Ethical question-WWYD?

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Specializes in orthopedic/trauma, Informatics, diabetes.

This is NOT a hw question. It is an actual thing that happened:

I might should have put it in school nurses, but this could happen anywhere I guess. A person (not a child) is having a severe allergic reaction to something they did not know they were allergic to-having trouble breathing, etc. Person does not have an epipen but a parent who has a child with a severe allergy has one one their person. 911 has been called. Nurse has to decide whether to give someone else's epi to person.

Would the nurse lose his/her license for giving the epi? Do you let the non-nurse bystander give it? Wait for 911 and hope the person lives?

I think this episode has prompted the schools to have epi on hand in case of a new onset anaphalaxis, but I thought this was interesting case.

I have to carry glucagon for my T1 son. I don't know what would happen if I gave it to someone unresponsive d/t hypoglycemia.

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That's a tough one.

You would essentially be giving someone a prescribed medication at the wrong dose, to someone without a prescription. (Out of your scope)

You can't advise a lay person to give a prescription med to another person without a prescription. (Out of your scope)

Ems has been notified and are en route? I wouldn't give the Epi.

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Your child was prescribed glucagon and instructions provided by their doctor.

It would be out of your scope to give glucagon to another person.

I know this sounds silly, but way down deep in the legality of it, if you give medications without md order, you are acting as a physician and if you dispense, you're acting as a pharmacist.

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Specializes in orthopedic/trauma, Informatics, diabetes.

I don't know if epi is a standard dose, I have actually never had to give it. Glucagon is a standard dose. I supposed I could not physically restrain another person from giving their epi to someone in distress, but I bet there would be legal ramifications for that person, if not me, too.

I think what ended up happening was that 911 got there in time, but I am glad I was not that nurse.

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Specializes in critical care, ER,ICU, CVSURG, CCU.

non lis. folks have broader protection in "good samarriton umbrella" than we do....

great question

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Honestly?

It would really depend....if EMS is coming and they aren't blue no. If they are turning blue.....maybe. Unless I am in Timbuktu EMS is right around the corner. I don't think I would.

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Specializes in Oncology.

I've been in almost this exact situation. I was volunteering as a camp nurse. A staff member stepped on a bee hive and sustained dozens of stings and started having total body swelling and some trouble swallowing. I loaded her up with Benadryl and called 911. A camper had an epipen two pack. Had I needed to, I would have used it and asked questions later. Thankfully, she was stable until transport. Even at the hospital she was not given Epi, just antihistamines and steroids.

i would also have no problems using glucagon on a known diabetic who is unconscious.

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I would wait for 911, when I took a safety and first aid class as an elective, it was stressed never to give medications to someone other than who it's prescribed to. Was 911/ems still on the line at that point? I would have asked them if it was an option

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Specializes in Oncology.

People in severe anaphylaxis can lose their airway in 30 seconds. Average EMS response time in an urban area is what? 4 minutes? Epinephrine is a standard dose. Auto injectors are near impossible to use incorrectly, and when they are, they're used in a way that results in an under dose. The dose of Epi in a pen is less than what your body can naturally produce in a fight or flight scenario. Epinephrine has NO contraindications in treatment of anaphylaxis.

I wouldn't be able to live with myself if I watched someone suffocate in front of me with the tool to stop or slow it at my disposal.

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Specializes in Oncology.

Also, if someone died of anaphylaxis in front of you, you don't think a jury would find a way to make you liable? Versus the chance of liability giving a med with essentially no chance of long term adverse effect?

Interesting article that hit my inbox last week.

http://www.medscape.com/viewarticle/838198?src=wnl_edit_specol&uac=107312PG

Further, it's been discussed here many times, but off duty nurses usually are covered by Good Samaritan laws.

Good Samaritan Laws — Do They Cover Nurses? | Notes from the Nurses' Station

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Specializes in orthopedic/trauma, Informatics, diabetes.

My issues wasn't with Good Samaritan issues, although I don't know how far the scope goes. It was more about administering a medication not prescribed for that person. I could not live with myself if I didn't give the epi and harm was done.

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This person never lost their airway, but had that been imminent and EMS was still minutes away then I would give the epi.

For those that wouldn't give it because it belonged to a bystander, would you perform an emergency trach to save someone?

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