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

Lev, MSN, RN, NP · Feb 22, 2016

I have dealt with 2 anaphylactic reactions. One was just this evening. That patient ended up intubated. She was not yet in shock since her BP was not tanking. Most people having anaphylactic reactions do not end in shock. When your patient's throat starts feeling funny or like it's closing you call a rapid response and try to thwart a full blown anaphylactic reaction.

Kooky Korky, BSN, RN · Feb 22, 2016

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

One step at a time, dear heart. You've gotten good info here. I think you'll be a fabulous student and nurse.

Codes depend on the facility. Usually (in my experience):

Code Blue = cardiac arrest, respiratory arrest because the pt is turning blue

Code Red or Dr. Red = Fire

Code Black or Dr. Black = serious weather approaching (hurricane, tornadoes)

Code Gray = terrorism attack or multiple casualties expected to start arriving from an accident involving many injured or ill people (vehicle accidents, plane crash, school or workplace shootings, many people being poisoned, explosions);

Code Pink = a nurse is being maltreated by a doctor and the other nurses gather around and make sure the maltreating person is aware he or she is being observed by all of them; a show of solidarity for one's beleaguered colleague;

Code Brown = serious bowel movement, pt covered with stool;

There are probably others and you should be given some orientation to the facility about its procedures, like where is the button to push, where does each worker report (like to ER or OR) and what are the duties - do you move pts away from windows so they don't get hurt by possible flying glass, for example. Do you act as a runner to get supplies from Central Sterile Supply? Do you keep a list of names of people arriving? All sorts of stuff like this will be taught to you in due time. It's great that you are dedicated to learning and I believe you will be great in your chosen profession. God bless you and keep us posted.

Take some food and water with you as well as a change of underwear, meds you must take, anything you figure you will keep in your car or locker or backpack and might need. As a student you will likely be able to take a break, so maybe the food isn't critical, but a banana, yogurt, something small and easy to keep nearby is nice to have.

calivianya, BSN, RN · Feb 22, 2016

I have never had a patient have an anaphylactic reaction from a medication I have given them, but I have taken care of several patients who had anaphylactic events either outside of the hospital or on a different floor and came to me for close monitoring until whatever provoked the reaction was out of their systems. Most just required routine scheduled steroids/Pepcid/Benadryl and didn't even need any PRNs. I've only had one that I had to practically sit on all night because I was sure we were about to have to intubate her, and even she managed to avoid a breathing tube all night long.

Taking care of patients with anaphylaxis really isn't as bad as it sounds. You're going to see a whole lot more patients with the other types of shock, and they are going to be sicker and harder to fix than someone who is anaphylactic.

chacha82, ADN, BSN · Feb 22, 2016

As a student the best thing you can do is be aware of the expectations for what you need to do in clinical. Do not sit down at a computer on the floor and chart or use a COW - make sure none of the staff needs to use them first. Be helpful to the nurse you are paired with or in the group. Do not walk into a room and ask to see "something cool." That is a patient and they are not there to be an experiment. If you are in line at a code to do chest compressions be prepared to do them! You should be ready to do tasks like vitals, I&0s, foley care, etc. Always write things down and have them ready to chart. You will do great and you will not be expected to function as an independent nurse when you start but good for you for wanting to be ready.

canigraduate · Feb 22, 2016

This has the feel of a troll post. Where'd you go, OP?

If you're that worried about an anaphylactic reaction, look up how to deal with it. Knowledge is power.

Based on your own studies, what are the actions you would take as a nurse?

1) Assess - is the patient in distress? Is the airway intact? Is the patient complaining of difficulty breathing? What physical evidence do you have that the patient is having a reaction? What are the current vital signs? What medication did the patient receive?

2) Diagnose - Is the patient having a sensitivity issue and is just itchy? Or is the patient having an allergic reaction?

3) Plan - What do you need to do to address what you found? What are the treatments for allergic reaction? What would you expect the doctor to order?

