I am second guessing myself again! Would like opinions, pro or con. This is the scenario........ middle school student ingests a known allergen. I work 2 schools, middle and prek-5. They are approx. one minute from each other by car......
12:40- student brought to my office at m/s, c/o throat tightness, hard to breathe, etc. I did not know this student had allergies, and I KNEW FOR A FACT that I did not have any meds for him there. call dad to verify.... So I pop him in my car and fly to E/S. (where I have an abundance of meds)
12:50- administer 10 mls of Benadryl (which btw I do not have an order for)........ wait a few minutes to see if relieves symptoms, no it does not....... the student is not starving for air, however his throat is swollen. i make the decision to give epipen (which I never had before) and call dad to let know and tell him I am calling 911.... which hospital does he prefer?
1:09- epipen given (again no order) and 911 called... they arrive within 5 minutes and access the child, he is doing well and they praise me up and down
they cart him of to the ED.......... later I found out he is doing well.
Here is my issue........ later I found out that school staff were ???? why I waited so long to call 911. I suppose to the untrained eye it does appear that way...... My ??? to you is......... would you have done anything differently? If so, please state rationale so I can learn from this....... thank you so much!
For backgrounds sake, I went straight from nsg school to school nsg, now yr 3. For reasons I will not go into, I AM THE ONLY MEDICAL PERSON at this school/district. There is NO ONE to call for advice. rdsxfn
Nov 8, '11
Phew... It's good that you want to analyze what happened. Jolie has raised some excellent points. Regarding what happened, remember Benedryl is great for a localized rxn ( I hate it that some Docs STILL insist this as an order for 1st line of defense -- research has shown it to be ineffective for a systemic rxn) , if you are seeing any symptoms that its systemic in that airway is at all compromised go to the Epi right away, as Sudsy mentioned. Regarding EMS -- their transport is better than yours. There are 2 plus providers, they have O2, and they can do quite a bit if they are ACLS.
So moving forward -- Can you get standing orders written for the future? I would also have an "oh crap" bag that you keep with you for emergencies when you are out of your office. In mine, I have emergency meds, emergency supplies, and my binder that contains copies of my standing orders, and the MD orders for my kids with known allergies.
I know that must have been a scary situation, so (((HUGS))) to you. Use it as a learning experience for how to prepare for the next time.
Last edit by MinnieMomRN on Nov 8, '11