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gypsyd8, MSN 10,420 Views

Joined Nov 28, '07. Posts: 281 (62% Liked) Likes: 620

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  • Sep 7

    Where is the North American research showing that the method shown in the video is a safe way for lay people to store and use epinephrine? Was the method approved by any pharmacists?

  • Sep 7

    There are a greater number of things that can go wrong though...1. Contamination, 2. The whole set is less sturdy...the auto injector is designed to be held to your thigh but can take a hit if a panicked person uses it, a pre fill you do yourself probably won't. 3. Needle size, depth, etc..also damage...
    there is a reason why auto injectors are so popular. They work well. They are easy to use. They are safe in your purse or pocket..even for kids.
    With the concessions being made in the face of the backlash, I feel that others out there are already moving to produce other products. A quick scroll through Google shows dozens of auto injectors for sale at about 40.00 that can be pre filled with any med...and are much safer to carry around.

  • Sep 7

    As a person who has used epi pen and the draw your own method...when in the middle of an attack ( allergy to shellfish) there is no calm and safe time to think about how to do the steps for filling a dose, and in a pre filled case, readying a needle. This is why the auto injectors are so useful and why they are recommended. When you are struggling to breath, there is very little going through your head other than...OMG I can't breath! To expect a lay person to complete an injection, in those circumstances, is asking a lot. IMHO the manufacturers of Epipen, should be regulated, or another competitor found. However that needs to be done. The auto injector is used so widely because it works and saves lives.

  • Sep 7

    Quote from traumaRUs
    Pre filled syringes are ok provided you follow certain precautions

    http://www.wildmedcenter.com/uploads...pinephrine.pdf

    The stability and sterility of epinephrine prefilled syringe. - PubMed - NCBI

    Hope these articles help to clarify this issue

    As I said, our EMT basics now draw up and administer epi 1:1000 as a matter of course. Having pre filled syringes in the household requires care just as being and insulin dependent diabetic requires caution around children.

    The only comment I would add would be to include the date of filling of the syringe so that it doesn't lay around too long prior to use


    Many if my pts have their families pre fill their insulin because they can't see the syringe and the click pens are too expensive. While not in use in the heartcare setting, home use is another venue.
    Studies from Thailand won't be helpful in the event of a liability case, it is more likely guidelines from American experts such as the National institute of Allergy and Infectious Disease NIH Gov would be used and their guidelines advise using an auto-injector for management of out of hospital anaphylaxis.

  • Sep 7

    If I were you I would pull the video until my malpractice insurer had assessed the video for liability concerns and my lawyer had assessed if the image of Epipen on the video is copyright infringement.

  • Sep 7

    Safety concerns that I had with the video are; storing a pre-loaded syringe in a toothbrush holder is a safety hazard if a young child gets their hands on it. There was no discussion about chemical stability and deterioration with exposure to air or light or what it looks like if it has deteriorated or expired and should not be used.

  • Sep 7

    Suggest you show the video to your malpractice insurance provider to see if they have any concerns regarding liability. I missed some of the instructions because the audio was difficult to hear during the demo.

  • Sep 7

    Mylan has agreed to waive the copay for nearly everyone for whom EpiPen is prescribed. This looks like it could be a recipe for disaster if a mistake is made, and a legal liability to you for suggesting it can replace an EpiPen.

  • Sep 7

    Some of the benefits of the epipen is that it comes in kit form so you either lose all or none of it. Another benefit is that an untrained person could read the directions and hopefully administer it if the person goes unconscious. Another consideration is in my area, EMT-Bs can use the epipen but they are not trained to draw up meds. That falls under EMT-I/advanced-EMTs/specialists/whatever they are now and paramedics.

  • Jun 24

    Quote from mlowell20
    Stupid new nurse question.. Why do you need a 10cc for a picc? Is that just what fits??
    Anything less than 10 cc has to much pressure and can damage line.

  • Jun 21

    This is really a very interesting subject, and it all hinges on how you define nursing. Actually, I used to develop these types of systems as a consultant & it paid very well.

    Most 'acuity systems' are simply laundry lists of tasks -- like the one outlined by a previous poster. These tasks certainly add to the workload, but they don't completely reflect the work of nursing.

    Workload and Intensity are actually 2 separate issues when it comes to staffing. You can have a 'high task' patient (comatose) but most of the the work could be handled by a nurse assistant. On the other hand, you could have a new diabetic - completely ambulatory and self care, but with extremely high teaching and emotional support needs - high intensity - that requires a LOT of RN time.

    Of course, acuity systems also fail to account for the ADT 'noise' (admissions, discharges & transfers) that are very time consuming. We all know you can start & end the shift with 4 patients, but the ones you ended up with are not the ones you started with!

    All in all, I don't think that there is any task list that can replace good old nursing judgement. I am a proponent of 'prototype' acuity systems that consider both workload and acuity. But they need to be coupled with additonal workload attached to the ADT.

    It's no wonder that so many hospitals have just given up and rely on ratios.

  • Jun 6

    I hate the pledge (Nightingale and of Allegiance) because both feel like indoctrination and mindless subservience.

    When I was a school teacher, I never made my students stand during the morning pledge recitations (both to Texas, which recently added under God as well, or to the USA) unless it was something they felt personally compelled to do. I myself never stood. I don't have to prove my patriotism to anyone.

