Epinephrine/Anaphylaxis Reports

CDE Health and Wellness / Report of Epinephrine Administration (2014-15)

 Respiratory
Cough
Difficulty breathing
Hoarse voice
Nasal congestion/runny nose
Swollen throat/and or tongue
Shortness of breath
Itching - mouth/throat
Tightness - chest/throat
Wheezing
 GI
Abdominal discomfort
Diarrhea
Difficulty swallowing
Nausea
Vomiting
 Skin
Flushing
General itching
General rash
Hives
Lip Swelling
Localized rash
Pale
 Cardiovascular
Chest discomfort
Bluish skin
Dizziness
Weak pulse
Headache
Heart racing
 Other
Sweating
Irritability
Loss of consciousness
Metallic taste
Red eyes
Sneezing

Disposition:

 HoursMinutes
Time

Form Completed By:

clear
* Indicates Response Required