How many have actually had to administer epi?

akulahawkRN, ADN, RN, EMT-P · Jan 14, 2015

As a Paramedic, I've had to administer Epi for anaphylaxis... just not in peds (and I'm thankful for that...) but I wanted to contribute this: the local EMS protocols for pediatrics here allow for us to give Epi (1:1,000) 0.01mg/kg IM every 15 minutes, up to 3 doses. The end points are return of normal BP or improvement in symptoms. What I can certainly say is that my experience with Epi in these cases is simple: it works pretty well, but you will also need something like diphenhydramine too, and we use 1 mg/kg up to 50mg, the normal adult dose for that, IV or IM.

Now I'm in California... you might want to check with your local EMS agency to find out what their protocols are as well so that you have some way to coordinate this stuff with an EMS response.

NanaPoo · Jan 14, 2015

My understanding is to call 911 after the first dose. I don't have plans to repeat a second dose!

I have not had to use an Epi-Pen, praise the Lord, but I've only been school-nursing for roughly 6 months. I run potential school emergencies through my mind frequently so I'll hopefully be ready for one should it happen.

I try to review videos on the use of our school AEDs, review the use of Epi-Pens, how to handle fractures (which I've seen plenty of) and especially compound fractures.

I had a near Epi-pen emergency when, on the last day before Christmas break, our 6th graders were performing their service work. They were across the street raking an elderly man's yard and the man decided to bake cookies for them. The kids dove in and 2 of my severe tree nut allergy kids were partaking without thinking. Within minutes their teacher was dropping them off here in the clinic with early symptoms. I was able to get Benadryl in them and pull out my general use Epi-Pens (it was service day-they left their backpacks-with their Epipens at home!) and have them ready. I held them in the clinic for 30 mins. I had called their parents. One mom came to pick up her son (no further symptoms). The other girls stayed with me and had no further symptoms. She finally begged to go back and rake more yards. I allowed her.

It was scary for a short while and thank goodness the Benadryl got in them fast. I stayed on them and asked about every 30 seconds if they were feeling anything new. Poor kids. LOL

I was thankful for the free EpiPens for schools I found about here. I had extra pens for these kids for that very reason and I was SO thankful when these kids showed up without theirs that day!

kidzcare · Jan 14, 2015

I have administered Epi once. Highly allergic student exposed to airborne particles on the bus. Had happened once before and mom was NOT HAPPY that I had not given epi (even though I saw no signs of anaphylaxis and no epi was administered by mom after the student was picked up). I wasn't taking any chances.

The student came in straight from the bus, told me what happened and that breathing was difficult. I immediately gave benadryl per the allergy action plan, had the principal in the room calling mom (it was decided after the incident when I DIDN'T give epi that an administrator would always be present if this student came in since there was a history of lying) and I asked the student if they felt they needed epi. Student said yes and I said OK and grabbed it while we called an ambulance. O2 sat was around low 80s if I recall accurately and high 90s by the time paramedics arrived. In and out of my office in less than 15 minutes-- the paperwork took longer.

That is the only incident I've had. I had another student who realized they had grabbed a sibling's lunch with a granola bar that had tree nuts. Had already taken a bite before realizing. I gave benadryl and no further issues. I work with older students so most of the time the allergies are already known and the students can read food labels.

kidzcare · Jan 14, 2015

My understanding is to call 911 after the first dose. I don't have plans to repeat a second dose!
I had called their parents. One mom came to pick up her son (no further symptoms). The other girls stayed with me and had no further symptoms. She finally begged to go back and rake more yards. I allowed her.

I believe the protocol is usually to transport to ER once epi is given.

I ALWAYS call parents about allergy r/t issues. Liability is too high. Head injuries too.

