What do you do when a pt goes into anaphylactic shock?

dudette10, MSN, RN · Feb 21, 2016

You are not expected to function as an independent nurse the day you start nursing school. Focus on that fact, and try to get your anxiety about nursing under control in a safe environment (school). Everything comes in due time. Good luck.

Julius Seizure · Feb 21, 2016

If you see that the patient is in distress in any way, get help. That's most important. Stick your head out in to the hallway and loudly call "I need help in here!!"

Live.Love.Nurse.â™¡ · Feb 21, 2016

Okay, first, take a nice deep breath. Better? You will learn these things. Your instructors will not just throw you to the wolves on your first day. Prior to beginning clinicals, they should tell you more of what to expect. Also, my first clinical day was orientation and this is where they explained the codes, where the code buttons were, etc. A few days following the orientation, they had us shadow nurses until we felt comfortable enough to start jumping in on the action. Even though, we started slow.. assisting with baths, assisting with transfers, etc. When you start to care for your own patients, they will likely be more "stable" with predictable outcomes. Once you prove yourself as a valuable nursing student, they will trust you with more difficult cases. But even then, you will always have a preceptor or nursing educator to assist you if things get out of hand. You are a student after all. Try not to stress yourself out about it. Instead of worrying about "what if this happens?" Or "what if my patient does this, what do I do?" just go in with confidence, take it day by day, and focus on learning as a student and if the time comes that you do experience a code, you'll surprise yourself with how well you handled it.

beekee · Feb 21, 2016

And be sure to ask your patients if they have any allergies before you administer medications. You can study things that aren't so obvious, such as an allergy to shellfish means watch out for contrast dye. As the PP said, you'll have help if anything happens.

CelticGoddess, BSN, RN · Feb 21, 2016

Why are you so concerned about a patient having anaphylaxis? In 5 years, I have only had 1 pt have an anaphylactic response.

As a nursing student, especially during your first clinical experience, they won't expect you to know what to look for, what to do. Just take a deep breath, and try not to worry about something going wrong. Your clinical instructor should be there for you and if you have questions/problems/concerns to to her(him). If a patient says that something is wrong, call for help.

Honestly, the best thing you can do for yourself right now is take a deep breath and try to relax and learn. Clinical can be very exciting but also sometimes, very routine. And you can learn a lot from the very routine.

Here.I.Stand, BSN, RN · Feb 21, 2016

I start clinicals in a few weeks. I'm in my first semester of nursing school.

Hugs!! I think it's intimidating for most if not all of us, because of the unknown and because nursing care is a big deal. Remember you're not being thrown to the lions; you have your clinical instructor and the staff nurses.

I'm so scared of my pts going into anaphylactic shock.
How do you know it's happening?
What do you do?
What do you tell the staff around you during this time?
What happens if you freak out and step away? Can you do that as a student since you don't know what exactly to do yet? (We weren't taught anything except that it's an emergency crisis reaction to whatever they're allergic to)

For what it's worth, the closest thing I've seen to anaphylactic shock was a pt having a transfusion reaction to the blood I was giving him. I've been an RN 13 yrs and this happened last month. I have personally had anaphylactic reactions to allergy shots when my body couldn't quite handle the amount of serum I was given. It wasn't shock because it didn't get to the point where my vessels were leaking/BP dropping. It's sudden onset itching and difficulty breathing from bronchoconstriction (when it happened to me, if I remember correctly I didn't have audible wheezing but coughed a lot and had a bit of air hunger.) It's generally treated with Benadryl and epi to bronchodilate and mediate that histamine response. Initially low BPs are treated with a bolus(es) of IV fluids; if BP doesn't respond to the fluids the MD can order a vasoconstrictive drip to get that BP up. The patient would be in the ICU if it came to that.

