Just gave Epi for the first time

Specialties School

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Happened at 11:25 this morning and am finally not shaking anymore. Kindergarten kiddo. Doing fine, under observation at ER right now for the next few hours. I need a glass (or three) of wine. Is it June 23rd yet????

Specializes in CPN.
Welcome to school nursing, where your definition of an emergency is completely different from everyone else's definition of an emergency!

I know! It's my second year, and I'm still getting used to it. I think I need a couple more years under my belt before I do!

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Specializes in CPN.
Another family is celebrating the continuance of life for their little one...all because of rapid assessment and prompt intervention by pedi_nurse who...Bam! Snatched another kid from the jaws of death! School nurses, that's what we do! Praise be to God and praise be to you for being there to thwart this child's encounter with death.:yes:

And to imagine I used to think I couldn't be a bad*ss nurse without being some hardcore CC/Trauma/etc peds nurse! Thanks, OldDude! (also, a fellow Texan here!)

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I'm new to school nursing but did you watch until he started showing symptoms of a reaction or did you give cause of his history of previous reaction. Or did you go by emergency action plan?

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I'm new to school nursing but did you watch until he started showing symptoms of a reaction or did you give cause of his history of previous reaction. Or did you go by emergency action plan?

My kiddo had a known fish allergy, said he took two bites of fish in the cafeteria and immediately started having an itchy throat. So he got Epi as it was a known allergen he ingested and had a history of reacting to it prior.

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Specializes in Emergency Department.
My kiddo had a known fish allergy, said he took two bites of fish in the cafeteria and immediately started having an itchy throat. So he got Epi as it was a known allergen he ingested and had a history of reacting to it prior.

Giving Epi that early might be a little aggressive, but it sounds like it was certainly reasonably appropriate. Good job! From my own practice and experience, I might have chosen weight-based diphenhydramine first (and if available) but if I suspect an airway problem is developing, I'd go for the Epi. Sounds like you were anticipating this scenario, and went for the Epi.

Gonna say it again, Good Job!!

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I'm new to school nursing but did you watch until he started showing symptoms of a reaction or did you give cause of his history of previous reaction. Or did you go by emergency action plan?

I see that MHDNURSE responded above and I'll add my experiences. If there are mouth symptoms (tingling, itchy, swelling) I'd go epi STAT. That can go bad FAST. I've had a student who accidentally brought her brother's lunch and took one bite of a granola bar with her allergen. She spit it out and her action plan stated Benadryl first so that's what I did and she never developed other symptoms.

The recommended protocol is moving away from "Benadryl and wait for other symptoms" and moving towards "Epi first and ask questions later." Better to give Epi and not need it than not have given it when it was needed.

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Giving Epi that early might be a little aggressive, but it sounds like it was certainly reasonably appropriate. Good job! From my own practice and experience, I might have chosen weight-based diphenhydramine first (and if available) but if I suspect an airway problem is developing, I'd go for the Epi. Sounds like you were anticipating this scenario, and went for the Epi.

Gonna say it again, Good Job!!

Most of the action plans that I got this year have drastically changed the use of Diphenhydramine. Almost all want the epi given if the student is having symptoms to a know allergy. They are not giving Diphenhydramine at all, it is nothing and observe or epi.

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Specializes in School Nurse. Having conversations with littles..
Welcome to school nursing, where your definition of an emergency is completely different from everyone else's definition of an emergency!

Annnnd for the win!! I would love to have THIS on a t-shirt!

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Were you able to use the Epi pen that had the kid's name on it. When I sub for a school nurse, I'm overwhelmed how many epi pens there are and I don't know the students. You acted quickly and saved the kid's life. Maybe the school should stop serving fish. Once I was at a school who didn't allow anyone to bring peanut butter into the school and served sun butter sandwiches.

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Specializes in School nursing.
Were you able to use the Epi pen that had the kid's name on it. When I sub for a school nurse, I'm overwhelmed how many epi pens there are and I don't know the students. You acted quickly and saved the kid's life. Maybe the school should stop serving fish. Once I was at a school who didn't allow anyone to bring peanut butter into the school and served sun butter sandwiches.

As I mentioned above, I use stock Epi for everyone. So much easier as I open my stock Epi locker, grab it and go. And then I can get it replaced for free after use usually within a week or so (and I have 2-4 pens on hand all the time). This makes it SO MUCH easier when Epi is needed.

I do have students that self carry, but in school I'm still grabbing my stock Epi. I work with older kids so it the adult sized Epi-pen for all. The OP worked with smaller kids, so I assume it is Epi-pen Jrs on her end.

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Were you able to use the Epi pen that had the kid's name on it. When I sub for a school nurse, I'm overwhelmed how many epi pens there are and I don't know the students. You acted quickly and saved the kid's life. Maybe the school should stop serving fish. Once I was at a school who didn't allow anyone to bring peanut butter into the school and served sun butter sandwiches.

Yes it was his own Epi. We are only allowed to use the stock Epi for an undiagnosed reaction (so for someone who is having a reaction and is not a known allergen). And in our state, only a RN can administer stock Epi, so if I were not in the building and a kid reacted, they have to use their own.

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As I mentioned above, I use stock Epi for everyone. So much easier as I open my stock Epi locker, grab it and go. And then I can get it replaced for free after use usually within a week or so (and I have 2-4 pens on hand all the time). This makes it SO MUCH easier when Epi is needed.

I do have students that self carry, but in school I'm still grabbing my stock Epi. I work with older kids so it the adult sized Epi-pen for all. The OP worked with smaller kids, so I assume it is Epi-pen Jrs on her end.

thankfully I have never had to give Epi at school. We have stock Epi but also request parents to supply their own Epipen for their child if needed. If I were to ever need to use Epi I imagine I would likely grab out of my stock - It is basically kept in a box right on my wall by the door - it would be easy and quicker for me to run and grab the stock Epi than to get into my cabinet and look for the students own supply. When I review EpiPen training with the staff I do mention to them to grab from the stock in my office and not waste time looking for the students own supply.

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