Gave my first epi-pen yesterday...

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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.

Specializes in School Nurse. Having conversations with littles..
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.

Yep, and on the nutrition questions, it was "dark, green, leafy vegetables" if I didn't have a clue what the answer was. :yes:

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Specializes in family practice and school nursing.

Great job! Thank goodness you were there and acted quickly!

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Specializes in kids.
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.

Cause some parents are BSC, Bat Sh*t Crazy!

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

Anytime my friend! I don't know much but will share when I can.

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She has had many discussions with the head nurse and as of now, no specific Epi for this student. However we do have stock Epi on hand. My worry is if the child has issues again, there will be that wait and see attitude in place as well as waiting for the mom to show.

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I have vials of epi and benadryl in my emergency bag. No 'stock' epipens though. At the risk of looking like a dummy... Did you give the benadryl po or as an injection?

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Specializes in IMC, school nursing.
No 'stock' epipens though.

Go to the epi-pen website, they offer 2 packs free every year to schools. Will need a physician's signature. Could try health dept. if you don't have a medical director, or local ER physician.

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Specializes in Pediatrics Retired.
I have vials of epi and benadryl in my emergency bag. No 'stock' epipens though. At the risk of looking like a dummy... Did you give the benadryl po or as an injection?

Benadryl by mouth, if they're conscious of course. The injectable works faster but I don't know of any schools or patients that have it on hand; usually in ERs or Urgent Cares.

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Go to the epi-pen website, they offer 2 packs free every year to schools. Will need a physician's signature. Could try health dept. if you don't have a medical director, or local ER physician.

I asked my nurse coordinator and she said the physician that does our standing orders chooses to use the vial because it's cheaper and the vials last longer. Bummer. Pre-filled syringes would be ideal.

And, thanks, OldDude! I actually have vials of benadryl along with epi. I don't know when/why I would choose to give the benadryl rather than the epi though....

P.S. Although I don't know the details, I saw some talk about ellipses... I love them.

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Specializes in ED, School Nurse.

I gave the Epi-pen through her pants. She was wearing sweatpants. If she would have had shorts on, I would have pulled her shorts leg up to administer, but I wasn't messing around with a long pair of sweatpants. I do not have injectable/IV Benadryl at school so she got a 2 PO doses of liquid Benadryl.

I am fortunate to have standing orders and an anaphylaxis protocol, as well as a school physician to sign off on said orders and protocol. However, if the nurse (me) wasn't here, this student legally could not have gotten the Epi-pen injection because unlicensed personnel can only administer an Epi-pen to those with a KNOWN allergy in my state.

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I do not have injectable/IV Benadryl at school so she got a 2 PO doses of liquid Benadryl.

Oh, this reminds me of another part of my story of the mom being pissed that I didn't give epi. The student told mom that she asked for epi and I gave her a second dose of Benadryl. What actually happened was that the student came in (has well documented multiple allergies) and told me that they had been exposed to the allergen. Not wanting to waste time, I grabbed the Benadryl and immediately gave 2tsp. Then I opened up the student's allergy action plan and saw that the doctor had written that 4tsp needed to be given, so I gave the other 2tsp right away.

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Specializes in Pediatrics Retired.
though....

P.S. Although I don't know the details, I saw some talk about ellipses... I love them.

I'm surprised you haven't been hammered already by Far, the ellipse police here. You were clearly in violation with the group of 4 after though. I will pray for your ellipse rule violating soul :blink:

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