How many have actually had to administer epi?

Specialties School

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I'm just curious, I've never had to *knock on wood* but I'm sure if I stay in school nursing long enough, the day will come. I run the scenario through my head all the time---if you have had to, I'd love to hear about your experience.

Also, the Illinois School Nurse Guidelines say a repeat dose can be given in 10 minutes if needed and the American Academy of Allergy, Asthma, & Immunology says 5-15 minutes depending on response up to 3-4 doses. Does your school have clearer guidelines on how long between doses? Our action plans don't really have a place for physicians to indicate when to repeat the dose. Thank you!

All the training I've had say to heck with the Benadryl and don't give it. It works on another system (mild reactions) and not respiratory symptoms.

Epinephrine is perfectly safe so you should go there first.

It is like coming upon someone who is unconscious - if someone is in the same area, point and say "call 911" while you assess.

Give the epi and if EMS doesn't get there within 5 minutes and they are still having difficulty breathing, you can give a 2nd dose of epi.

There were some well-publicized cases of kids not getting epi in time because the symptoms seemed mild to the person assessing (one of these was a parent). Medical authorities have changed the protocols to say give epi first and they also want kids to carry two epi-pens.

Take a look at the care plan on the website below:

Treatment & Managing Reactions - Food Allergy Research & Education?

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Here is another good website just for stories about kids and reactions.

My son experienced anaphylaxis… And I’m (sort of) glad. | Allermates Blog

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If a kid is getting epi for anaphylaxis they absolutely need a trip to the ER! The risk for rebound reaction is real and not pretty!

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Specializes in School nursing.
All the training I've had say to heck with the Benadryl and don't give it. It works on another system (mild reactions) and not respiratory symptoms.

Epinephrine is perfectly safe so you should go there first.

It is like coming upon someone who is unconscious - if someone is in the same area, point and say "call 911" while you assess.

Give the epi and if EMS doesn't get there within 5 minutes and they are still having difficulty breathing, you can give a 2nd dose of epi.

There were some well-publicized cases of kids not getting epi in time because the symptoms seemed mild to the person assessing (one of these was a parent). Medical authorities have changed the protocols to say give epi first and they also want kids to carry two epi-pens.

Take a look at the care plan on the website below:

Treatment & Managing Reactions - Food Allergy Research & Education?

I only give benadryl if the reaction is skin-based (i.e. hives); everything else, Epi. This is what I train the teachers about as well. 95% of the time, this is also the allergy plan provided by a student's doctor.

In the cases I've had an Epi-pen on stand-by is when I am waiting to see if that mild skin reaction takes one step towards progressing. I haven't seen it - yet. I don't have stock Epi-pens and have kids with a nut/peanut allergy and no prescribed Epi-pen (or parent will not bring one in)...it scares me, even with EMS quick response times.

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I only give benadryl if the reaction is skin-based (i.e. hives); everything else, Epi. This is what I train the teachers about as well. 95% of the time, this is also the allergy plan provided by a student's doctor.

In the cases I've had an Epi-pen on stand-by is when I am waiting to see if that mild skin reaction takes one step towards progressing. I haven't seen it - yet. I don't have stock Epi-pens and have kids with a nut/peanut allergy and no prescribed Epi-pen (or parent will not bring one in)...it scares me, even with EMS quick response times.

I have one student who is highly allergic to bee stings and his parents won't bring an epi pen to school because it is "too expensive".

We don't have stock epi pens although a law was passed that went in effect in January mandating that schools have to have them HOWEVER . .. . there was nothing in the law about how to get the epi pens. You have to have an order from a physician and so far where I live, no physician is willing to be that liable to write a prescription for a school district to purchase the pens for each campus.

Legislators . . . . are crazy. :sarcastic:

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Spidey, have you tried https://www.epipen4schools.com/ ? That's where we get our Epi from!

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Specializes in kids.

@ Farawyn RN

It is drawn up from a vial (1 cc) into a syringe and then you switch off the need for an atomizer. 1/2 cc Left nare followed by 1/2 cc Right nare. This is only given if seizure activity is longer than 5 minutes, and it is an EMS transport call. Midazolam is actually versed. I am glad I have not needed to use it!

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Spidey, have you tried https://www.epipen4schools.com/ ? That's where we get our Epi from!

Yes, I've seen it but you still have to have a valid prescription and that's the issue. No local physician will take on that liability.

I have to train two people per campus who have to volunteer - no one can make anyone volunteer according to the legislation. I have 11 campuses.

A doc would be taking a huge risk to write prescriptions for each campus and then let lay people be the ones who give the epi.

So far, no takers. I don't blame them.

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Specializes in Peds, Oncology.
Yes, I've seen it but you still have to have a valid prescription and that's the issue. No local physician will take on that liability.

I have to train two people per campus who have to volunteer - no one can make anyone volunteer according to the legislation. I have 11 campuses.

A doc would be taking a huge risk to write prescriptions for each campus and then let lay people be the ones who give the epi.

So far, no takers. I don't blame them.

We have 51 schools in our district and our school physician wrote the order for the epi pens and standing orders. We are 1 nurse: 2 buildings for the most part so lay people are trained to give it when we are not in the building. We don't have any issues getting people trained to give epi, it's the diastat that one wants to give. I have almost 100% of my staff epi pen trained in one school.

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:) We don't have a school physician. I'd never heard of that before last week.

And we don't have a nurse at every campus. It is rare for a nurse to even work full-time.

It is different in each state. I found that out when I went to my first NASN conference the first year I started my job as a school nurse. So many amazing differences.

I can't even imagine having a nurse at every campus. I can barely get done the minimum mandates . . . .some stuff just can't be done working 17 or 24 hours a week.

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Specializes in Peds, Oncology.
:) We don't have a school physician. I'd never heard of that before last week.

And we don't have a nurse at every campus. It is rare for a nurse to even work full-time.

It is different in each state. I found that out when I went to my first NASN conference the first year I started my job as a school nurse. So many amazing differences.

I can't even imagine having a nurse at every campus. I can barely get done the minimum mandates . . . .some stuff just can't be done working 17 or 24 hours a week.

Our "school physician" is just basically contracted to resign our standing orders each year, comes to a meeting with us, otherwise he doesn't do any other work for us. He's belongs to a large pediatric group here.

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Our "school physician" is just basically contracted to resign our standing orders each year, comes to a meeting with us, otherwise he doesn't do any other work for us. He's belongs to a large pediatric group here.

So far, we are having trouble finding someone like that.

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