Horrible day! Need reassuring!

  1. So today was one of the worst days ever in my 5 years as a school nurse. At noon, right when I have 7 meds to give, a student at recess was running and tripped and his tooth went thru his lip. It was very bloody and he was freaking out. There was about a 1/4 inch hole and he needed stitches for sure, plus he has a broken tooth. Mom came ,( he lives across the street from school) and took him to urgent care.

    That was not the problem! The problem was during this time a K student (5 yr old) felt "hot" and the staff wanted to call his parents to pick him up. The principal had made an announcement that my office was "currently closed" (all the kids were coming for meds and the child with the lip injury was still screaming and would not calm down while waiting for his parent). K staff said that principal told them not to call " and wait 5 mins, nurse will be open" and to bring him up. So my office is finally clear of lip kid, ( after 30 mins) and this boy comes and has a fever of 103.8!!!!! I call his parents immediately and tell them to come right now and get him, that he was sick and needed a doctor.They do not speak English, but said "yes on way". He was A+ O the entire time, I gave him a cool cloth and he was lying down resting until dad came. I keep checking in on him every few minutes and he was 103.2-103.6. he fell asleep. I had JUST checked on him again, he was the same, when his dad walks and I bring him over to where he is laying and he is having a seizure!!!
    The father flips out and screams " what you do to my boy!". I ask if he has ever had a seizure or any medical issues, he says no. He picks the kid up off the bed and goes running into the main office with him, meanwhile I walkie talkies to call 911 .
    Keep him safe on side, etc...
    He was breathing the entire time and had a good HR and he was semi alert, he knew dad was there. Ambulance arrived and takes him to hospital. I am waiting to hear what happened.
    But now, principal gets mad at me because I did not give him Tylenol!!! Really in the 29 mins he was in my office, I tried to get him to have a sip of water, he didn't want any. Plus I am not forcing a 5 year to have a med when the parents were on the way. I think that if principal had let the K staff bring him to me, or let them call home , he would have been seen by me almost an hour sooner and possibly could have not seized!

    I am so upset, I am still shaking. I feel I did everything right, would you have done anything different? I pray this boy is ok, I am positive it was afebrile seizure, I know , can't diagnose, but I bet my life on it.

    Thanks for listening. I am just upset and waiting for the fall out tomorrow. I know this is long! Thanks for reading my mess.
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  2. 25 Comments

  3. by   Windchaser22
    Hang in there and breathe. Your the medical professional, not the principal. A child can have a febrile seizure BEFORE they spike a temp, at a temp of 101 or higher, if they have a family history etc. if it was febrile it was most likely viral and giving him Tylenol would not have prevented it. Cooling him down would not have prevented it. Your boss can look it up if she doesn't believe you. As a side note, she shouldn't have said you were closed. It's not their job to assess what needs to be seen and dealt with. Instead, maybe she could've sent you help...If this was the child's first seizure they should be evaluated anyway.
    Seems like you did what you could.
    Hoping for a good outcome. Keep us posted!
  4. by   peacockblue
    It's hard being the only medical person in the building g and when multiple things happen at once, you have no one to back you up. I know my admin wants nothing to do with blood, vomit or any body fluid so they will come no where near my office when things are happening. Sounds like you did the best you could with the situation as it unfolded. And yes, someone else could have sat with the bloody lip kid and someone else could have called the kinder kids parent. As it was, it all got thrown on you and you did the best you could. Let us know how everyone is.
  5. by   moreoreo
    I agree with everyone else. You did what you could in the circumstances. I have had it happen too that the office always seems full when mishaps come up (this is the biggest reason why I have been taking measures to cut down on unnecessary visits-- it's a safety issue). I hope that your administration will support you when it comes to the second child, if necessary. (Honestly Dad probably was just panicked.) Additionally, hopefully you documented your close/frequent assessment and intervention.

    I agree it's on the principal that he "closed" your office. Sometimes when I call 911 the office staff pull other kids out of my office and into the main office to wait (to allow me to prioritize the emergency and to provide privacy to the child in crisis) but I wouldn't want them to tell the whole school not to send anyone. Honestly it's not your fault this happened. By the time he was with you his temp was already so high. You kept him safe and parent was on their way. You sent to the hospital when it became necessary.

