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jess11RN jess11RN (Member)

Need to vent and process this

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At the tail end of my day today , I got a call from a teacher who was sending student up to my office thinking student was having an allergic reaction.

Student has full body hives, no further symptoms. I try to call mom, no answer. Get my AP, take vitals, think for a minute, still can't get ahold of mom, decide to give stock epi.

Paramedics arrive and question why I gave stock epi and why they were called-in front of the student!!!! Emergency contact arrives (still can't get ahold of mom) and they subtly try to convince them to refuse transport to the ER. What?!?! Of course, by the time emergency contact asks for transport (thank goodness), paramedic looks at student and hives have dissipated, redness still present (thanks epi!). Tells emergency contact that it wasn't hives, probably just a rash. I KNOW it was hives.

I cannot believe this just happened!

Regardless of what the paramedic had to say, I know that I did the right thing. And to add, I am so incredibly thankful that the teacher noticed this and called me right away and so thankful that admin and the secretaries were there to help and have my back.

3 more days until break.

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A virtual pat on the back from me. You did the right thing regardless of what the paramedics think.

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Yes, you did the right thing.

I once had a student with full body hives (started out more localized), called Dad, Dad coming. This was in the very early days of finally getting stock epi for me. As I was walking with kid and Dad to the front door, kid stops and you could hear the stridor loud and clear. Dad didn't speak English and I was running to my office for stock epi while calling for Spanish translation help back for Dad and having someone else call 911. I had Epi in student in ~20 secs. Epi worked immediately and EMS arrived about 6 minutes later. Student had unknown allergen. It was one of the scariest allergic reaction progressions I have seen personally.

Full body hives can progress - Epi was needed. You will never regret giving Epi. You may regret not giving it. That has become my mantra.

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I thought this only happened to me. I have used my stock Epi a lot - all first time allergies in High School students. Every time the paramedics try to tell the parents that I "cured" the allergy and they should just follow up with an allergist sometime. It has got so bad I have asked my supervisor if she can speak to our local EMS station. My best one was a teacher that they convinced to sign the release and said she could wait with me until her boyfriend picked her up. My parting shot to them was "See you in 10 minutes when that Epi wears off". Sure enough...

I try to get to the parent before they speak to the paramedics and detail graphically what will happen when the Epi wears off.

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We called EMS a couple of weeks ago after an hour of known asthmatic with no meds at school and a parent who couldn't give us an ETA. When EMS got there, they barley acknowledged me and my HA - certainly didn't ask for report. It sucks, but I'm glad I'm not the only one EMTs treat this way. I wonder if they treat the ER nurses like this....

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We called EMS a couple of weeks ago after an hour of known asthmatic with no meds at school and a parent who couldn't give us an ETA. When EMS got there, they barley acknowledged me and my HA - certainly didn't ask for report. It sucks, but I'm glad I'm not the only one EMTs treat this way. I wonder if they treat the ER nurses like this....

Coming from the ER to school nursing, I can assure you they treat them much differently than the school nurse. They do not ask me for report and pretty much disregard anything I report as if it were false. I called 911 for a teacher with a HR of 170 earlier this year. When medics arrived, it was "only 140" at rest, laying on their stretcher. Yeah... I lied. I lied about his HR of all things, and the fact that he has chest pain, dyspnea, and is diaphoretic. *eyeroll*

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Coming from the ER to school nursing, I can assure you they treat them much differently than the school nurse. They do not ask me for report and pretty much disregard anything I report as if it were false. I called 911 for a teacher with a HR of 170 earlier this year. When medics arrived, it was "only 140" at rest, laying on their stretcher. Yeah... I lied. I lied about his HR of all things, and the fact that he has chest pain, dyspnea, and is diaphoretic. *eyeroll*

Only 140. Sweet baby Moses.

Jess- it depends on the squad you get. I had a staff person get stung by a bee. She took my stock Benadryl as she started to have a lip/throat reaction. I had Epi standing by....long story short, the captain tried to tell her she was diaphoretic and had a feeling of impending doom because of the "adrenaline" and then he tried to tell me she declined transport. And I said: You telling her she doesn't need to go is not the same thing as her declining.

Ultimately her boss convinced her to go and she did have full-on anaphylaxis in the rig.

I've also had one guy tell a lady with 10/10 chest pain that she did not need transport, and that was before he'd even put leads on her.

But I've had great experiences too, like the time when the student probably needed Narcan. And every time the guy in charge second guessed me, at least one of the crew went out of his way to thank me (so they probably know what's what). Also, if I arrived and was tasked with the decision to transport, I'd probably want my own set of vitals first. Not saying it's right....but it is what it is.

Do not second guess yourself. Sure...you could have waited for Epi until something WORSE happened....and then you'd be cussing yourself for not giving it sooner, right? I am waiting for Old Dude to chime in.

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Of course you did the right thing. You saw known symptoms of a serious allergic reaction and you did what you could to ensure the student didn't die. You did your job and you did it well. The EMT was out of line. I've never had an issue with EMTs, but that might just be the area I'm in and luck of the draw.

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I have several acquaintances who are EMTs/Paramedics and every once in a while, one of them will post a meme on FB that essentially rips nurses to shreds... I can't even read the comments on those things. I don't like to generalize, but a lot of them have a God-complex and they are hell-bent on being right/above everyone else, even if the patient loses out. When I worked LTC, we had a dementia patient who fell trying to move her dresser at 2am. Her leg somehow got caught/pinned between the dresser and the wall. Screaming in pain any time we tried to get her into a position of comfort after clearing her inital neuros. EMS called. They tried to convince us that she didn't need transport despite her clearly having dislocated her femur/pelvis (you could see the head of her femur poking through internally) and if they got her into bed she'd be fine, just use the hoyer. F THAT. We basically made them take her and sure enough, not only was her pelvis broken, but her hip dislocated as well.

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I've written about my poor experiences with EMTs and even ER docs telling me I shouldn't have given Epi with facial swelling and breathing pattern changes because the kid was fine by the time they arrived.

Whatever, a kiddo (or adult) life is not going to be on my hands. As someone said, you'll never regret giving it, but you will regret not.

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Here's what I have to say about it...Bam! Another kid snatched from the jaws of death! School Nurses, that's what we do. Screw EMS, you're the one on the front line and you kept someone's loved one from going over the abyss. Excellent assessment, independent critical thinking skills, and intervention! Reach over and pat yourself on the back!

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You were the one there to make the assessment. Yes, an antihistamine *may* have been an option, but the epinephrine obviously reversed whatever reaction was happening. It might not have progressed beyond the hives, it may have gone into full anaphylaxis. Why take the chance? These things can turn on a dime. In my humble opinion, you were right on the mark. The medics were unprofessional and need to review epinephrine and allergic reactions.

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