The Lyme School •  Lyme, New Hampshire
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Policy Manual

Policy: EBBD
Emergency Treatment of Anaphylactic Shock

In the interest of safety for staff and students, the Lyme School Board authorizes the school nurse in an emergency to treat an individual with symptoms of anaphylactic shock by administration of an Epi-pen or Epi-pen Jr., subject to the attached procedures and in compliance with New Hampshire statutes and the recommendations of the School Nurses Association.

1ST READING: 27 March 2003

ADOPTED: 24 April 2003
REVISED: 24 June 2003

Procedure for Treatment of ANAPHYLAXIS

Definition: A rare, extremely serious form of allergy which may occur in persons not previously known to be allergic or hypersensitive. The reaction ranges from mild, self-limited symptoms to rapid death.

Causes: Extreme sensitivity to one or more of the following:

1. Insect sting, usually bee or wasp.
2. Medication or immunization, usually by injection.
3. Food or pollen.
4. Industrial or office chemicals, or their vapors. (spirit dup1icator liquid, carbonless copy paper, etc.)

If a student or employee of the Lyme School is exposed to an allergen such as the above named allergens and exhibits the following symptoms which were not present prior to the exposure it should be assumed that the student or employee is experiencing Anaphylactic Shock. In such instances, it should be realized that an emergency exists. The Epi-Pen Auto Injector may be used and the student or employee injected as outlined in the procedure below. The procedure should be limited, if it can be readily determined, to individuals who are hypersensitive or severely allergic to an allergen and display symptoms of allergic response.


1. Sudden onset. Symptoms beginning within 15 minutes after exposure to inciting agent usually result in more severe type of anaphylactic reaction.
2. Feeling of apprehension, sweating and weakness.
3. Feeling of fullness or tightness in chest or throat.
4. Respiratory difficulty, such as wheezing.
5. Change in quality of voice
6. Oral Edema; “thick tone” (swelling of tongue)
7. Tingling sensation around mouth or face, nasal congestion, itching, wheezing.
8. Low blood pressure with weak, rapid pulse.
9. Vomiting, abdominal cramps.
10. May be accompanied by hives with severe itch.
11. Loss of consciousness, shock, coma.


Epi-pen Jr. 0.15 mg for weight up to sixty-six (66) pounds (30 kilograms).
Epi-pen 0.3 mg for weight above sixty-six pounds (30 kilograms).


1. Evaluate Symptoms
2. Activate Emergency Squad (911) CALL FOR HELP
3. Pull off gray safety cap.
4. Place black tip of auto injector on front outer aspect of either upper thigh (anterolataraI) at a ninety-degree (right) angle.
5. Press “pen” hard into thigh and hold for several seconds.
6. Discard auto injector in an appropriate manner.
7. Massage injection area for ten seconds.
8. Emotional support needed.
9. If student is still at school in 15-20 minutes, and symptoms are still present, smaller doses of Epi-pen Jr. may be repeated if available.
10. Do not leave child or employee.
11. Await arrival of emergency personnel for transportation.
12. Contact person designated to be reached in case of emergency.

Documentation of event in the health record and notification to the child’s or employee primary care provider is important. Counsel against further exposure to sensitizing agent. If this is the child’s or employee’s first episode, implementation of a individual health plan is indicated.