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.
To echo what some of the other commenters said ... I'm a school nurse, and if a student is clearly anaphylactic and I don't see EMS coming through the door, I would have no qualms about using another student's Epi (but thankfully, I have stocked Epi too.) I could live with losing my license---yes, it will be awful. Yes, my family and I would find ourselves in sudden financial trouble. But we will find a way, and we will overcome it, and knowing that I'm in this position because I tried to or did save a life will console me.
I could never live with knowing that someone died because I didn't act out of fear of losing my license or my job. What is legal and what is right aren't always the same thing.
There was a nurse in a nearby district who was fired because she used another student's albuterol nebs on an asthmatic clearly in distress who did not have their own meds. The parent of the child she saved, the parent of the child whose medications she used, AND the physician of the child she saved all wrote letters to the district expressing their gratitude for what she had done, and pleaded with the district not to fire her, but they did anyway. I don't know if the BON took any action on her license. Very tough situation, but I would've done the same.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I have been in this EXACT situation. I gave one kid's epi to another kid who was quickly headed to full blown anaphylaxis. This was at a boy scout camp and it was going to be about 60 min before we could even call EMS (we were on a hike and far from the camp, no cell coverage) and given the distance my estimate was a 30-40 min EMS response time AFTER we called.
It was the right thing to do, I was convinced at the time the kid would have died without it. How there could be an ethical concern about this I don't know.
Since then I carry my own epi pen in my medic bag.
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.
Exactly.
In worst case scenario:
If the situation gets to a point where a person is cyanotic and having difficuty breathing, we all know what the outcome is going to be (eventually). If I was with a person experiencing symptoms that I know are going to cause their death within a matter of minutes, I'm going to do any and everything in my power to help them. If you don't know exactly how long until EMS arrives and you choose not to intervene, you are surely going to end up with a pulseless, non-breathing person and then have an even bigger problem on your hands. Not to mention the survival rate for out-of-hospital cardiac arrests is poor so the person's chances for a successful recovery tank.
I could not live with myself knowing that I let someone die because of my fear of getting "in trouble". In line with the above poster, I do feel that one day I will have to answer for my choices/actions....and it's d*** sure not going to be the BON.
To add....I said I would do anything in my power, meaning anything I am capable of.
I am capable of giving someone an injectable medication. I AM NOT capable of performing an emergent tracheostomy and would not attempt this as my chances of causing more harm (or killing) the person would be too great.
I surely wouldn't want someone who's untrained at it slicing my throat and trachea open.
(And I say this as someone who has first-hand experience with severe SOB which lead to complete respiratory failure, vent support, etc. Even with the sheer panic of SOB, I would have been horrified if the arriving EMS providers decided they were going to try to do a tracheostomy on me )
As a school nurse, I am lucky to have stock epi-pens and standing orders from a doctor to administer if someone presents with symptoms of severe allergic reaction, but if I didn't have the stock pens and someone was in so much distress I felt they would die, I would use another person's prescription and worry about the consequences later. As far as performing an emergency trach, there is no way I would be capable of doing that correctly, so I would never even attempt it.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
For those that wouldn't give it because it belonged to a bystander, would you perform an emergency trach to save someone?
I WOULD have given it and yes I would preform an emergency cric if it meant I could save a life. I was trained to do them as an army medic and in a last ditch attempt to save a life I would do it.
I would give it if they had no airway. I'm sure the first thing EMS will do is give epi. Any on this board, or are you all hiding in the emergency discussions?
I think having stock epi as allowed by state regs, makes me more comfortable in giving it when it appears or is evident that someone is having an anaphylactic reaction.. I do get squirrelly though, using someones elses. What if THEY have an emergency? How do you justify having used their meds and putting them at risk?
It is an ethical dilemma and having taken an ethics class and working my my way through the whole process, I think that meeting the greater good trumps the potential fallout.
Some days I just wanna be a romance novel writer.....
I am a member of a rather large support group for people with severe allergies and as far as I know most of us carry "double" supply of two adult doses plus two Juniors just in case EMS gets late. In addition, we all know how to be extra careful and can get refill in any pharmacy. So, leaving the "legal" owner of the med without protection should not be a great concern
If the person's airway was closed and EMS wasn't there? Yep, I'd give it. Death vs. license? I think I'll risk the license and save the life, and beg the board for mercy later.
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.
Blondy, I would love to have you as my nurse or child's nurse. Saving a life is of utmost importance than a license. If I ever lost my license under such circumstances, I would never live with any regrets.
Specializes in ICU, APHERESIS, IV THERAPY, ONCOLOGY, BC.
This is a very good discussion I worked in W. Africa a no. of years ago and was on call for emergencies 24/7. One night I received a call where a US citizen, a woman had eaten something in a local restaurant, was experiencing a possible anaphylaxtic reaction. Conscious but difficulty in breathing, hives.. Her colleague - a non healthcare person sourced her epi pen and gave her the injection while I was on my way to treat her. REad West Africa as having very limited hospitals and health care personnel. Fortunately I arrived just as she did, I rushed her to the treatment area, I called a local doctor who had been vetted, set up O2, iv fluids, iv benadryl and steroids in our clinic with ongoing vs monitoring.
The background was that she simply carried an epi pen because she was in a 3rd world country. She did not know her specific allergy but was told by her own GP at home to carry an epi pen in case of unknown reactions because she was going to be working in a 3rd world country.. .The doctor arrived later and examined her. She did well, after careful monitoring, multiple doses of antibistamine and steroids and continued O2.
While the majority of us live close to available health care facilities, the conditions of anaphylactic reactions prompt immediate reaction. In this case her life was saved by a lay person a friend who gave her the epi pen she carried. Would we carry an epi pen so routinely, probably not unless our medical history demanded it. However we do not know when unknown severe allergies can occur '.....
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Kittery
1 Article; 172 Posts
To echo what some of the other commenters said ... I'm a school nurse, and if a student is clearly anaphylactic and I don't see EMS coming through the door, I would have no qualms about using another student's Epi (but thankfully, I have stocked Epi too.) I could live with losing my license---yes, it will be awful. Yes, my family and I would find ourselves in sudden financial trouble. But we will find a way, and we will overcome it, and knowing that I'm in this position because I tried to or did save a life will console me.
I could never live with knowing that someone died because I didn't act out of fear of losing my license or my job. What is legal and what is right aren't always the same thing.
There was a nurse in a nearby district who was fired because she used another student's albuterol nebs on an asthmatic clearly in distress who did not have their own meds. The parent of the child she saved, the parent of the child whose medications she used, AND the physician of the child she saved all wrote letters to the district expressing their gratitude for what she had done, and pleaded with the district not to fire her, but they did anyway. I don't know if the BON took any action on her license. Very tough situation, but I would've done the same.