Over 120 thousand people in Poland suffer anaphylaxis and almost 100 of them die every year as a result [1]. Most cases of anaphylactic shock happen outside the hospital, that’s why knowledge of symptoms and first aid is crucial. Adrenaline injected intramuscularly is the most effective treatment for this serious condition [2,3]. Unfortunately, the majority of people have never seen the procedure of drug administration. That’s why those who witness anaphylactic shock don’t know how to react or simply call emergency services. As fast response time is the key in this condition, many patients do not receive help in a timely manner. Pediatric Scientific Circle from Medical University in Gdańsk has developed a project, whose aim is to educate the general public about anaphylactic shock and to show how to use adrenaline auto-injectors [4].
The project was based on non-formal education with subject-performed tasks. Non-formal education relies on committed volunteers (in this case medical students), who firstly acquire knowledge about given topic, then conscientiously prepare training program and share knowledge with their peers later. The advantage of this method is its accessibility, as training can take place anywhere. Furthermore, prepared topics are based on the needs of the target group and not on the overall curriculum, which often does not take into account the interests of the individual. Moreover, projects like that provide a mutual benefit for both the students and the educators, who in this case had to consolidate the knowledge about anaphylaxis and adrenaline.
The project was divided into three stages. First, the medical students’ knowledge on anaphylactic shock, first aid and how to administrate adrenaline with automatic injectors was evaluated. The second stage consisted of the training – the students obtained information about the topic and practiced their manual skills using adrenaline auto-injectors. In the third stage, a re-test of the knowledge was administrated to assess the improvement. There was an assumption, that medical students were potentially one of the best prepared group of general public to act properly in similar emergencies. Despite that fact, most of them had never had an opportunity to perform adrenaline injection. Even among medical students the training turned out to be necessary.
Introduction to the topic
Allergies are not only among the most common chronic diseases in Europe, but also affect an increasing number of patients [4]. The most serious complication of an allergy is anaphylactic shock, which can be life-threatening. Anaphylaxis is a severe, dynamically progressing, systemic hypersensitivity reaction to a given allergen [5]. The most common stimuli that cause anaphylactic shock are hymenoptera venom, food and medicines. The incidents of anaphylaxis had increased in number significantly over the past 20 years [6-7].
Etiology and pathogenesis
Anaphylaxis occurs due to the release of inflammatory mediators and cytokines from mast cells and basophils. It may be caused by the IgE-dependent mechanism (e.g., food, drugs), IgE-independent mechanism (e.g. contrasting agents used in radiology, NSAIDs, biological agents) or by and non-immunological reactions that result from direct mast cell activation (e.g. physical effort, alcohol) [8]. Anaphylaxis typically presents many different symptoms over minutes or hours [3]. The most common areas affected include: skin (80–90%), respiratory (70%), gastrointestinal (30–45%), heart and vasculature (10–45%), and central nervous system (10–15%). There are usually two or more systems involved [3].
Diagnosis
Anaphylaxis is diagnosed with classification based on person's signs and symptoms [5,9]. Diagnostic criteria include:
1) Involvement of the skin or mucosal tissue plus either respiratory difficulty or a low blood pressure
2) Two or more of the following symptoms after contact with an allergen:
- Involvement of the skin or mucosa
- Respiratory difficulties
- Low blood pressure
- Gastrointestinal symptoms
3) Low blood pressure after exposure to a known allergen
- Infants and children - low systolic pressure (depending on age) or more than a 30% decrease in systolic pressure
- Adults - systolic blood pressure <90 mmHg or more than 30% of baseline
The patient’s history and symptoms are crucial for the diagnosis of anaphylaxis. Additional tests are used to determine what type of an allergic reaction has occurred and to evaluate mast cell involvement [5,10].
Treatment
After the onset of symptoms, the most important thing is to terminate contact with the allergen, e.g. stopping the drug admission or removing the sting. First-line drug is adrenaline, which should be used at a dose of 0.5 mg in adults, and in children 0.01 mg / kg body weight (max 0.3-0.5 mg). It is administered intramuscularly, preferably in the lateral surface of the quadriceps femoris muscle [2,3]. Research shows that anaphylactic shock occurs mostly in public spaces and at home. In such situations, adrenaline autoinjectors should be used, as they offer a fast and easy way to administrate the drug by a person without specific first aid training [11].
The aim of this study was to evaluate the level of knowledge about anaphylaxis and ability to use adrenaline auto-injectors among medical students and to determine an improvement after a training based on non-formal education.