How Well Was Anaphylactic Reaction Treated at Your Hospital\'s Emergency Room?

Posted on: Sun, 04/13/2003 - 2:17am
Anonymous's picture
Anonymous (not verified)

This question stems from another thread running re CEPA Protocol re anaphylaxis in Canadian hospitals.

When you took your PA child to the hospital, having an anaphylactic reaction, how well do you think the reaction/your child/you were treated? Was the reaction treated quickly and effectively?

Also, did you arrive by walk-in or by ambulance?

It's a beautiful day here and I'm off to the dog park (yes, the dog park [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img] ) so I'll place my answers in later.

I have been to emergency twice with Jesse for anaphylactic reactions. Different hospitals. Both times we were walk-ins.

The how well part answers I'll post later. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Many thanks and best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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Posted on: Sun, 04/13/2003 - 4:59am
MommaBear's picture
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Joined: 09/23/2002 - 09:00

Quote:Originally posted by Cindy Spowart Cook:
[b]This question stems from another thread running re CEPA Protocol re anaphylaxis in Canadian hospitals.
When you took your PA child to the hospital, having an anaphylactic reaction, how well do you think the reaction/your child/you were treated? Was the reaction treated quickly and effectively?
Also, did you arrive by walk-in or by ambulance?
[/b]
Cindy,
Could you clarify please:
Is this question in reference to one's [i] perception [/i] of being [i] treated well [/i], or in reference to how adequately [i]Standards, Policy, and Protocol [/i] were met? ie: [b] appropriate [/b] care given the current Standard, Policy, and Protocol at the time care was rendered?
MommaBear [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]

Posted on: Sun, 04/13/2003 - 8:53am
Anonymous's picture
Anonymous (not verified)

Momma Bear, hopefully to clarify, but perhaps not:-
When you arrived at triage, were you taken seriously? Based on the CEPA Protocol and the stage of anaphylaxis your child was in at the time you arrived at triage, were you *properly* put at Level 1 or Level 2? Did the doctor who eventually dealt with your child know what they *should* know about anaphylaxis? Were any incredibly stupid comments made by staff (i.e., nurses, doctors) that you couldn't believe you were actually hearing from medical personnel (I have to receive permission from someone to post a stupid comment they were given)? Did you end up staying for observation or were you allowed to go? When you left, were you prescribed an Epi-pen (if this was your first time with a reaction)? Were you prescribed a liquid steroid?
Basically, did the hospital "get it" as much as you, the PA parent does now or did then?
Since I'm here now, I'll answer. I just realized that Jesse has been to emerg three times due to his PA. The first was the first time he had a reaction. Looking back at that reaction now, I do think it was anaphylactic (more than two systems involved), but by the time we got to emerg, the symptoms were subsiding. The emergency staff took us in quickly, he was assessed quickly, we were given a prescription for an Epi-pen and allowed to leave (again, the symptoms were subsiding).
The second time was when Jesse almost died. He had been administered an Epi-pen. As soon as we got to the hospital, he must have been assessed as Level 1 and we were taken quickly into emerg. I can't remember now how many people were there to work on him. The doctor administered another Epi-pen and an I.V. was set up for him. We were kept in intensive care for the night and left the following morning only after being assessed by a doctor and given another prescription for a replacement Epi-pen, and also a course of Pedi-Pred.
The last time we went to emerg was in December month. I think because there were no respiratory problems, and now understanding how assessment is done (from the information in the other thread), we were assessed at Level 2. It was frightening for me because I was sitting in the room waiting to be seen by the doctor and holding by Epi-pen in my hand at the same time in case I had to use it. As I have posted numerous times here, this reaction was very unusual. It did not progress as quickly as previous anaphylactic reactions and actually halted itself before an Epi-pen was administered and even before Benadryl was administered.
The doctor did say that Jesse should take Benadryl for the next two days. I asked him about a 'script for Pedi-Pred and he said no, he didn't need one (I disagree). Then, we were allowed to leave. I also believe I asked the doctor how long I should observe Jesse and he gave me an incorrect answer (it is 24 hours at least).
So, the first time, yes, pleased. They diagnosed PA and gave us a 'script for an Epi-pen (even if no other information re PA was given).
The second time, absolutely. The doctor and the team that worked with him were absolutely fantastic. The doctor spoke with me about the seriousness of Jesse's allergy, etc. after things had calmed down a bit. Also, we were kept in intensive care and not allowed to leave until a doctor had checked Jesse. And we left with a 'script for an Epi-pen and Pedi-Pred.
The third time, okay, now I understand why I had to wait to be seen by a doctor - Jesse was not having respiratory difficulties at the time we entered triage. But as far as the doctor and his knowledge re anaphylaxis and PA, I felt that he was lacking.
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
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Posted on: Sun, 04/13/2003 - 9:21am
MommaBear's picture
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Joined: 09/23/2002 - 09:00

