Emergency Treatment Sheet

EMERGENCY TREATMENT FOR ALLERGIC REACTIONS

Name: ___________________________________________________________ has a severe allergic reaction to: _________________________________________________________________________

Signs and symptoms of a severe allergic reaction can include any of the following:

hives, swelling, shortness of breath, wheezing, coughing, chest tightness, hoarseness, throat closing, vomiting, nausea, abdominal cramps, diarrhea, loss of consciousness.

Action: If a reaction is occurring, the Epipen should be administered immediately. Call 911. Call Mother ___________________________________________________________ or Father ___________________________________________________________ or emergency contacts. Call the Doctor's office at __________________________________________________________

The patient has been given an Epipen and trained in proper use in the event of an allergic reaction. This Epipen should be readily available to the student at all times. We would suggest that someone from the school be trained and feel comfortable in the administration of Epinephrine.

The most important factor in the treatment of a severe allergic reaction is the early or immediate treatment with the Epinephrine. Do not hesitate to give epinephrine, it is in no way harmful or detrimental to children and may prevent a life-threatening event.

Emergency Contacts: Name _________________________________________________________________________ Relationship _________________________________ Phone _____________________________ Name _________________________________________________________________________ Relationship _________________________________ Phone _____________________________ Name _________________________________________________________________________ Relationship _________________________________ Phone _____________________________

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Parent Signature	Date	Doctor's Signature	Date