4) Implement - Call the doctor, ask for what you need to treat the patient, and do what the doctor says.

5) Evaluate - Is the treatment working? How do you know? What physical evidence do you have? Do you need further intervention?

Answer these questions in your studies and you will know what to do.

That Guy, BSN, RN, EMT-B · Feb 22, 2016

You will know a true anaphylactic reaction when you see it. It is terrifying to witness.

djh123 · Feb 22, 2016

OK, here's the first answer: "Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. It typically causes more than one of the following: an itchy rash, throat or tongue swelling, shortness of breath, vomiting, lightheadedness, and low blood pressure. These symptoms typically come on over minutes to hours."

But you're asking too many questions at once, and seem generally stressed out. Take a deep breath! You're not the only one who is, or was, stressed out about clinicals beginning. As others have said, you're not an independently-functioning nurse when you're a student. And anaphylactic shock isn't all that common. You'll probably do fine. Although it's kind of cliched to say so, take it one day at a time, one clinical at a time, one situation at a time. And try to remain level-headed rather than panic. I know that's easier said than done, but I'm much better at that now than I was when I started. Assess the situation, pay attention to symptoms, think of the likely possibilities. And hey, when you're a student, and you don't know the answer(s), ask questions. And if the nurse(s) you're working with aren't as helpful as they could or should be, or even if they are, remember to look related things up after the clinical, so you'll know better how to handle the situation when you're on your own.

OCNRN63, RN · Feb 23, 2016

Well, if my patient is going into anaphylactic shock i typically start running around. If they code, lunch time!

I'm so glad to see this. I was just thinking this thread is screaming for a post from NOADLS. Thanks for picking up the baton.

Farawyn · Feb 23, 2016

I'm so glad to see this. I was just thinking this thread is screaming for a post from NOADLS. Thanks for picking up the baton.

Not NOADLS. He would delegate.

It's that other dude with the well oiled hair of whom you are thinking.

cracklingkraken, ASN, RN · Feb 23, 2016

That's probably not going to help much since that is a well-debunked myth. It used to be assumed that the reason someone would be allergic to shellfish is that it contains higher levels of iodine, this was before we understood that not all meat proteins are the same; some can trigger an allergic response while others don't, it had nothing to do with the iodine. This is further debunked by the fact that you can't be truly allergic to iodine. It's an element which is incapable of triggering an antibody mediated reaction, and in modern societies is completely unavoidable.

Whaaaa!? Mind blown.

ScrappytheCoco · Feb 23, 2016

Emergency Department RN here.

In 3 years I have seen only 1 true case of anaphylaxis...about 15 minutes after administering Rocephin IM.

I have never ever seen a transfusion reaction. (Knock knock)

The best advice I ever received from an old ER doctor was that "it's not your emergency." Take it seriously, call for help, and do what you're told when help arrives. relax! And good luck in nursing school.

akulahawkRN, ADN, RN, EMT-P · Feb 23, 2016

Emergency Department RN here.
In 3 years I have seen only 1 true case of anaphylaxis...about 15 minutes after administering Rocephin IM.
I have never ever seen a transfusion reaction. (Knock knock)
The best advice I ever received from an old ER doctor was that "it's not your emergency." Take it seriously, call for help, and do what you're told when help arrives. relax! And good luck in nursing school.

I used to work as a Paramedic and I've treated a few true cases of anaphylaxis, one of which was the first call of my field internship. Yes, anaphylaxis is very scary and it's one of the few times that you absolutely must act very very quickly. The advice you got from your "old ER doctor" is excellent advice and I've been following it for many years. It allows you to work both fast and efficiently during times of "high drama" where your patient is having their emergency.

What was the outcome of (literally) my first call? Well, the patient went from being in severe distress and having a severely compromised airway (not completely closed, thankfully) to only a very mild distress and no airway problems within 5 minutes and was likely discharged home just a few hours later with a very strong understanding that taking someone else's antibiotics isn't a good idea...