Quote:Originally posted by MommaBear:
[b] Cindy,
Could you clarify please:
Is this question in reference to one's [i] perception [/i] of being [i] treated well [/i], or in reference to how adequately [i]Standards, Policy, and Protocol [/i] were met? ie: [b] appropriate [/b] care given the current Standard, Policy, and Protocol at the time care was rendered?
MommaBear [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img][/b]
Cindy,
I still stand by my original post. [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]
MommaBear

Posted on: Sun, 04/13/2003 - 9:41am
Corvallis Mom's picture
Offline
Joined: 05/22/2001 - 09:00

We've been seen twice- the initial reaction, which was anaphylactic (and was clearly triaged as such by our HMO's nurse on their 1-800 number... long story)
Anyway, when we arrived at the ER with our then 11 mo. old, she was crying, floppy, swollen to nearly unrecognizable and covered in blistery hives. Both eyes were swollen nearly shut. We TOLD the ER staff that this was a peanut reaction. They told us they would (gasp!) call the doctor in. ( [img]http://uumor.pair.com/nutalle2/peanutallergy/eek.gif[/img] that's right- there wasn't one there.)
We were led into a room where we waited forty minutes before evaluation- by which time our daughter was CLEARLY (in hindsight) in shock- she was ghostly white, floppy, and marginally responsive. We were not given medication until the ER doctor arrived another twenty minutes after that. By that time, they came back and reevaluated us as she was beginning to get better- this is about an hour and a half after the ingestion... we were given a HUGE dose of oral Benadryl (about a tsp/5mL for a 18 lb infant!) at that point on the doctor's recommendation. By the time he saw her, she was fast asleep- that bizarre twilight sleep following a reaction- and we left with no epinephrine. He did at least tell us to get rid of anything containing PN in our house- including pn oil.
Were we handled correctly? You tell me. *I* don't think so, and not ONE of our regular physicians ever has, either. Our allergists have told us in very frank terms that we are fortunate she did not progress because she would be dead.
Second trip- (different city) We were taken very seriously- dd and DH were taken back to a room IMMEDIATELY and her stats were taken- by this time, Benadryl was kicking in and skin symptoms were subsiding, though we were still complaining that she was acting "shocky"- This reaction was the one that involved ALL of anaphylaxis' symptoms in less than 10 minutes save airway involvement, coma, and death. I hope that we don't have to go to that to get appropriate care. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] All in all, I was much much happier with how the second incident was handled. The ER doctor said that our quickness with the Benadryl was what stopped the anaphylaxis from progressing- our allergist later agreed.
We got a stern talking to from our allergist for not administering epinephrine- which I *know* we should have done- he warned us that given her history, next time we may literally have only seconds to do so or it could be too late. He also told us that the ER should have taken her blood pressure FIRST THING. And that next time (God help us) we must insist upon it- throw a fit if necessary, be as nasty as needed, but get it done. Next time I will also just throw my insurance cards at the ER admitting nurse and tell her to figure it out herself- I am going back to be with my daughter. I spent most of my time that first ten minutes filling out paperwork- which I suspect would not have happened if we had come in an ambulance.
Both times we were walk-ins, but I really don't think it would have made a difference. Where we have lived has just never been that busy at the ER- so we generally wouldn't have a long wait for anything. We have never been kept at the ER long enough, IMO, but in defense of this, we live close enough that its probably OK for us to go home sooner- we can be back in five minutes.
(Wow- I'll bet you all can still feel the searing anger from the recounting of our first ER visit- three years ago this May, but not an instant has faded. [img]http://uumor.pair.com/nutalle2/peanutallergy/mad.gif[/img] )
So- my bottom line is this:
1. Make certain that the ER staff you speak to are clear on the point that this is not just "allergies" and hammer your point home if they don't get it. A full evaluation is needed NOW for anaphylaxis.
2. Small town=laid back attitude. Make it clear if you are a walk-in that you are there because it was FASTER than calling 911.
3. If you have anaphylaxis that presents unusually, you need to be a lot more proactive/assertive. Barfing/hives/wheezing isn't synonymous with anaphylaxis.
Hope this helps someone. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
[This message has been edited by Corvallis Mom (edited April 13, 2003).]

Posted on: Sun, 04/13/2003 - 10:46am
Anonymous's picture
Anonymous (not verified)

I was originally writing a really long post, but, in a *nutshell*, I'm happy with the treatment I've received both for myself and for my son.
When it was life or death it was treated that way. When it was not it wasn't.
I was given information and asked appropriate questions. Not everything was perfect, but, doctor's are human as well.
My experiences have included a large city, overcrowded ER as well as a small town, laid back empty ER. And although it wasn't life or death the doctor took extra time to make sure we knew what to do and where the nearest hospital to our cottage was. He was EXTREMELY helpful and knowledgeable. In my opinion he made only one error - rather than prescribing an epi-pen he told me to go to my gp and get a prescription. That was the same complaint I had at the big city hospital though - they told me to go to gp to get epi-pen.

