Just when I thought I had a safe, sane nursing job.........
I was eating my lunch this afternoon when one of my staff members yelled, "Marla, you'd better come have a look at (name withheld)---something's wrong with him!" Within 15 seconds here came the both of them, the one caregiver literally dragging the other, whose eyes had swollen shut and who was grabbing at his throat and gasping for breath. All he could do was whisper "throat.....tickles.......can't breathe". We got him to a chair and he continued to wheeze and cough weakly; he shook his head when I told the med aide to call 911, but no sooner had I turned my back to direct traffic away from him than he collapsed on the floor!
By this time, he was unresponsive; his pulse was thready, tachy, and slightly irregular, and his skin was cool and clammy. Sternal rub brought him around only for a brief second; I couldn't get a BP, and in the meantime the dispatcher was telling my med aide to prepare to do CPR. Bless her heart, she was scared half out of her wits, but she's had training, and she did everything correctly........fortunately, we never lost his airway or his pulse, and the EMTs got there and slammed in some epi and some Benadryl, which brought him around enough to reduce the swelling and enable him to talk. THEN he didn't want to go to the hospital!! Dang kid---I know he doesn't have health insurance, but he'd been minutes from death right there on the floor, so I told him "No way, buddy, you're GOING."
At that, he smiled, just a little, and said to the EMTs, "You heard her.....and I always listen to my nurse". That's when we all knew he'd be OK..........but what a FRIGHT!! The poor residents were almost beside themselves; they all know and even expect that someday they'll be the ones taken out that door on a stretcher, but even some of our former nurses and our ex-MD were more than a little shaken by seeing this strapping young man laid low........and by what, we still don't know. He's had asthma since he was a child, but no history of anaphylactic shock before today. WHEW!!!!!!!!!
The last I heard, they gave him a little more Benadryl and some prednisone and sent him home; he'll be fine in a day or two. I hope he got an RX for an Epi-Pen---the staff and I privately agreed among ourselves to chip in for it since he doesn't have much money---or, failing that, we can figure out what caused the anaphylaxis. Of all the situations you never expect in assisted living, I'd have to say coding a co-worker would have to rank close to the top. Thank God he'll be all right........in fact, I half-expect that kid to show up for work in the morning, even though I've given him the rest of the week off. Thank God for Benadryl and epi and EMTs. And thank God for giving this young man a second chance!:yelclap: :w00t:
I would think in most states a pharmacist would know that he or she could give an epi shot and call the doc for an RX once things were stabilized/in the am.
I was in a VERY rural area once with a young man who was allergic to bee stings, with history of anaphylaxis, stung on the neck - 911 told us the one ambulance they had was not available to come, it had been tied up with a car wreck and transporting those victims !!!
This was a weekend and we were all out of town at a retreat. Hospital was 40 miles away, walmart pharmacy was 11 miles away. So we gave the fellow liquid benadryl, put the young man in the car and headed into the walmart - pharmacist called the er doc at the hospital - got an rx for an epi pen on the spot and handed it to us on the spot as he labeled the box! He did say though that had our young man been in worse shape he would have given it and called later. Then we went to the hospital with that - at least knowing we had SOME way to keep him out of complete anaphylaxis.
Then read him the riot act for not having an epi pen of his own in the first place!
This brings up an interesting point. The pharmacist saved your life by giving you the epishot, thank goodness. Legally he couldn't do that - now could he? I've thought about this because I carry an epipen. If I saw someone in anaphylactic shock of course I'd do the proper thing, call 911. But if they don't get there in time and the person might actually up and die - I'd give them the shot. I'm not an RN yet. What happens if one does this, RN or not? Oh the ethical quandry and quick decisions!
Technically, he risked his job by saving my life. Although I don't remember it, apparently when I pushed through the door into the Walgreens I was able to call out that I was having an allergic reaction as I fell to my knees. The whole thing is a blur to me. I am so grateful to the pharmacist, if it wasn't for him I probably would not have survived.
Lori, I've gone into full-blown anaphylaxis too. To Sulfa. Now if I even have to give a Sulfa pill to a patient, I wear gloves. Would not want to go through that again.
I wear gloves too when handling penicillin, and I won't hang it unless there is noone else available who can hang it, and even then I wear eye protection. It would be a nightmare if a drop of IV penicillin flew into my eye when I was prepping the line! I have a keychain proclaiming my penicillin allergy too, just in case. The docs who treated me said that if I have another exposure to penicillin, I almost certainly won't survive it.
Specializes in LTC, assisted living, med-surg, psych.
I'm happy to report that my staff member was at work this morning (against nurse's orders, of course) and I swear, my ribs are aching because he gave me some of the biggest hugs I've ever gotten in my life!! He looks great---in fact, he looks better than he did for the past week or so---and best of all, he's OK!!
Specializes in LTC, assisted living, med-surg, psych.
That's what I was thinking.........I've discussed it with my administrator, and I'm going to write an incident report so we at least have a record of it.
And no, they didn't give him a scrip for an EpiPen....the hospital here in this town believes in the "treat-em-and-street-em" school of caring for the uninsured. :angryfire I told him to go back there when he gets off work and DEMAND one if he has to---I'll be more than happy to back him up, and I'll pay for the darned thing too, that's how strongly I feel about this whole thing. We still don't know WHY this happened to him...I just want him to be protected in case it happens again!
Good save. In light of this happening in a health care facility the first thought that comes to mind is a latex allergy. Next would be something he ate or inhaled. He probably should see an allergy specialist, but without insurance this is going to be hard to do. His risk or reoccurence is pretty high unless its figured out what he reacted to and he can prevent exposure.
Of note about Epi pens , alot of insurances dont cover them- I have had several and none did. Second if you use it you must go to the ER.
Specializes in NICU, PICU, PCVICU and peds oncology.
About a year ago one of our nurses had an anaphylactic reaction to shellfish in our staff break room. The offending substance seemed innocent enough: the flavoring packet from a package of ramen noodles. Apparently the shrimp protein in it disbursed through the air and this gal reacted. Now recall we are a peds unit... what do we know about grown-ups? Luckily one of our new staff nurses had come to us from an adult ER and she took over control of the scene. The whole episode was handled so well that our coworker was back at work in a week. The only complaint our management had was that no one called a code when she went down.
Then just the other day one of our nurses, who is 31 weeks pregnant and has missed a lot of work because of it, fainted in her chair while getting report. No one is able to ID the cause of her faint; her BP was high when they got a cuff on her, her blood sugar was normal, she's not anemic... who knows. She spent four hours in ER and then came back and finished her shift, but at the desk. Our PCM told her she has to start her mat leave now. No more swoons in the unit puleeze!
:w00t:
He looks great---in fact, he looks better than he did for the past week or so---and best of all, he's OK!! 
traumaRUs, MSN, APRN
87 Articles; 21,288 Posts
Marla - you rock!