Ethical question-WWYD?

[mmc51264]

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.

[psu_213, BSN, RN]

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]

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

[Libby1987]

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]

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]

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]

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.

[Barnstormin' PMHNP]

I was first on scene at an accident last week and it took EMS 20 minutes to get there, just sayin'....

If the Epi was dosed correctly and they had lost their airway, yes, I would give it. As far as emergency trach, yep, I would do that too if I had to. I say this because my son had severe Croup until he was 9 and we lived 20 minutes out from the hospital and EMS would take an hour to get here (if they could even find it). I researched it and had a plan what to do if I couldn't keep his airway open. I vividly remember sitting on the front porch watching him suffocate with his tongue protruding but he was able somehow to get enough air in and fearing that the time had arrived to do it. They finally gave us an Epi pen for those wonderful events.

So I guess the short answer is I would do what was necessary, using good judgment. (universal principles of nonmaleficence and beneficence )

[Libby1987]

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.

i actually don't believe many nurses would weigh out the legal risks in a real life threatening anaphylaxis situation. OP didn't seem to reach that point though.

I only have the basic training so it would be very frightening to me, but if somone were going down and I suspected the cause, or it was obvious, getting sued for trying to help probably wouldn't cross my mind. I would think lack of attempt with death as the outcome would be more of a legal problem.

[ohiobobcat]

I am a school nurse. We carry stock epi-pens and I am covered by standing physician orders to administer an epi-pen to any individual experiencing anaphylactic symptoms in the school setting.

Outside of the school setting, I would have a hard time not giving available epi to someone who was clearly in anaphylaxis. That's a tough call.

[dheath17]

Giving Glucagon to a pt with HYPOglycemia would be a correct action. Even if the person has HYPERglycemia you would be safe to give the glucagon because a blood sugar of "0" will definitely kill the patient whereas a high BS can be treated afterwards with insulin.

[KatieMI, BSN, MSN, RN]

I have severe allergies, used Epi countless times and know that one appropriate for age SQ dose can kill only someone with heart/main vessels already in pretty bad shape. So I was not that scared, and there was no other person around who knew what and how to do. I probably hesitate a bit more if the kid had a big scar on his chest, to my luck, his mom was near and, by her, the kid was healthy.

Apart of that, the child was going to die for sure in front of 50+ adults. I knew that one chance for him to live was sitting in my purse, so I used it.

[psu_213, BSN, RN]

As far as emergency trach yep, I would do that too if I had to.[/quote']

I could see myself giving epi without a doctor's order, in the field, if someone had severe airway compromise. I could never imagine doing an emergency trach (or watching another nurse perform one). Sure I could make an incision in someone's trachea and shove something in there…however, to do it correctly requires certain anatomical landmarks that a provider must identify to avoid nicking a vessel or severing a nerve. While nothing may happen to you or your license by giving epi, you are most definitely putting your license (and you house, car, etc.) on the line by perfuming a trach. No matter how great your intentions are, and no matter how many ethical principles guide your decision, you are not going to be protected from the BON, lawyers, etc. when things go wrong (and they most likely will).