Posted on: Sun, 04/13/2003 - 11:06am
darthcleo's picture
Offline
Joined: 11/08/2000 - 09:00

my only experience with anaphylaxis was for myself, strangely enough, not for my son... And that was, oh, 15 years ago already. Gosh, time flies...
I was leaving the hospital after a test where they injected a contrast substance into my knee. Just before leaving the xray area, I told the nurse I was having hot flashes. She looked at my eyes, and agreed I may possibly be having a small reaction. She got a doctor right away. The doc said, yup, a small reaction. He got the allergist right away. The allergist said, yup, small reaction. Got me epi, benadryl, oxygen, put me on a gazillion monitors and told a nurse to stay with me for 3 hours!
At one point, I couldn't hear anymore, I was so swollen my ears were blocked. I could clearly see my eyebrows, as they were in the way of my sight. I was glad I had the nurse by my side, if *that* was a small reaction!!!
I was told to consult with an allergist, who confirmed the allergy and a million others, but never prescribed an epi.

Posted on: Sun, 04/13/2003 - 11:45am
Anonymous's picture
Anonymous (not verified)

Corvallis Mom, I liked the points that you made at the end of your post. I do believe they will or can be helpful to a PA parent that has not had to take their child to emerg with an anaphylactic reaction. I am sure there are a lot of members posting here whose children have not experienced anaphylaxis.
I appreciated each post above. I do think that our sharing of experiences, such as ones at the E.R. are important to help other PA parents, whether it be their first time going with their PA child, or simply the next time. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
Many thanks and best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
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Posted on: Sun, 04/13/2003 - 1:15pm
cynde's picture
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Joined: 12/10/2002 - 09:00

Of our two trips to the ER for DS anaphylactic rxns, the first was a walk in, the triage nurse took us in immediately, and the Dr. was in within seconds.
For the second anaphylacitc rxn we went in an ambulance after they had stabilized him, we were taken into an exam area immediately and seen by a Dr. in less than a minute.
Both times were in a small town hospital that can still be busy at times. When we walked in, we were taken in ahead of at least a half-dozen people. When we went by ambulance I did not see the waiting room.
Neither time were we kept their for observation, or had biphasic reactions mentioned, even though I knew about the possibility. I was comfortable about taking him home and watching him sleep. We are not far from the hospital. I would not have left if I was not comofortable, but next time I will mention it to the ER Dr. so they do not send any unsuspecting parents home without this type of information.

Posted on: Sun, 04/13/2003 - 11:05pm
MommaBear's picture
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Joined: 09/23/2002 - 09:00

Corvallis mom,
Was the ER you went to a hospital ER? I am trying to figure out why an ER physician wasn't on the premises? (Or was he?) Where was this "ER"? Did you ever follow up on that?
As to arriving by ambulance, depending on the type of ambulance service your area has access to, much pre-hospital care can be attended to. It is desirable to achieve as much patient "stability" as is possible given particular situations prior to transport (or at least en route). Our ER has communication with ambulances comming in to help us prepare for situations.
Disclaimer: This post not intended as advice in any manner or form.

Posted on: Mon, 04/14/2003 - 1:54am
MommaBear's picture
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Joined: 09/23/2002 - 09:00

corvallis mom,
The other reason I ask (in my previous post) is because I am wondering if "all hell was breaking loose" in the ER. If so, there frequently are policies, procedure and protocol that deal with [i] hell [/i], so to speak. One that comes to mind is placing an institution on "By-pass". Ambulances which quite possibly carry the [i]most critical[/i] individuals can be diverted to appropriate, alternate facilities to appropriate care in a more timely fashion.
As long as the subject is out there.......... the particular EMS system I am familiar with has Policy, Procedure, and Protocol to transport individuals meeting certain criteria to appropriate facilities by chopper. On a regular basis, such lands at the particular institution I am employed by.
I will also note that when my father presented to the ER by ambulance, a vascular team was available to the hospital within 30 minutes (I might even venture to say in less time, but this is a rough estimate). This based on presenting with a ruptured AAA. Although he made a decision not to utilize the services of such a team, [i] the alternative was available [/i].
A timely link that discusses a similiar topic (note specificity where applicable):
[url="http://www.careforall.net/AccesstoHealthCare/EmergencyBypassStat0967/index.asp"]http://www.careforall.net/AccesstoHealthCare/EmergencyBypassStat0967/index.asp[/url]
MommaBear [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]
Disclaimer: I do not guarantee the accuracy or content of the link in this post. This post not intended as advice in any manner or form.

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