto injector for any individual
					 over 60 pounds into the muscle towards the front and outer side of the
					 thigh.
									Follow with nebulized albuterol while awaiting
					 EMS.
									If symptoms persist, repeat epinephrine auto injector
					 followed by nebulized albuterol every fifteen minutes while awaiting EMS
					 arrival.
									Administer CPR, if indicated.
___________________________ ___
Prescribing Health Care Practitioner Date
When signed by a licensed prescribing health care
				  practitioner, these orders shall serve as a prescription as defined in Neb.
				  Rev. Stat. §
									71-2475 for emergency use for
				  epinephrine auto injectors and nebulized albuterol to be used
				  accordingly.