HELP: anaphylactic attack

Here is my order:

1) Notify the physician. This is a potential code situation and step one is get some help. He/she may need to manage the airway, or they can administer drugs while you call 911.

2) O2 per non-rebreather mask. The patient's airway is swelling and you need to provide as much oxygen as possible. repositioning to open the airway will not be enough.

3) Epi subq. You need to stop or slow the inflammatory response and you don't have time to establish IV access.

Now some people may say airway is always first, but I would be yelling for help while I'm hooking up the Os and grabbing the epi pen.

Well, you'd want to stop the reaction immediately (or buy some time until the patient is in the ER) and you'd also want to protect the airway, so I'd go from there for picking answers.

My problem with the epi option the poster has is that it's an IV admin. With the options given, especially since the poster is in nursing school. I'd yell for help and then start with the ABC's.

Nursing instructors love the ABC's answers.

Option D gives the epi option as subcutaneously, which should be available in a clinic giving allergy shots.

My problem with the epi option the poster has is that it's an IV admin. With the options given, especially since the poster is in nursing school. I'd yell for help and then start with the ABC's.

Nursing instructors love the ABC's answers.

Option d in the OP is for epi subq. I've never worked in a clinic, but my guess is that any place giving allergy shots has an epi readily available.

I am highly allergic to shell fish and the last time I was exposed to shrimp I was in my car and I made it to the pharmacy. I went to the pharmacist and she saved my life by giving me childrens liquid Benadryl, but dosed for me of course. I was on the phone with my sister during the whole time, an ambulance was called and they came and they said they would have done the same thing but through a shot. Believe me you won't have time to get an IV in, the problem is not the O2, you can have the O2 on full blast at 15lpm its not going to help if the o2 can't get through the inflamation. But, your in a clinic call the Dr. they will most likely give Epi.

1) Open airway

2) Give Epi: IM not SubQ, give IM or even IV if needed

3) Start IV, see above

Putting a nonrebreather on somebody who cannot ventilate is an exercise in futility, therefore it's not in my top three.

D Epi 1 st.

Being that open airway is an option, we must assume a closed airway. Likely, opening the airway will be the first consideration.

My first thought is that you can't give the Epi unless you have some type of standing order.

My picks - assuming we have no standing orders -

Open airway, get vitals, notify MD.

If there is a standing order for Epi then i'd do that before notifying MD. I;ve seem quite a few instances of a panic attack mimicking anaphylaxis without the drop in BP, so i'd still want vitals.

Within my scope of licensure I would contact MD in a clinic setting, have the epi already there , (I'm assuming since you know it's a full blown ana shock you've done the ABC's) give it and of course from there continue assessing the ABC's. Also I would have been monitoring vitals post-epi. Clinical settings in an emergency are set up so differently with protocol than say a hospital or I'm guessing a nursing home.....I really don't know. In my case when I have done clinical work I've followed that protocol. In the hospital I've followed that protocol.

Sharona