Quick-Thinking Pharmacist Saves Customer

[BidingMyTime]

We've discussed this before from a theoretical perspective, with most people saying they would not give an epinephrine shot. Well, here is a pharmacist who did (and didn't even bother giving him a flu shot first! haha)

Quick-Thinking Pharmacist Saves Customer

Personally, I still would NOT. If someone is well enough to drive themselves to CVS (as this person did), then they are well enough to wait for an ambulance to arrive. I'm happy it worked out well for this pt, although I wonder if this pharmacist will be disciplined by CVS over this (my guess is yes.....)

And seriously! I really don't get people going to their local pharmacy, when it is clearly obviously they need immediate medical care. I guess I should be happy that people think so much of their local pharmacist, but it doesn't matter how capable their local pharmacist is, or ever if there were a MD/DO at their local pharmacy, there is a very limited amount of care that can be given without medical apparatus available.

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[RxPreceptor]

He totally should have used drive thru

 

[PharmDBro2017]

You wouldn't give someone with anaphylaxis/throat swelling an epi shot?...

Have you actually seen it occur from a real time perspective? I know I have, and within 15-30 seconds the person was gasping for air like a fish out of water and barely muttering "I can't breathe"... it was terrifying. Just my two cents, yes I would use the epi pen and save their life.

 

[BidingMyTime]

You wouldn't give someone with anaphylaxis/throat swelling an epi shot?....

I have not been trained to diagnose, outside of an allergic reaction to flu shots, nor does my liability insurance (nor my employer's liability insurance) cover my diagnosing. If someone comes into my pharmacy not breathing, there are many other things that could be the cause (choking, LBS, opiod overdose, heart attack, etc.) This patient admittedly had no history of food allergies, so honestly, that would not have been my first guess at what was happening. Patient's going to an emergency room not breathing aren't immediately stuck with an epi-pen, and there is a very good reason why.

 

[radio frequency]

They should have gone to the ER, but this case seems fairly cut and dry. Patient ate food, experiences signs of an allergic reaction, then signs of anaphylaxis. Though the article doesn't specify, I assume the pharmacist was discussing the allergic reaction with the patient before the obvious onset of the anaphylaxis. If I wasn't paralyzed by the suddenness of it, I'd give epinephrine, too.

Hard to say how I'd react in that actual situation--unlike ER docs and nurses who regularly see and respond to acute cases, most of my patients are ambulatory so it's possible that in the heat of the moment, maybe I wouldn't have had my wits about me. That's why the ER is the best place for a patient to go. Good thinking on the part of this pharmacist though.

 

[Claydoe]

This happened to me maybe 2-3 weeks ago. A girl got some ice cream from next door and unknown to her it had peanuts in it. Her throat swelled up and her Mom didn't know how to use it so i gave her an epi pen some benadryl and called an ambulance. Are you really going to watch an 8 year old not be able to breathe and not do anything over liability concerns? The good Samaritan law exists for a reason. Plus if you're lucky the mother you help will have some good looking daughters who come in to thank you for saving their sister's life.

 

[owlegrad]

You hope the 8 year old has a good looking sister?! Gross!!!

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[CetiAlphaFive]

This happened to me maybe 2-3 weeks ago. A girl got some ice cream from next door and unknown to her it had peanuts in it. Her throat swelled up and her Mom didn't know how to use it so i gave her an epi pen some benadryl and called an ambulance. Are you really going to watch an 8 year old not be able to breathe and not do anything over liability concerns? The good Samaritan law exists for a reason. Plus if you're lucky the mother you help will have some good looking daughters who come in to thank you for saving their sister's life.

 

[Claydoe]

You hope the 8 year old has a good looking sister?! Gross!!!

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lmao the sister was 24 no need to take a seat anywhere. Orthodox jews have kids forever

 

[Claydoe]

Good Samaritan law does not apply to licensed health care professionals

Liability Under the Good Samaritan Emergency Response Act (N.J.S.A. 2A:62A-1)
The New Jersey Good Samaritan statute encourages and protects bystanders, including doctors and paramedics, at an accident scene to render assistance to someone in need without fear of being sued if things go wrong. But what happens if you are injured by a first responder? Generally, anyone who helps in an emergency is generally considered immune to liability claims in case they make a mistake but people may still have claims under a few exceptions including noticeably negligent, reckless or intentional behavior.

 

[Sine Cura]

B-b-but pharmacists aren't real doctors.

 

[owlegrad]

Ok apparently I was told incorrectly.

Perhaps it varies by state?

 

[RxPreceptor]

On second thought the rph should be disciplined for not doing the most economically responsible option and using an adrena click generic ($110) vs epi-pen ($700+) vs ambulance drive (~$1,000+)...in the heat of the moment of course.

Variable scenarios to OP: would you be willing to let the patient self admin? Would you be more willing to do so if the patient had a history of filling the Rx & was without refills?

 

[PharmDBro2017]

I have not been trained to diagnose, outside of an allergic reaction to flu shots, nor does my liability insurance (nor my employer's liability insurance) cover my diagnosing. If someone comes into my pharmacy not breathing, there are many other things that could be the cause (choking, LBS, opiod overdose, heart attack, etc.) This patient admittedly had no history of food allergies, so honestly, that would not have been my first guess at what was happening. Patient's going to an emergency room not breathing aren't immediately stuck with an epi-pen, and there is a very good reason why.

I see where you went with that. My question was specific to knowing that it is anaphylaxis. You very well know the signs/symptoms. We actually did an epi drill (mock pt/pharmacist interaction at my school). In the real life situation, I don't think you'd have time to look up their allergy profile, see if they filled for epi pens before on their profile, etc. like some people are talking about... let's use our common sense and training, right? A patient isn't going to be thinking in their right mind, especially while driving... maybe the pharmacy was the nearest medical-type facility around. Hell that was the place he knew would for sure have epinephrine... this pt obviously made an intelligent choice rather than trying to drive an extra couple miles (if not more) to the ER gasping for breath? He could've wrecked and died in the car trying to reach the ER.

In my case, I watched someone get stung when they got too close to a hornet's nest... stung in the face and upper body ~20x at least. If the ambulance didn't arrive within a few minutes and administer epi, they would have died. That has changed my outlook on this situation permanently.

Worrying about your job and getting disciplined/losing your job vs. trying to save someones life? Is that what you'd do in an emergency situation, analyze it like that within a mere couple seconds to make the appropriate decision? If you knew for a fact it was anaphylaxis (in my case, you saw hornets sting), what would you do?

 

[BidingMyTime]

Good samaritan laws vary by state, I can't imagine any state allows a "good samaritan" to administer prescription drugs which they aren't licensed to prescribe, or which haven't already been prescribed to the patient.

So the question is, why is epinephrine a prescription at all? Why isn't it available OTC everywhere?

Obviously at some point, it seemed logical to make it prescription only, given that, why should there be any expectation for non-prescribers to break the law and administer epinephrine?