Anoxic Brain Injury - Nurse Accused of Not Treating Asthma

[Katillac, RN]

I feel horrible for everyone involved in this situation.

LAKEVILLE, Minn. (FOX 9) - A family says their daughter suffered a traumatic brain injury and is now in a vegetative state after her school nurse in Lakeville, Minnesota didn't treat her asthma.

In a lawsuit filed on Thursday, the family's attorneys say the nurse at McGuire Middle School failed to properly evaluate her and sent her to gym class where she lost consciousness and had to be taken to the hospital. Now, they say she will require caretaking services for the rest of her life.

Leading up to the date of her medical emergency, the family says their daughter Aaliyah had a long history of asthma with severe exacerbations that required medical intervention. The school district and nurse were aware of the severity of her condition, according to the lawsuit.

https://www.fox5ny.com/news/family-minnesota-girl-in-vegetative-state-after-school-nurse-failed-to-treat-her-asthma

[beachynurse, ASN, BSN]

I would reserve comment until I knew all facts to the story.

[JenTheSchoolRN, BSN, RN]

One side of the story, as I have many questions. Did student have inhaler at school? How did she present at nurse's office?

Asthma is scary; kids compensation until suddenly they don't. At my school, I can excuse a student with asthma from gym for 1-2 days if my assessment determines it is needed for their health (then doctor's f/u and note needed). What is the policy in this school? Also was school nurse a RN, LPN, or health aid that is being called a nurse?

But reminded me to confirm that my Liability Insurance was up to date for this school year.

[Katillac, RN]

Yep, for sure there's more we don't know than we do. All I've been able to glean from other stories is the student was 14 years old and the school has denied responsibility. It could have gone down so many different ways. It could be that the nurse (and you're right, it isn't stated whether RN, LPN or other) exercised perfect clinical judgment but the parents were approached by a lawyer who smelled money to be made. Or it could be anything else, we don't know.

In no way am I suggesting blame. I guess I should have said my point in posting this was I have mad respect for school nurses who need to navigate these waters, which can become life and death matters or be a routine assessment and back to class, every day. I was thinking it's such huge responsibility to manage the well-being of hundreds of kids, especially because you're pretty much a single practitioner.

[JenTheSchoolRN, BSN, RN]

3 minutes ago, Katillac said:

I was thinking it's such huge responsibility to manage the well-being of hundreds of kids, especially because you're pretty much a single practitioner.

Yep, this. School nursing is so much different than any other area of nursing because often you are a single practitioner; and every single person you work with doesn't understand your job (and sometimes its importance).

Those of us here mainly love it, but we work with many challenges often given to us by non medical staff.

[ruby_jane, BSN, RN]

Oh dear heaven above.

This is why I auscultate breath sounds on someone with a known case of asthma. Every. Time.

I, too, wonder if the parent chose to complete the asthma action paperwork, notify the nurse, and provide medication.

In my other district we had an 8th grader who died from her asthma exacerbation whilst in her sports period. When it was all over, it turned out that she was carrying her own inhaler without paperwork and the nurse had no idea of the condition because nobody told that nurse anything.

Not that I have it to give...but I wonder if an Epi pen would have been efficacious. That walks me into the fine line of assessing versus prescribing....

[JenTheSchoolRN, BSN, RN]

Just now, ruby_jane said:

Not that I have it to give...but I wonder if an Epi pen would have been efficacious. That walks me into the fine line of assessing versus prescribing....

Interesting about Epi. For the first time this year, I have a student with both asthma and food allergies, so they also have an Epi pen. AND Epi pen is part of their asthma action plan for red zone treatment.

[ruby_jane, BSN, RN]

1 minute ago, JenTheSchoolRN said:

Interesting about Epi. For the first time this year, I have a student with both asthma and food allergies, so they also have an Epi pen. AND Epi pen is part of their asthma action plan for red zone treatment.

Epi was (not sure it still is) part of the cascade program for cardiac arrest in the hospital I worked at 10 years ago. That's what made me think of it. But I'm wandering far out of my scope....

[BeckyESRN]

3 minutes ago, ruby_jane said:

Epi was (not sure it still is) part of the cascade program for cardiac arrest in the hospital I worked at 10 years ago. That's what made me think of it. But I'm wandering far out of my scope....

There is an Epi based OTC inhaler back on the market, so I think you're on the right track!

My standing order for Epi says for signs and symptoms of allergic reaction and honestly, sudden onset SOB looks a lot like an anaphylactic symptom to me!

[cid1]

A nurse in my district a while back used an undesignated Epi pen on a bad asthmatic. It helped and she went to ER with 911.

[jnemartin, BSN, RN]

1 hour ago, JenTheSchoolRN said:

Interesting about Epi. For the first time this year, I have a student with both asthma and food allergies, so they also have an Epi pen. AND Epi pen is part of their asthma action plan for red zone treatment.

Yep! I attended a SN conference in the spring that discusses asthma, allergies, and all the big issues - and both the pulmonologist and allergist said that EPI in the case of an asthma attack can be helpful (or, specifically, "will not hurt"), and that albuterol in the case of severe allergic reaction can also be helpful (or, "will not hurt"). Now, I do not have a school stock of albuterol, but I do have EPI and would be calling 911 before giving it to an asthma attack, but still... very interesting!

[CanIcallmymom, BSN, RN]

2 hours ago, BeckyESRN said:

There is an Epi based OTC inhaler back on the market, so I think you're on the right track!

My standing order for Epi says for signs and symptoms of allergic reaction and honestly, sudden onset SOB looks a lot like an anaphylactic symptom to me!

I do not have stock epi or standing orders for it, but I agree that s/s anaphylaxis and s/s asthma exacerbation are extremely similar.