Where You Are:
You are an FY2 doctor working in GP surgery.Who the Patient is:
Jason Winslow 8 years old boy was admitted to the hospital with anaphylaxis after ingesting peanuts one week back. His mother Becca Winslow has questions about how to use the EpiPen.Special Note:
There is an EpiPen Trainer on the table inside the Cubicle.What you must do:
Please talk to the mother and teach her how to use the EpiPen.
APPROACH
Smile
- Introduction: Introduce yourself and explain your role.
- ID check: Of the mother and her son.
I can see from my notes that you came for your son Jason Winslow. Is that correct?
It’s nice to meet you Becca. Could you confirm Jason’s age for me please? - Build Rapport:
How is he doing now?
How was the hospital stay?
How was the care by the doctors?.. etc. - Main concern:
(she wants to learn about EpiPen), here you should praise her how caring as a mom she is. (IPS). - Assess her knowledge: child, attack, and EpiPen.
- Child: When he has been diagnosed with Allergy, Allergy regarding food & medications?
- Attack: Recap
What happened?
What they did?
What symptoms he had? (Rash, swollen lips, wheeze chest).
For how long did it last?
What was your reaction?
Who have been around him? (what they noticed over him) . - EpiPen:
When was the EpiPen prescribed for him?
Did you use it before? do you know how to use it?
What if she tried to use the pen but cannot remember how…, called the ambulance (always acknowledge and reflect).
- Manage the Panic attack of the mother and encourage her:
- Tell the mother that what she did was brave and that it saved her son’s life.
- Encourage her to gather strength next time and calm down when trying to use the EpiPen.
- Check / Safety Net:
Check that she knows what she might observe or look for symptoms of Allergy.
Do you know when you might have to be using the EpiPen?
Do you have any idea of the signs of severe allergic reaction?.
“Swollen lips, wheeze, rash, difficulty of breathing, fainting… etc” - Teach:
- Here it comes the mission of how to teach the EpiPen.
- Again, you can score high in IPS.
- For example, as you said you were afraid to use the EpiPen (if she said that to you) to the level that made you panic.
- Manage the panic attack here:Mrs. Winslow, I understand that being in this kind of situation could have been unimaginable hard for you.
- But you know that you are doing that to save your son’s life( use the name for more IPS).
- Please try to take your breath, calm down, and do it.
- At that point she will try to get as much as she can of how to use this EpiPen.
(Before use) Explain the Pen:
- It’s a device, it’s like a syringe.
- It contains a very important medicine ( Adrenaline ) to treat anaphylactic attacks.
- It has to ends (blue and orange).
- The orange end contains the needle (blue to the sky, Orange to the thigh ) Needle is covered and retractable so do not worry to get hurt.
- Check expiration date ( exchange them at GP if expired or used ).
- Check (this small window) it contains the drug watch for any changes (sunlight can affect the medication inside) , that is why it is very important not to keep it in extremities of temperature.
How to use it (Show and do):
- Hold it Like a grip (blue to the sky , Orange to the thigh, remember this to always know which way to hold)
- Remove the blue cap.
- Swinging motion to the thigh ( like so ).
- Push it until you hear the click.
- It can go through all the clothing, but make sure there is no button or anything in the pocket while injecting.
- Keep it in place and count 10 elephants.( Why you count? So that you can make sure all the medication is injected in that 10 seconds).
What to do next:
- Call 999, and you need to say (‘ANAPHYLAXIS’ or Severe Allergic reaction if you forget to remember that— why? To elicit a fast response by the ambulance and paramedics team)
- Please again don’t panic, lie your child on floor and stay beside him.
Finishing:
- Involve her in the conversation, Do you know why you should stay near him?
- To watch for any signs, if he gets better or not, after 5 minutes if your son didn’t get better or the ambulance didn’t arrive yet, You will be in need to give him another shot � typically just as I showed you.
- After that: It’s necessary to put your child under observation for few hours. As there is risk of delayed reaction and your child’s health and safety is our priority.
You already safety netted her early, you can also add.
- We can refer your child to Allergy Clinic where he can be assessed further.
- Make sure that you will replace the two EpiPens because it is a SINGLE USE , from nearest Pharmacy or GP . We can set a reminder for that.
- Make sure his school and anyone taking care knows about his conditions and let him carry them all the time, in the hard covering box.
- Remind her the signs to look for in a severe allergic reaction
- ( SOB, Cyanosis, Rash, Wheeze, swelling of lips or Lump in the throat, fainting)
Offer a Leaflet with all information she might need later.