    During my LVN pinning, we weren't told about the Nightingale pledge recitation until pinning rehearsal, and I was beyond pissed. I recited it because I felt pressured to do so and because I'd already been overruled in terms of venue when the ceremony was held in a church. I had to listen to an invocation and a benediction, standing in a Christian church, and recite something I found personally offensive. Recitation of this pledge is just one more in a multitude of ways southern education continues to skirt the separation of church and state.

  • May 27

    I'd be classified as a Millennial according to this piece since I was born in '81. I feel older than the typical person who belongs to the Millennial cohort due to being in my mid-30s, but anyhow...

    Although I'm very computer-literate, I didn't grow up with a computer in the household. I'm also a team player, but far from enthusiastic about the concept of work. I also lack any morsel of dedication to the workplace itself. Let me rephrase that: I will never be loyal to an employer.

    You see, I was 20 years old when Enron collapsed in 2001. The masses of upper middle-aged Enron employees who lost their retirement savings due to misconduct from upper management did not benefit from their profound loyalty to the company. That news story had an impact on me.

    I am a team player, but work is not the most important aspect of my life. It never will be. I will never give my all to a workplace, only to be steamrolled in the end.

  • May 20

    The day started out normally enough: come into work, get my assignment, and start preparing my OR. I didn’t need to move in right away; while we normally move patients into the OR around 0700, my patient wouldn’t be moving in until 0800. And so, when the trauma code was called overhead at 0654, I was called upon to scope out the trauma bay.

    I headed down to the ER, expecting the usual car accident, stabbing, or shooting. Well, it was a car accident all right, but certainly not the usual. A young woman, on her way to work, struck head on by a drunk driver. Yes, before 7a.m. But the heartbreaking part was that this woman arrived with the CPR device compressing away, her obviously pregnant belly bouncing in sync with the compressions. The baby was in obvious distress, and there was no time for transfer to the OR or to wait for an OB to arrive from maternity, four floors away. The trauma surgeon did an emergency C-section, right there in the trauma bay. Suddenly, we had not one but two trauma patients. And both were coding.

    Baby boy was intubated and gradually his color improved, although respiratory function, heart rate, and pulse ox remained well below norm. He was sent to a nearby children’s hospital NICU, with many crossing their fingers and saying a prayer that he would make it.

    We never did get mom back. We tried drugs, we tried external pacing, we tried every trick in the book. All without success. We did what we could to get her incision closed and cleaned up for family to see.

    We all heard the husband/father arrive. The wails as he was told his wife didn’t make it, the sobs as he was walked into the trauma bay and sank to his knees. Every single person in that trauma bay was crying right along with him, even those known as the crusty old battle-axes who have never openly shed a tear.

    I’ve cried over patient situations and deaths before, but always privately and usually in my shower at home after a hard day at work. But this was a situation where I couldn’t hold it together, and I was certainly not alone. This was one of those traumas that will likely haunt many involved for the years to come.

    Many healthcare employees are involved in events in the workplace that can lead to traumatic stress brought about by strong emotional responses (Vaithiligam, Jain, & Davies, 2008). In light of these events, hospitals should provide support to involved employees. Many offer an Employee Assistance Program (EAP), but is an EAP always enough? Employees may be reluctant to contact the EAP if they fear their employer will find out they have sought mental health help.

    My facility goes beyond the EAP and provides critical incident debriefings when deemed warranted or if staff request a debriefing. The most recent was after a sudden onslaught of more than a dozen heroin overdoses that led to poor survival rates and several becoming organ donors. I am sure there will be one to follow today’s events.

    Debriefing allows those involved in a traumatic event to process it, vent emotions, and address potential physical or emotion harm that may result from the experience (Davis, 2013; Vaithiligam, Jain, & Davies, 2008). A timely debriefing that occurs within 72 hours of the precipitating event can reduce short- and long-term crisis reactions and psychological trauma (Davis, 2013). Healthcare employees can greatly benefit from the option to attend a critical incident debriefing. Does your facility provide this crucial support?


    References

    Davis, J. A. (2013). Critical Incident Stress Debriefing From a Traumatic Event. Psychology Today. Retrieved from https://www.psychologytoday.com/blog...raumatic-event

    Vaithiligam, N., Jain, S., & Davies, D. (2008). Helping the helpers: Debriefing following and adverse incident. The Obstetrician & Gynaecologist, 10, 251-256. doi: 10.1576/toag.10.4.251.27442

  • Apr 27

    Student Advantage is not a "federal" program. At least here in Michigan everybody uses Certified Background which uses their own certified labs like Quest. Unfortunately, this factor alone will not solve the problem. Even moving across the country may not solve the matter because the OP will have to answer all these ubiquitous "name ALL the colleges you'd ever attended" and the likes.

    If OP is absolutely adamant about eventually doing nursing, one workable (though long) way is to get entry level non-nursing degree or certificate. The choice is wide from commercial CNA or MA schools to undergrad in PT, OT, speech, laboratory and the like. Most of these degrees require clinicals, but many, especially for-profit schools, have ridiculously lax requirements. After going that and working for a while the OP will be able to start "direct networking" in order to personally convince a school that the whatever could be dug up from the past can be safely overlooked. If not successful, the OP will get real work experience and exposure to dozens of other health care occupations not less interesting and less restrictive than nursing.

    IMHO, the situation like described is a pretty good illustration why MJ must be legalized and accepted yesterday. I do not (and physically cannot) use it, but seeing a talented young woman whose life was won in years-long battle against cancer doing social work (which she hates quietly) instead of nursing (which she dreams of) ONLY because she literally has choice between Marinol every day and TPN for unknown length of time is heartbreaking. It is just so plain wrong.


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