School district apologizes for nurse delays treatment

[dudette10, MSN, RN]

The student went to the nurse's office after fearing she had eaten peanuts and asked for an EpiPen injection. According to the article, the nurse advised Benadryl, then when the student insisted on the EpiPen, the nurse called the mother to confirm, who informed the nurse to give her daughter the injection and call 911. The student's Allergy Plan includes a directive to use the EpiPen first. The student was sent to the hospital, but the mother is also upset because no one from the school went with the student in the ambulance.

There are a lot of holes in this story: Did she ingest peanuts? What were her presenting signs and symptoms? What was the medical assessment of the girl once she arrived at the hospital? Did anyone confirm that the pesto's pine nuts had been substituted with peanuts?

What do you all think?

District 214 apologizes after nurse allegedly delays student with peanut allergy from using EpiPen - Chicago Tribune

[klone, MSN, RN]

There are a lot of holes in this story: Did she ingest peanuts? What were her presenting signs and symptoms? What was the medical assessment of the girl once she arrived at the hospital? Did anyone confirm that the pesto's pine nuts had been substituted with peanuts?

I think that the nurse screwed up. As someone with a lifelong anaphylactic allergy to tree nuts, I side wholly with the student. It doesn't matter if she has NO presenting s/sx. If she believes she has ingested peanuts (and trust me, when your whole life you've been trained to detect a nut in a piece of food, you get pretty good at being able to discern if there are nuts in something or if you just ate a tiny bit of nut), then per her allergy plan, she should get the Epipen immediately. A delay could kill her. And it's not like we're dealing with a 6-year-old here. She's 14 or 15 years old, far old enough to take personal responsibility for her allergy and should be taken seriously about it.

Even if the pesto did not have peanuts in it (and yes, I too have had false alarms), I believe it's still recommended that the Epipen be administered if you have strong belief there was an exposure, even if there aren't yet any sx.

[morte, LPN, LVN]

allegedly the food service admits to subing peanuts for pine nuts.... the part you did not quote, that i am interested in, is what "masking" was the mother talking about, ie using benadryl would "mask" the symptoms but allow the anaph. to continue....

[dudette10, MSN, RN]

Thanks for your thoughts. Another news story included confirmation from a district rep that food service did substitute peanuts, which is very strange.

[TiffyRN, BSN, PhD]

i am interested in, is what "masking" was the mother talking about, ie using benadryl would "mask" the symptoms but allow the anaph. to continue....

I thought that was interesting also. Perhaps "blunting" might be a better term for what benadryl would do. In other words, mildly effective against an anaphylactic reaction. It's been years since I left for the world of neonates and they rarely can rustle up much of an immune reaction. But I seem to remember that standard treatment for suspected allergic/anaphylactic reaction was IV benadryl, steroids and maybe epi if there was any evidence of airway compromise. I understand in a pre-hospital setting you might need to be more aggressive especially with a known allergy, but to say benadryl is bad, I don't buy that.

[llg, PhD, RN]

The written Allergy Plan on file with the school said, "Epi pen first," -- the RN should have known that and given the Epi pen immediately. No if's, and's, or but's. That plan is in place for situations exactly like the one that occurred.

And the school should have been sensible enough (and sensitive to the importance of appearances, public relations, etc.) to send a school representative to the hospital -- not in the ambulance, but in a separate car -- to stay "with the situation" until the parent arrived.

[Notgoingaway]

Hey! That's my old high school! But I doubt the school nurse when I was there is there now. Lived right across a field from Hersey.