Gave my first epi-pen yesterday...

[ohiobobcat]

Student ate a granola bar and a bag of flavored chips. Then she broke out in hives. I gave her Benadryl. Then the hives got worse. No other symptoms. I gave her more Benadryl and called mom to come get her. As mom was on her way, student started c/o shortness of breath. "I feel like there's a bubble in my chest." Epi-pen given. Called 911. Called mom again so she would know what happened and so she wouldn't panic when she saw the ambulances in the parking lot.

I worked in the ER, so I have treated many allergic reactions, but I have never actually used an Epi-pen before. I guess I can check that one off my bucket list (?!?) now.

[abc123RN]

Great job!! I have never had to use Epi at school, at least not yet. I have given to myself, bee sting, no a golf course, and no I didn't go to ER after...I finished the round. Not my best round, but at least I finished.

[MrNurse(x2), ADN]

So I will ask this question, as I have never given one either. The literature says to give it in the thigh and the video shows giving through clothing. Does the injection site have to be bare skin or ? can you really give through clothing??? With all the worry over inappropriateness, I definitely understand the necessity to inject through clothing.

[abc123RN]

So I will ask this question, as I have never given one either. The literature says to give it in the thigh and the video shows giving through clothing. Does the injection site have to be bare skin or ? can you really give through clothing??? With all the worry over inappropriateness, I definitely understand the necessity to inject through clothing.

Yes, you can give through clothing. Some of the EMS friends have reported giving through jeans. I would imagine heavier clothing would need to be removed.

[bsyrn, ASN, RN]

Awesome job! This student was very lucky to have you!

[vikivail26]

We are not allowed to give any medication unless the student supplies medication and has an authorization from the doctor. I wish we could keep a few meds like that on hand for emergencies. You did a great job!

[MrNurse(x2), ADN]

Thanks abc123RN. Felt kinda stupid asking it, but every sterile field, microbiology moment comes flooding back into my memory.

[kidzcare]

The one time I've given epi was through the student's pants. I don't remember if it was jeans or leggings or what. At that point, infection is low on the priority list. Airway is the first priority.

I remember taking the NCLEX and telling myself that on every assessment question- ABC- Airway, Breathing, Circulation. Everything else can wait.

[OldDude]

Thanks abc123RN. Felt kinda stupid asking it, but every sterile field, microbiology moment comes flooding back into my memory.

I think the gist of it hinges on the patient knocking on death's door and the time factor. If you inject through the clothing the medicine will already be working before you could unbuckle the belt or unsnap the pants; removing the clothing delays treatment. In the days of ER yore when kids would come in CPR in progress we would stick any vein we could find to get a line, with no site prep at all. If the kid lived we'd worry about infection later but that delay in administration of medicine while you clean and prep the IV site might literally be a matter of life or death. One never knows.

[Shari888, BSN, RN]

I gave my first epi-pen a few months ago. Similar situation. Child however did have a known allergy. Collapsed in class. Was awake and aware but had blue around the lips. I gave the Epi and called 911. Was impressed with how quickly it worked and the child looked much better. Paramedics came and said I did the right thing. Mom eventually comes in and goes with the child to ER. Later on complains that I should not have given the Epi and that the child was previously ill and had collapsed because of that, not because of the allergy. Now refuses to keep an Epi pen for the child in the health room and asks to be called whenever the child comes to the health room for whatever reason. Head nurse is now nervous for any of us to give Epi. The whole situation is ridiculous but the child is ok and that is the most important thing.

[kidzcare]

I gave my first epi-pen a few months ago. Similar situation. Child however did have a known allergy. Collapsed in class. Was awake and aware but had blue around the lips. I gave the Epi and called 911. Was impressed with how quickly it worked and the child looked much better. Paramedics came and said I did the right thing. Mom eventually comes in and goes with the child to ER. Later on complains that I should not have given the Epi and that the child was previously ill and had collapsed because of that, not because of the allergy. Now refuses to keep an Epi pen for the child in the health room and asks to be called whenever the child comes to the health room for whatever reason. Head nurse is now nervous for any of us to give Epi. The whole situation is ridiculous but the child is ok and that is all I care about.

Yikes. As a parent, I'm thinking it's better to give it and realize it may not have been needed than to hold off and realize that you should have given it. Just like giving nitro for chest pain- maybe it's indigestion or gall stones, but if I have a pt with a cardiac history complaining of new onset chest pain at the SNF I work at, you can bet your bippy I'm giving them nitro.

I once had a mom complain to my superintendent about me not giving epi. Student was known for lying to teachers and whatnot. kid told her mom that she asked me for epi and that I said no. :sarcasm: I would not tell a child with a plethora of known allergies that he/she could not have epi if they thought their throat was closing. I assessed her and there was no anaphylaxis, O2 in the 90s, and normal BP. Grandma picked the student up and they never gave epi at home. I will never understand why the mom thought I should have given epi when she didn't think it was necessary to give it once she was with her child.

[zombieghoast]

I gave my first epi-pen a few months ago. Similar situation. Child however did have a known allergy. Collapsed in class. Was awake and aware but had blue around the lips. I gave the Epi and called 911. Was impressed with how quickly it worked and the child looked much better. Paramedics came and said I did the right thing. Mom eventually comes in and goes with the child to ER. Later on complains that I should not have given the Epi and that the child was previously ill and had collapsed because of that, not because of the allergy. Now refuses to keep an Epi pen for the child in the health room and asks to be called whenever the child comes to the health room for whatever reason. Head nurse is now nervous for any of us to give Epi. The whole situation is ridiculous but the child is ok and that is all I care about.

Can't that be seen as medical neglect if mom purposefully refuses to keep an epi pen on stock?

[Cattz, ADN]

Thanks abc123RN. Felt kinda stupid asking it, but every sterile field, microbiology moment comes flooding back into my memory.

That's a legit question. I haven't given one either. But, the 2 anaphylactic emergencies that I have seen. (neither happened at school) As scary and fast as the symptoms advanced, I wouldn't waste the time to get to bare skin. (unless their clothing were too thick).