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PUID: 54 || PLAB 2 Mock :: Teaching: Epipen

Updated: Aug 10


Summary:

This case focuses on teaching a caregiver (the mother) how to identify and manage an anaphylactic reaction in a child with a known peanut allergy. The scenario evaluates the candidate's ability to deliver effective teaching, gauge understanding, correct misconceptions, and ensure safe long-term care planning.



Key Points:


History Taking and Data Gathering

  • Clarify previous episodes of anaphylaxis and current presenting symptoms

  • Ask about other medical conditions like asthma

  • Determine other known allergies

  • Establish context of the incident and sequence of events

  • Identify where the child spends time (e.g., school, daycare)


Understanding and Demonstration

  • Confirm who you are talking to (mother, caregiver, etc.)

  • Ensure the caregiver understands by checking their knowledge at least three times

  • Use conversational style; avoid monologues

  • Address and correct misunderstandings immediately


Teaching the Use of an EpiPen

  • Demonstrate proper use: "Blue to the sky, orange to the thigh"

  • Hold for three seconds until click is heard

  • Emphasize removing the safety cap before administration

  • Do not ask patients to demonstrate unless explicitly required


Use of Two Pens

  • Explain need for a second dose if symptoms persist after 5–10 minutes

  • Call an ambulance after the first dose regardless of improvement


Important Considerations:

  • Always check understanding using simple recall questions

  • Follow up medical jargon with layman's explanations

  • Check the fluid in the EpiPen monthly; it should be clear with no particles

  • Always offer — don’t assume — an allergy bracelet

  • Document relationship to the patient clearly


Diagnostic Approach:

  1. Confirm allergic trigger (e.g., peanut)

  2. Assess past and current symptomatology

  3. Rule out other comorbidities (asthma, other allergies)

  4. Evaluate environmental risk factors (school, daycare, etc.)



Management:


Immediate Management

  • Administer first EpiPen dose

  • Call emergency services (mention suspected anaphylaxis)

  • Administer second dose if symptoms persist after 5–10 minutes


Preventative Measures

  • Carry two EpiPens and an antihistamine at all times

  • Inform schools and caregivers

  • Offer educational materials

  • Arrange follow-up in 1–2 weeks

  • Advise avoidance strategies for allergens


Long-term Management

  • Provide allergy action plan

  • Provide allergy bracelet

  • Ensure medications are stored in accessible locations


Communication Skills:

  • Use empathetic language ("It’s normal to feel overwhelmed")

  • Listen actively and paraphrase

  • Avoid robotic or rehearsed stock phrases

  • Signpost transitions in consultation clearly

  • Offer to set up follow-up appointments


Ethical Considerations:

  • Consent: Always identify the caregiver and explain their role

  • Confidentiality: Respect privacy while collecting history

  • Duty of care: Provide accurate education to prevent harm

  • Equity: Ensure all caregivers are educated, not just the parents


Additional Resources:

  • Resuscitation Council UK: Anaphylaxis guidelines

  • NICE Guidelines: Anaphylaxis overview

  • GMC’s Good Medical Practice and Confidentiality guidance

  • “Understanding Your Results” (GMC PLAB feedback guide)

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