Allergies and running codes

[usetimewisely]

Ok, so lately, I have been struggling with how to be prepared if I ever have to run a code on one of my patients. I do a good job with learning their history, and reporting changes during my shift. But, in a true code, how to you address a patient's allergies? Especially when they have a list a mile long! I feel like I'd be the thorn in everyones side since I'd be afraid to push meds that have been ordered, but not reviewed and cleared by pharmacy. To me, that's an extra safety step I'm skipping if I just pull it out and give it like I've seen others do. On the other side of things, maybe they are just that familiar with the drugs, while I still have to look up stuff with my scheduled med pass. How do you handle pushing meds with patient allergies?

[akulahawkRN, ADN, RN, EMT-P]

If you're that worried about it, I would suggest taking a look at the code meds you might push during a code and cross-reference them with the patient's allergy list. If you find a match, make sure you know which med it is and if that med is called for in a code that you're participating in, make sure that the team knows the patient's allergic and be ready to suggest an alternative that's used for the same purpose and is available on the crash cart.

More likely, you won't have to worry about allergies. If you get ROSC and the patient is allergic to something that was pushed, they'll probably treat for anaphylaxis at that point. I'd be much more worried about allergies while the patient still has a pulse than if the patient doesn't have a pulse.

[schnookimz]

If they're dead, you can't make it worse. :)

[MunoRN, RN]

It's good to think safety first, but remember that patient safety is still a balance between risk and benefit.

The most common code drug, epinephrine, is an endogenous chemical and isn't really possible to have a true allergy as it isn't complex enough to trigger an antibody/antigen response. There are various other drugs used which might carry a risk of reaction, but keep in mind how anaphylaxis is usually treated; with epinephrine, which you're likely giving anyway as part of the code. The other concern would be airway, and some form of airway protection is usually part of a code.

While I hear your concerns, it would seem very unlikely that the potential delay would be more beneficial than simply giving the drugs as indicated.

[ChristineN, BSN, RN]

It is very unusual a pt would be allergic to a code medication. I would be more mindful if they have a latex allergy, as if you have to place a Foley or central line there could be latex in the supplies.

I have been part of a code where a pt went into cardiac arrest from sudden bleeding. We were giving 1 unit of blood every 5-10 min without regards to any possible transfusion reaction because at this point the risks vs benefits of running the blood slower wasn't worth it.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I'm an ER nurse and I frequently don't even have a name on my codes, much less a history or list of allergies!! I agree with all the previous posts, you code a pt because they're dead,..give the meds!!

[vampiregirl, BSN, RN]

Another thing to consider is that some (or in some cases many) of the medications that are listed as allergies are meds that patients encountered side effects with - and in some cases expected side effects.

I had a patient once report an allergy to benadryl. When I asked what s/s she experienced after taking it, she reported it made her sleepy...

I agree with the previous posters comments...

[usetimewisely]

Ok, thanks yal. Helps me quite a bit. I call myself mentally preparing for a code as the primary nurse. I think I'd feel better if I could do a mock code. Where I work, we don't do those. So, on to the next best thing, I use my imagination. Now that I've read these responses, my question seems a little silly now. But....it was answered! So thanks again!

[akulahawkRN, ADN, RN, EMT-P]

Ok, thanks yal. Helps me quite a bit. I call myself mentally preparing for a code as the primary nurse. I think I'd feel better if I could do a mock code. Where I work, we don't do those. So, on to the next best thing, I use my imagination. Now that I've read these responses, my question seems a little silly now. But....it was answered! So thanks again!

Please don't consider your question silly at all, after all, you asked the question instead of simply wondering about it. Good for you!!!

[BuckyBadgerRN, ASN, RN]

I worked in dentistry for many years before returning to nursing school. If I had the proverbial dollar for every person that told me "I have to have the 'novocaine' without the epinephrine b/c I'm allergic to it", I'd have no nursing school debt! My standard response was "you do know that your body is producing natural epinephrine as we speak, right?"

It's good to think safety first, but remember that patient safety is still a balance between risk and benefit.

The most common code drug, epinephrine, is an endogenous chemical and isn't really possible to have a true allergy as it isn't complex enough to trigger an antibody/antigen response. There are various other drugs used which might carry a risk of reaction, but keep in mind how anaphylaxis is usually treated; with epinephrine, which you're likely giving anyway as part of the code. The other concern would be airway, and some form of airway protection is usually part of a code.

While I hear your concerns, it would seem very unlikely that the potential delay would be more beneficial than simply giving the drugs as indicated.

[BuckyBadgerRN, ASN, RN]

I was an EMT for 20 years and will always remember the call for a LOL with chest pain. Her neighbor was there, who was a nurse (yes, an actual licensed RN). We explained our protocol for giving nitro and the RN/neighbor jumped in and practically screamed at us "NO! She's allergic to nitro, do NOT give that to her!!". We asked what happens if she takes nitro? The answer? "she gets a headache and her ears ring". Hand to God.

Another thing to consider is that some (or in some cases many) of the medications that are listed as allergies are meds that patients encountered side effects with - and in some cases expected side effects.

I had a patient once report an allergy to benadryl. When I asked what s/s she experienced after taking it, she reported it made her sleepy...

I agree with the previous posters comments...

[martymoose, BSN, RN]

I

The most common code drug, epinephrine, is an endogenous chemical and isn't really possible to have a true allergy as it isn't complex enough to trigger an antibody/antigen response.

I once had a pt who said they were allergic to epinephrine. They said it made their heart race.

Duh.