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PUID: 51 || PLAB 2 Mock 5 :: TeachingProcedures4: EpiPen

Summary:

This PLAB 2 station focuses on a pediatric patient being discharged following an anaphylactic episode. The primary task is to educate the parent about EpiPen use, ensuring they are prepared to handle potential future anaphylactic events.


Key Points:


Initial Data Gathering

  • Limited and focused history only is required as the patient is stable and being discharged.

  • Clarify what the parent wants to know early—ask about concerns to guide the station.

  • Confirm:

    • If EpiPen was used

    • Previous anaphylactic episodes

    • Comfort and confidence level with EpiPen

    • Number of EpiPens carried and whether they’ve received training


Allergy-Specific History

  • Ask about known allergens and previous reactions.

  • Inquire about barriers to using the EpiPen previously.

  • Check if caregivers (e.g., school staff) are informed and trained.


Important Considerations:

  • This is primarily a teaching station; heavy data gathering is unnecessary.

  • Start with asking for concerns to target the teaching.

  • Dedicate at least 5 minutes to demonstration and explanation.

  • Summarize and check understanding after teaching.

  • Encourage a supportive, non-judgmental tone; reassure the parent.


Diagnostic Approach:

  • History of allergic reaction: symptoms, exposure, and response.

  • Confirmation of anaphylaxis features (e.g., breathing difficulty, hypotension).

  • Identify risk factors for recurrence and current management plan.



Management:


Demonstration of EpiPen Use

  • Use an actual EpiPen if available.

  • Teach with the phrase: "Blue to the sky, orange to the thigh".

  • Steps:

    1. Remove blue safety cap.

    2. Jab the orange tip into the thigh (outer side).

    3. Hold for 3 seconds (count “1 Mississippi, 2 Mississippi…”).

    4. Can be given through clothing.


Emergency Action Plan

  • Always call 999 after use—mention the word "anaphylaxis" to prioritize the call.

  • If no improvement after 5–10 minutes, give the second EpiPen.

  • Monitor for response while awaiting ambulance.


Preventive Advice

  • Avoid allergen exposure (e.g., specific restaurants).

  • Carry 2 EpiPens at all times.

  • Inform school and extracurricular activity leaders.

  • Use an allergy bracelet.

  • Check EpiPen expiry and fluid clarity regularly.


Follow-Up

  • Arrange GP follow-up in 1–2 weeks.

  • Provide written materials/leaflets for reinforcement.


Communication Skills:

  • Address emotional impact: normalize fear and guilt.

  • Reassure: focus on empowerment and preparedness.

  • Use simple language, avoid medical jargon.

  • Ask for repetition of key steps to confirm understanding.

  • Avoid stock phrases—be natural and empathetic.


Ethical Considerations:

  • Respect the parent’s need for support and guidance.

  • Ensure informed, practical instruction for managing life-threatening conditions.

  • Promote shared responsibility with caregivers.


Additional Resources:

  • GMC: Good Medical Practice (Domain 2 – Communication)

  • Resuscitation Council UK: Anaphylaxis guidelines

  • BSACI: Patient leaflets on EpiPen use and allergy management

  • NICE Guidelines: Management of anaphylaxis

  • PLAB Examiner Tips (importance of checking understanding, avoiding rote learning)

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