Epi-pen protocols?

|nexus| · Aug 17, 2004

I work in a camp in Massachusetts. Our standing orders say the following about anaphylaxis:

Anaphylactic shock reaction to bee sting insect bite/food / latex

If any of the following conditions apply, administer epinepherine, oxygen, benadryl, call 911 and notify child's parents:

Tachynpnea, tachycardia, cyanosis, poor air movement, air hunger, anaphylactic symptoms such as hives, selling of mouth or eyelids, throat itching, shortness of breath, wheezing.

Benadryl dose:

25 to 40 lbs give 12.5 mg

40 to 90 lbs give 25 mg

60 to 90 lbs give 37.5 mg

>90 lbs give 50 mgs

Epinephrine dose (1:1000 aqueous, subcutaneously)

0.1 cc if under 60 lbs

0.2 cc if 60 to 100 lbs

0.3 cc if over 100 lbs

Hope this helps

:)

Gompers, BSN, RN · Aug 17, 2004

anaphylactic symptoms such as hives, selling of mouth or eyelids, throat itching, shortness of breath, wheezing.

Kind of off-topic, but THANK YOU for mentioning throat itching!!! Sometimes people don't believe it is an allergic reaction for some reason. I had a CT scan a few years back with injectable dye, and right away I had lots of itching in my throat and mouth. The radiologist SWORE I wasn't having an allergic reaction to the dye! I had to literally BEG him to give me IV Benadryl. I was freaking out, picturing myself going into anaphylactic shock and needing to be trached right there in the CT room. :angryfire

BeenThereDoneThat74, MSN, RN · Aug 18, 2004

I work in a camp in Massachusetts. Our standing orders say the following about anaphylaxis:
Anaphylactic shock reaction to bee sting insect bite/food / latex
If any of the following conditions apply, administer epinepherine, oxygen, benadryl, call 911 and notify child's parents:
Tachynpnea, tachycardia, cyanosis, poor air movement, air hunger, anaphylactic symptoms such as hives, selling of mouth or eyelids, throat itching, shortness of breath, wheezing.
:)

You have oxygen at your camp?!? Also, do you mean IV Benadryl?

The criteria listed above is similar to the standing orders we have (without the 02). But the DOH said it wasn't good enough. :nono:

Who 'writes' your standing orders?

|nexus| · Aug 21, 2004

You have oxygen at your camp?!? Also, do you mean IV Benadryl?
The criteria listed above is similar to the standing orders we have (without the 02). But the DOH said it wasn't good enough.
Who 'writes' your standing orders?

We do have oxygen at our camp. We were able to rent a portable tank from a local medical supply company for something like $20 or $30 a month.

And no, the benadryl isn't IV, it's PO.

As for who writes our standing orders, I really don't know, to tell the truth. My camp director handed them to me to get signed by the camp pediatrician, and I'm not entirely sure that our director would know the source either. (I am not at camp anymore, otherwise I would just ask). Every year our camp doctor gives us his signature approving the orders, but if we ever had to have any serious ammendments like the DOH is asking you to make, I'm not sure where I would turn.

Is there anybody out there who knows how one would go about making a major ammendment to camp standing orders? If the camp that bonemarrowRN worked at this year came under scrutiny then it probably won't be long until the Massachusetts DOH starts asking for the same type of changes in our standing orders.

CCHP-RN · Oct 20, 2004

It figures!! My first week at camp, and the DOH comes. The only issue he found was with our standing orders for Epi-pen. We have a standing order with the Ped. in town on criteria for administring it. He said it wasn't good enough. I'm in NY (Suffolk county). Can anyone tell me what they have in place? (I'm home already, and camp ends this thurs, but I'm just curious for next year).

I know this is a little late, but it might help for future issues.

I work in correctional health care which has to have patient care protocols. We can't have prescription medications on our protocols, but you could tweek them to meet your needs. I am betting your DOH wants more assessment info documented as to when to give the meds, but you never know with the DOH. We have them for everything from athletes foot to amputations and everything in between.

I have attached the file for "BITES". If you need more, PM me. I would be glad to share (since I wrote them). - Cristi

Bites.doc

nightingale, RN · Oct 20, 2004

Wow, Cristi, that is a great sheet!

I have not done Camp Nursing recently, otherwise I would ask for more of your sheets, perhaps someone else will ask for them.

Thanks for posting that!

CCHP-RN · Oct 20, 2004

Thanks!! If you ever need any of them, just email me @

[email protected]

BeenThereDoneThat74, MSN, RN · Oct 21, 2004

I wish I would have had that last year!! Being a peds heme/onc nurse, I was kind of clueless as to the environmental problems, but I knew exactly what to do with the asthmatic!!

tridil2000, MSN, RN · Dec 22, 2004

I know this is a little late, but it might help for future issues.
I work in correctional health care which has to have patient care protocols. We can't have prescription medications on our protocols, but you could tweek them to meet your needs. I am betting your DOH wants more assessment info documented as to when to give the meds, but you never know with the DOH. We have them for everything from athletes foot to amputations and everything in between.
I have attached the file for "BITES". If you need more, PM me. I would be glad to share (since I wrote them). - Cristi

christi-

that's a great sheet but i'd add to the priority assessment...

has the pt had a previous anaphylaxis reaction before?

to what? when?

and add

administer epi pen immediately.

you just have to go with potecting the airway always first. a known history of anaphylaxis is the best indicator that the patient needs epi stat.

also, you have 'elevate the limb' of a snake bite. this encourages the venom to reach the lymph system and enter the main venous circulation quicker, hence cuasing more potential damage. with snake bites, or spider bites etc, you should keep the limb in a neutral position.

trish

hmcna · Mar 13, 2005

You have oxygen at your camp?!? Also, do you mean IV Benadryl?
The criteria listed above is similar to the standing orders we have (without the 02). But the DOH said it wasn't good enough.
Who 'writes' your standing orders?

We've had oxygen at both the summer camps i've worked at over the last few years....

I wrote my own standing orders.... reviewed them with the camp director, and then had the camp dr review and sign them..... in 2 out of 3 camps.