This really stuck out to me because so many docs write for me to give Benadryl first:
Quote
American Academy of Pediatrics (AAP) made it absolutely clear in their clinical report entitled “Epinephrine for First-aid Management of Anaphylaxis” published this February: Give epinephrine immediately when anaphylaxis is suspected.
What about the role of Benadryl and other antihistamines? Aren’t you supposed to administer those first?
No. The report clarifies the use of antihistamines as well:
H1-antihistamines prevent and relieve itching and hives but do not relieve life-threatening respiratory symptoms, hypotension, or shock; therefore, like H2-antihistamines and glucocorticoids, they are adjunctive treatments and are not appropriate for use as the initial treatment or the only treatment.
Specializes in ICU/community health/school nursing.
8 hours ago, SchoolNurseK said:
Looking back, there were several times with my own son that I should have done epinephrine instead of giving the benadryl and watching him. I even once drove toward the hospital "just in case" and now I am wondering what I was even thinking!?!? Anyone else seem to have a block of nursing judgment when it comes to your own children?
No block. Not at all. You were told that Benadryl came first for a mild reaction. The problem is that "mild" reaction today is progressively more severe next week/month/whenever.
The fact that you drove toward the hospital indicates to me your nursing judgment was working just fine!
I just had a parent request that I administer PRN Zyrtec for a preschool kid with an anaphylactic peanut allergy "if she just has mild hives." I don't even want to know if a doctor ordered that, and I certainly don't want to give it and then sit there for however long I'm supposed to sweat it out to make sure the reaction truly is just "mild hives."
I just had a parent request that I administer PRN Zyrtec for a preschool kid with an anaphylactic peanut allergy "if she just has mild hives." I don't even want to know if a doctor ordered that, and I certainly don't want to give it and then sit there for however long I'm supposed to sweat it out to make sure the reaction truly is just "mild hives."
I have had multiple people tell me that this is what their allergist told them to do... feels wholly unreasonable to me. When has claritin or zyrtec ever worked quickly? I have to take zyrtec every day to keep my environmental allergies in check and if I miss a day or two, it generally takes 7-10 days to take effect again....
I have had multiple people tell me that this is what their allergist told them to do... feels wholly unreasonable to me. When has claritin or zyrtec ever worked quickly? I have to take zyrtec every day to keep my environmental allergies in check and if I miss a day or two, it generally takes 7-10 days to take effect again....
Agreed. I have only seen this once on an allergy action plan and did clarify with doctor on it (ended up switching it to benadryl for the school orders).
I will say this about Epi and what I say to all my teachers during training: You will NEVER regret using an Epi-pen. You may regret not using an Epi-pen.
I have had multiple people tell me that this is what their allergist told them to do... feels wholly unreasonable to me. When has claritin or zyrtec ever worked quickly? I have to take zyrtec every day to keep my environmental allergies in check and if I miss a day or two, it generally takes 7-10 days to take effect again....
Zyrtec and allegra do take a period of time to become effective - that's why I don't administer them during school hours at all, unless a parent forgot to give in in the AM and they bring me one tab to give for the day. Also, allergy meds like Zyrtec and allegra can act as "uppers" on some and "downers" on others - like make them jittery or drowsy. And I'm not about to try to GUESS which reaction I'm going to get!
So last year I had a student who had an allergic reaction to an unknown substance. I gave him Epi and parent came to take him to the ER. I had given them 15 minutes to get here or I'd call ems, they made it plenty of time. I told the child's dad that he needed to go to the ER and that he looked better for the time being, but could have a secondary reaction. They did not heed this and instead went to the pediatrician, where he proceeded to go into anaphylaxis again in the waiting room. Felt bad that the kid had to go through that, (and only a little bit of "I told you so")
Zyrtec and allegra do take a period of time to become effective - that's why I don't administer them during school hours at all, unless a parent forgot to give in in the AM and they bring me one tab to give for the day. Also, allergy meds like Zyrtec and allegra can act as "uppers" on some and "downers" on others - like make them jittery or drowsy. And I'm not about to try to GUESS which reaction I'm going to get!
My son has ADHD and seasonal allergies. Claritin wasn't covering his allergies in the Spring, so we switched to Zyrtec and OMG it completely eliminated the effect of his ADHD medication. He was so hyper and restless, it was terrible.
I have 1 student with a Claritin order for allergic reaction (with epi, not on its own) because he also has a seizure disorder and benadryl lowers the seizure threshold.
So last year I had a student who had an allergic reaction to an unknown substance. I gave him Epi and parent came to take him to the ER. I had given them 15 minutes to get here or I'd call ems, they made it plenty of time. I told the child's dad that he needed to go to the ER and that he looked better for the time being, but could have a secondary reaction. They did not heed this and instead went to the pediatrician, where he proceeded to go into anaphylaxis again in the waiting room. Felt bad that the kid had to go through that, (and only a little bit of "I told you so")
Yuck. I'm glad they at least went to the doctor vs just home...
But this is why I added the line to the health section of our handbook that says "if an Epi-pen is used on a student, EMS will be called immediately." I also have that built into my general Allergy Action plan. I don't care how fast you can get there. Sure, I have orders to give a second Epi pen (but teachers don't), but I'd prefer if EMS did that. I call them after calling EMS to say that I've given your child Epi and we will meet you at [insert hospital of your choice within my city].
Now if they beat EMS there and decline the ambulance straight to EMS, can't do anything there. But EMS usually makes it <6 minutes. I've never had a parent get to school that quickly ;).
One can never be wrong giving the epi first because for any subsequent drugs to work, the blood pH must be near normal. The acidosis of shock syndrome must be treated first. I don't know how you school nurses do your job out in the field without a drug cart:)
One can never be wrong giving the epi first because for any subsequent drugs to work, the blood pH must be near normal. The acidosis of shock syndrome must be treated first. I don't know how you school nurses do your job out in the field without a drug cart:)
Yuck. I'm glad they at least went to the doctor vs just home...
But this is why I added the line to the health section of our handbook that says "if an Epi-pen is used on a student, EMS will be called immediately." I also have that built into my general Allergy Action plan. I don't care how fast you can get there. Sure, I have orders to give a second Epi pen (but teachers don't), but I'd prefer if EMS did that. I call them after calling EMS to say that I've given your child Epi and we will meet you at [insert hospital of your choice within my city].
Now if they beat EMS there and decline the ambulance straight to EMS, can't do anything there. But EMS usually makes it <6 minutes. I've never had a parent get to school that quickly ;).
honestly, I don't remember if I called EMS and the parent refused to them or if they said that they would be right there and were. My go-to is to give Epi, call ems. I can't imagine I deviated from that, but I may have, knowing that the parents were home and 2 blocks away.
Question as I'm still only in my second year. We had a child come into my office with the entire side of her face swelling up. Ironically, the parent was on her way to deliver meds and doc orders at time (first week of school). Kid was calm and as I was about to get epi ready (standing order), mom came in and gave her benadryl which worked within two minutes. Her mom said that always does the trick....and took her home! So...I have both epi and benadryl here for her. Should I have done anything differently? I apologize for a stupid question.
ruby_jane, BSN, RN
3,142 Posts
No block. Not at all. You were told that Benadryl came first for a mild reaction. The problem is that "mild" reaction today is progressively more severe next week/month/whenever.
The fact that you drove toward the hospital indicates to me your nursing judgment was working just fine!