called 911

Specialties School

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I am a relatively new school nurse. The other day I got a phone call from one of my elementary schools (while I was at one of the my other schools) that a student was short of breath and struggling to breathe. They stated that she had been running in gym class when it started. No PMH or allergies that we knew of. I asked a few questions and then drove over to that school as fast as I could (about 15 minutes). Her face was bright red, lung sounds were wheezing, very labored breathing, tachypneic, O2 in the low 80s. She'd been like this for about 20 minutes at this point. Principal said she hasdn't gotten any better. Attempted to call mom, but initially could not reach her, so I called 911. While I called 911, the secretary reached the mother and she was on her way as well. EMS got there and put 2L of O2 on her. Within a couple of minutes, the wheezing went away, her O2 went up to the mid 90s, and her breathing became less labored. Mom arrived after the student looked much better from the oxygen. Mom has asthma. We took the O2 off of her and she continued to do fine at this point. EMS talked to the mom and didn't feel that she needed to go to the ER, but encouraged her to follow up with her PCP and get tested for asthma (which I generally agreed with). Mom ended up taking the student home and said she was going to call her PCP.

Of course, since this has happened I've been questioning whether calling 911 was the right thing to do or if I should have held off. The nearest hospital is 45 minutes away. I had absolutely nothing at school that I could give her (we can only stock epi and narcan). What would you have done?

Specializes in School Nurse. Having conversations with littles..

Glad the kiddo is ok. What a scary situation. It sounds like you are in somewhat the same situation as I am, (being in more than1 building, with miles in between.) To cover the other buildings- where I am not- I have provided a copy of this http://health.mo.gov/living/families/schoolhealth/pdf/EmergencyGuidelinesForSchools.pdf . It is Emergency Guidelines when the nurse is not there. I have posted the link before, but here it is again, in case it would be helpful.

Happy Happy Day!

Specializes in School Nurse. Having conversations with littles..

Another thought- Whoever covers your job when you are not in the building- secretary, health aide, admin., etc. Are they certified/trained in First Aid? If so, they should be able to decide if a student that is this bad, whether to call or not. There is a really nice page in the resource that I provided the link above for- "WHEN TO CALL EMERGENCY MEDICAL SERVICES." Has a list of several different reasons to go ahead and call EMS.

To be honest, if one of my students are as ill as it sounded like this one was. My Secretaries/Admin. know that if I am 15 minutes away. That I wouldn't want them to wait for me to get there before they call 911. They know that we have limited "tools in our closet" to handle life threatening situations. Also, I have told them that there is nothing "magical" about the nurse. I can only do so much.

Good luck, this is a crazy boat we are on!! :)

Great job calling 911, and I would consider having called before driving over, unless you have the means for definitive care for a pediatric patient in respiratory distress, I think calling in people who do as early as possible is prudent. Like others have said, much easier to explain prudence rather than negligence.

Specializes in kids.

I would say no on the Epi as well and never hesitate to call. Trust me they wanna be called vs not especially with a kiddo who can tank quickly. Good time to review the what ifs for when you are not available.

"When in doubt, ship 'em out!"

You absolutely did the right thing.

For perspective, our school district has stock albuterol and nebulizers in each school and a very specific respiratory distress protocol we can activate independently. My standing orders for that protocol are to call 911 if SpO2 is less than 85%, period.

You did the right thing and honestly I would have wanted the staff to do so earlier if exhibiting that much distress.

Good job!

Specializes in Emergency Department/Labor and Delivery.

Did EMS run a 12 Lead on the kiddo?

Did EMS run a 12 Lead on the kiddo?

No, they didn't do much other than put O2 on her. They listened to her lungs when they first got there and said that her lung sounds were clear- which they most definitely were not. They took her BP, and I already had my pulse ox on her finger. That was pretty much it. Her mom did take her to the doctor and she has an inhaler prescribed which is at school now thankfully.

Specializes in School Nursing.

I think you absolutely made the right call! I have asthma and have had sats in the low 80s. I ended up on O2 in the intensive care unit for 3 days. You did the right thing. Thank you.

Specializes in Pediatrics Retired.
I think you absolutely made the right call! I have asthma and have had sats in the low 80s. I ended up on O2 in the intensive care unit for 3 days. You did the right thing. Thank you.

You think that caused any brain damage? :whistling:

Wow O2 tanks in school?! I would have had them call while I was on the way, but you for sure did the right thing by calling!! We do not have stock albuterol. I have used caffeinated drinks in a pinch but not sure it would help someone with sats that low. Good Job!!

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