    Take a deep breath and think good thoughts. Hold your head high and know you did what you could! Both children are safe thanks to your care and at the end of the day, any reasonable person will know that.
  6. by   OldDude
    One of those days in school nursing where lady luck poops right down your shirt collar. You did nothing wrong. No one suffered anything really bad. It was all emotion and you were the only constant of objectivity and sanity. So, settle down, go in tomorrow, smile and wave, and move on. Keep in mind, it's not the number associated with a fever but the level of consciousness and orientation. I've seen a 3 year old with a rectal temp of 107.3 awake, alert, talkative, and OK. Febrile seizures occur with a change in temperature up or down, not a number threshold. I've seen febrile seizures with a temp of 99.5. If you can predict them you could likely know where Amelia Earhart is. Otherwise, no big deal on the tooth and a hole through the lip. You were just the bug today and not the windshield. Don't deviate or falter in regard to administration. You are the health care professional...they are not; end of story. OK????????
  7. by   scuba nurse
    Thanks guys for the support! I know I did all the right stuff and my social worker was there and got all out of my office and the rest of the staff were great. I know my nsg supervisor will be on my side if principal becomes a problem. I had some wine and dinner and calmed down a bit!
    See you tomorrow, good night!
  8. by   NutmeggeRN
    Somedays we do our best and hope for the best! The "closing" of the is office is on the principal. The kid was sick and 29 min was not going to make a huge difference in whether or not they were likely to have a seizure. We triage and make our best professional judgement based on what we see. If you did not see h im (due to said closed office), you could not triage him. When you did see him, you called the parent. There is no crystal ball. Hang in there!
  9. by   Flare
    Hang in there. I don't know about your state's laws, but in my office i would not be permitted to give tylenol for that fever unless the child already had an order in place - in my district i don't have a standing order for tylenol. The bottom line is that there is one of you. You triaged, you did the best you could and given the situation, 30 minutes is not a long wait. If they were to take the child to the ER or a dr's office, they would surely wait longer than 30 minutes to be seen. I am trying to picture the office staff trying to call these parents (whom i obviously don't know) and am wondering if they would have come if they knew the child hadn't been seen because you were tied up with a different emergency. My guess is yes - but that when the inevitable seizure happened at home that you would be in the hotseat anyhow.
  10. by   JenTheSchoolRN
    Scuba, I do have a standing order for acetaminophen, but to be honest, with a temp of almost 104, I'm calling the parent for a pick-up and I won't usually give acetaminophen if parent is in route and taking student to be evaluated.

    Otherwise, I totally agree with all of the other posters here, especially pointing out that a febrile seizure can happen without any warning and at any temp. Sorry it was such a day, scuba and ::. We have all had one of those days.
  11. by   scuba nurse
    Quote from Jen-Elizabeth
    Scuba, I do have a standing order for acetaminophen, but to be honest, with a temp of almost 104, I'm calling the parent for a pick-up and I won't usually give acetaminophen if parent is in route and taking student to be evaluated.

    Otherwise, I totally agree with all of the other posters here, especially pointing out that a febrile seizure can happen without any warning and at any temp. Sorry it was such a day, scuba and ::. We have all had one of those days.
    Yes I do have a standing order for Tylenol, and the parents did sign off for him to have it. BUT, he wouldn't even take a sip of water, so not sure how I was going to get Tylenol into him. And the parents were on the way, I usually ask when they come to pick up if they would like me to give some Tylenol before they leave. (I didn't in this case obviously).
  12. by   BedsideNurse
    Doesn't sound like he would have taken it, but maybe in the future if a kid has a serious temp ask the parent if you can give Tylenol while they are on the way....What a horrible day; a lot of variables out of your control but I know it's still upsetting. :/ It's not your fault, but I can see why the parents were upset. I'd be freaked out too if I came in the office and my kid was seizing, although I wouldn't be asking what'd you do to him. It sounds like the student was coming around ok by the time he left, so glad everything is probably okay. What a bummer.
  13. by   JenTheSchoolRN
    Quote from scuba nurse
    Yes I do have a standing order for Tylenol, and the parents did sign off for him to have it. BUT, he wouldn't even take a sip of water, so not sure how I was going to get Tylenol into him. And the parents were on the way, I usually ask when they come to pick up if they would like me to give some Tylenol before they leave. (I didn't in this case obviously).
    Oh no, you were on point! I would not have tried to give that kid meds when he wouldn't even take water (not to mention that getting a 5 year old to take medication can be trial without that hurdle to begin with). Dad was on the way, you were monitoring. You took appropriate action when situation worsened.

    You were great. Your principal would be a butt to give you a hard time on this.
  14. by   WineRN
    That is a tough day.

    As everyone else said, you did everything right. I think in the heat of the moment people say things and become angry before understanding the situation. Your principal probably just knows that Tylenol reduces fevers, and jumped to thinking that administering that would have fixed everything. But like others said, he probably still would have had the episode even if you forced him to take the Tylenol some how.

    And who knows how the boy was presenting to the teachers. I have little ones sent all the time because even though they are acting absolutely fine but the teacher just happened to touch them or notice sweat on the little one's forehead and they have temps in the 101-102 range. No one is at fault here, it just happened.

    Lots of positive vibes being sent your way for a better rest of the week.

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