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Ethical question-WWYD?

Posted

Specializes in orthopedic; Informatics, diabetes. Has 9 years experience.

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.

Sassy5d

Has 11 years experience.

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.

Sassy5d

Has 11 years experience.

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.

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 9 years experience.

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.

sallyrnrrt, ADN, RN

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

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

great question

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

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.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

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.

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

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

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.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

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

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 9 years experience.

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.

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?

psu_213, BSN, RN

Specializes in Emergency, Telemetry, Transplant. Has 6 years experience.

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

I'm not sure where you are going with this. Of course no nurse in their right mind would perform a trach in any circumstance--let alone "in the field" (I'm guessing even a physician who is trained in performing trachs would not improvise to do one in these circumstances).

It's easy to say what I would or would not do here, but I don't know how I would react in that situation…I guess it depends on just how much airway trouble they are having. My inkling would be to give the Epi rather than watching the person die, but I can't really blame a nurse who is not comfortable giving the med.

Wave Watcher

Specializes in Community Health/School Nursing. Has 7 years experience.

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.

Epi-Pen doses are prescribed by weight. You have the epi-pen junior and then the regular epi-pen. If you give the regular epi-pen to a child

I'm not sure where you are going with this. Of course no nurse in their right mind would perform a trach in any circumstance--let alone "in the field" (I'm guessing even a physician who is trained in performing trachs would not improvise to do one in these circumstances).

It's easy to say what I would or would not do here, but I don't know how I would react in that situation…I guess it depends on just how much airway trouble they are having. My inkling would be to give the Epi rather than watching the person die, but I can't really blame a nurse who is not comfortable giving the med.

I was going..if you're remote from EMS (I read the OP as a severe allergic reaction in a non hospital situation) and you either do something or watch someone die, would you do anything whether trained or not at that point?

calivianya, BSN, RN

Specializes in ICU.

I would advise the owner of the epi that he/she could save someone's life right now with the epi, but I would not give it myself. I would feel horrible if someone died. I would also feel horrible if I lost my license, lost my job, and lost my mortgage. It would have to be happening to my family member or my SO (who can and would support me if I lost my job, and whom I am willing to lose my job for) for me to give it myself.

OldDude

Specializes in Pediatrics Retired.

I answer to and have been taught about life by a higher "Authority" than the Nurse Practice Act; if you know WHO I mean. Morally, I could not stand by and watch someone die because I was afraid of losing my nursing license or some type of litigation. I would utilize everything available to me if I thought it would help save a fellow human being and let the chips fall where they may.

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine. Has 8 years experience.

Been there, done that (my Epi Junior, which is standard dose delivery device for children before age of 12, for a child of 10 stung by a bee in the middle of a national park trip; the child swell beyond recognition in minutes, was getting blue and was obviously losing airways). It took EMS good 3/4 of an hour to get there, and the first thing they did was second shot as the first one was weaning off and kid started to lose pressure.

Got many, many thanks from EMS people and later call from hospital, nothing too bad happened. Mom was thankful as well. No other questions was asked.

When something as bad and dramatic as REAL anaphylaxis happens, the last thing one usually thinks of is theoretical legal consequences of the action which, with rather high probability, will save that human being's life. We all know too well here that one will break the victim' ribs by doing high-quality CPR, that aspirin does severe side effects. Should we, therefore, pay no attention and do nothing above the phone call if we see someone suddenly complaining on severe chest pain with associated symptoms of heart attack instead of offering him or her that 325 mg of aspirin recommended by American Heart Association, and run away when the person collapses instead of starting CPR?

It would be an ideal situation to live in world where highest-level medical assistance available everywhere within 5 min or so, but it is not like this everywhere. That's why I carry Epi Junior in addition to my adult version.