You'll want to stay with the patient but call for help -- call a rapid response (a team that responds to urgent changes in pt condition but not quite coding; see below for my explanation on coding). Another RN can call the MD and bring you meds and supplies while waiting for the RR team. In the meantime you'd want to make sure the pt's IV was in working order, try to start a 2nd one if they only have one. Put on some O2 or turn it up if they already have it on.

As a student you won't be expected to know what to do; that's why you're there to learn. (You also won't be independently starting IVs or giving emergency meds as a student, but as an RN yes.) However, you can't freak and step away. Stay with that pt, and as a student when staff shows up back out of the way but do watch and learn. Be available as an extra set of hands should the RN ask for supplies out of reach, record VS etc.

Also, what is "code"? My professors say it a lot saying either they never had a pt who codes or they had one who codes.
What does code mean and what is it?
What do you do in the event?

"Code" or code blue refers to a cardiac and/or respiratory arrest. You call the code (hit the big blue code button, yell "Someone call a code!!" if you can't get to the button for whatever reason, etc.) and then initiate your BLS. Does the pt have a pulse? If not start compressions. Does he have a pulse but not breathing? Get that ambu bag and start ventilating. The code team will come with the crash cart and take over. What drugs they use and the decision to defibrillate vs. cardiovert vs. externally pace is getting into ACLS and will be managed by those certified in ACLS. Again, stay with the pt, be available to answer questions about the pt's history and events leading up to the arrest, take your turn in the chest compressions rotation (those are hard work!! so we take turns)

Please tell me all of the codes. Please tell me what type of emergency situations can happen and what you need to do (in details and explain why).

Code blues can be the result of way too many things to explain here -- H's and T's of ACLS | , acute cardio or neurogenic shock, respiratory arrest can happen with drug overdoses or brain injuries ........

But as a student or a floor nurse, it's all going to come down to call for help and initiate BLS.

You may hear a "code stroke" called, which is a relatively recent thing I want to say. It is called when a pt suddenly develops stroke symptoms, and is responded to by RNs and neurology MDs. Time is brain, and these pts can be fully assessed and treated more quickly with a dedicated team.

I'd like to know to be safe than sorry and make sure my pts lives are not at risk because of my lack of knowledge and me being so scared freezing up.

You're in school to gain that knowledge. And again, you're not alone. Even if you do freeze (it sometimes even happens to an RN during their first emergency) you have a team there to help.

Jensmom7, BSN, RN · Feb 21, 2016

Thirty six years of nursing and the only episode of anaphylactic shock I ever came across was the one I had.

Lev, MSN, RN, NP · Feb 21, 2016

Here.I.Stand gave great answers to your questions. I can see that you are nervous about clinicals and that is alright. Make sure to keep the lines of communication open and you will be fine.

imintrouble, BSN, RN · Feb 21, 2016

Thirty six years of nursing and the only episode of anaphylactic shock I ever came across was the one I had.

More than twenty years and I've seen zero. I'm careful about allergies. I ask every patient what they're allergic to prior to giving meds. Even when the armband is visible, and I have it written down.

It also helps my patient population is mostly geriatric. There are few surprises with new allergic reactions, when a person is older.

VANurse2010 · Feb 21, 2016

And be sure to ask your patients if they have any allergies before you administer medications. You can study things that aren't so obvious, such as an allergy to shellfish means watch out for contrast dye. As the PP said, you'll have help if anything happens.

That's actually a myth, i.e. not evidence-based at all. Just saying.

emtpbill, ASN, RN, EMT-P · Feb 21, 2016

That's actually a myth, i.e. not evidence-based at all. Just saying.

Actually patients are at a three fold risk

Patients reporting iodine or seafood allergy should be questioned as to the exact nature and severity of the reaction. If possible, seafood allergy should be distinguished from other causes of seafood intolerance. The presence of a seafood allergy places the patient at a threefold risk of an adverse reaction to contrast material.

https://radiology.ucsf.edu/patient-care/patient-safety/contrast/iodine-allergy#accordion-clinical-implications