OldDude · Jan 14, 2015

akulahawkRN reminds us of a very important element of treating anaphylaxis; don't forget to treat the cause. About 10 years ago I could hear "raspy" breathing walking toward my clinic and in walks a teacher whose face reminded me of a Klingon from Star Trek it was so swollen. I gave her epi, benadryl, and some tagamet I had on hand. Afterward I picked the phone to dial 911 but she stopped me saying her husband was on the way to take her to her doctor, who had dealt with this before. I disagreed but she was an adult and could refuse if she wanted to. Anyway, In just a few minutes her airway cleared and by the time her husband arrived, after about 30 minutes, most of the swelling had resolved. Evidently the food she had for lunch had MSG in it and she was allergic to MSG. I've administered epi to kids in the Urgent Care I work in but no kids at school...yes Kittery - "knock on wood!"

akulahawkRN, ADN, RN, EMT-P · Jan 14, 2015

I have administered Epi once. Highly allergic student exposed to airborne particles on the bus. Had happened once before and mom was NOT HAPPY that I had not given epi (even though I saw no signs of anaphylaxis and no epi was administered by mom after the student was picked up). I wasn't taking any chances.
The student came in straight from the bus, told me what happened and that breathing was difficult. I immediately gave benadryl per the allergy action plan, had the principal in the room calling mom (it was decided after the incident when I DIDN'T give epi that an administrator would always be present if this student came in since there was a history of lying) and I asked the student if they felt they needed epi. Student said yes and I said OK and grabbed it while we called an ambulance. O2 sat was around low 80s if I recall accurately and high 90s by the time paramedics arrived. In and out of my office in less than 15 minutes-- the paperwork took longer.
That is the only incident I've had. I had another student who realized they had grabbed a sibling's lunch with a granola bar that had tree nuts. Had already taken a bite before realizing. I gave benadryl and no further issues. I work with older students so most of the time the allergies are already known and the students can read food labels.

Sounds like you managed to prevent that kid from getting worse as that student was probably well on the way to having a really bad day at that point. Good work! I would further imagine that a quick listen to the lungs would have demonstrated very tight breath sounds. Epi can be a wonder drug in these cases!

akulahawkRN, ADN, RN, EMT-P · Jan 14, 2015

akulahawkRN reminds us of a very important element of treating anaphylaxis; don't forget to treat the cause. About 10 years ago I could hear "raspy" breathing walking toward my clinic and in walks a teacher whose face reminded me of a Klingon from Star Trek it was so swollen. I gave her epi, benadryl, and some tagamet I had on hand. Afterward I picked the phone to dial 911 but she stopped me saying her husband was on the way to take her to her doctor, who had dealt with this before. I disagreed but she was an adult and could refuse if she wanted to. Anyway, In just a few minutes her airway cleared and by the time her husband arrived, after about 30 minutes, most of the swelling had resolved. Evidently the food she had for lunch had MSG in it and she was allergic to MSG. I've administered epi to kids in the Urgent Care I work in but no kids at school...yes Kittery - "knock on wood!"

A good way to look at this is treating allergic reactions and anaphylaxis is that benadryl or an equivalent histamine blocker needs to be used to stop the reaction in its tracks. Epi is used as a reversal agent if the patient becomes symptomatic and starts progressing toward the anaphylaxis side of things. Also don't forget to be very mindful of the onset times... PO is slow. IM or IV is going to be much faster. If you remember, try to identify the source. If the person is a staff member, don't forget to ask about medications, including OTC, for heartburn as sometimes that can be the source of the anaphylaxis.

kidzcare · Jan 14, 2015

Sounds like you managed to prevent that kid from getting worse as that student was probably well on the way to having a really bad day at that point. Good work! I would further imagine that a quick listen to the lungs would have demonstrated very tight breath sounds. Epi can be a wonder drug in these cases!

I did a more thorough assessment, I just don't want any possibility of identifying information on here :) I had typed up something quite a bit longer and then edited out a bunch of details and gender identifying pronouns-- because, HIPAA.

schooldistrictnurse · Jan 14, 2015

One of our secretaries has administered TWICE to the same student. (different school years)

Kiddo! Please learn to ask what's in the food!

JenTheSchoolRN, BSN, RN · Jan 14, 2015

I have never (-fingers crossed-) in a school setting, but have before I became a nurse on a friend who luckily always carried an Epi-Pen. I have had my fingers wrapped around one ready-to-go on a few students though in case symptoms progressed after benadryl dosing. The nurse just before me had used an Epi-pen twice recently on the same student. We are a completely peanut-free school, so that does help cut a few unknowns.

My plan is 1 dose Epi, call 911, transport. I'm lucky I'm an area that average EMS response time is less than 6 minutes.

SassyTachyRN · Jan 14, 2015

Yes, last school year, which was my first year as a school nurse. Did Benadryl first but the reaction progressed so gave epi and called 911.