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Discussion

911 call

Hi all, I haven't really posted before, but I'd appreciate some feedback since school nursing is new to me and I'm really trying to grow and learn something from each experience. I like this position and really want to be successful. Today I was called on the playground by another teacher. The student was on the ground holding his head, not moving. Teacher says she did not witness fall, another student told teacher he fell and did not give many other details. When I get there teacher says his initial reaction was repeating "my head hurts", but when I got there to assess him, he wasn't following any commands (wasn't telling me his name, where he was, open eyes, squeeze fingers) just mumbling. Pupils were equal, dilated (approx.5 mm). Given all of this I did not feel I should move him so I made the decision to call 911. Last update I received he was now awake/alert and waiting results of a CT scan at the hospital. All other tests appeared normal. I did come to find out he does have a history of behavior problems, that he can be withdrawn. Did I overreact? Are there any other steps/assessment you would have done? Any other questions/commands you would have asked?

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    You did everything just right...NURSE! Don't second guess yourself! He wouldn't be getting a CT if the MD thought this was a BS visit. Excellent assessment and intervention.

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    I'm seconding Old Dude's post!

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    I would say you did your job with EXCELLENCE !!! Never feel bad about protecting a child who has incurred a head injury. Always err on the side of safety. Well done my new nurse friend !!

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    An unwitnessed (?) fall and a minimally responsive kiddo...I would have called, too. Followed by a call to parents. If they happen to be able to make it there quickly, they can always make the decision whether or not to transport via ambulance. GOOD JOB!

    Also, you need to talk to your administrator because you need to be aware of any kiddos who may have a behavior plan. Not that it should cloud your judgement, of course.

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    You absolutely did the right thing. Can you imagine the $ hit storm that would have occurred if you assumed he was just being "difficult" and sent him back to class and he had a concussion?!?

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    An unwitnessed (?) fall and a minimally responsive kiddo...I would have called, too.

    Exactly!

    Can't fake dilated pupils. Better to have called 911 than have sent the kiddo back to class with a serious injury. Great job!

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    You did not overreact, and even if you did, it's better to be cautious.

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    Excellent job! You did everything right.

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    Ahh....your first EMS call!! And everyone survived, which means you did a good job!

    Even if the kid has a history of not choosing to speak to adults....after the unwitnessed head injury and abnormal vitals I would have played it exactly as you did. And I'm going to second everyone's "never second guess calling EMS." At my disposal: ice packs, crackers, and AED, and my nursing judgement. I have nothing to fix "it's getting worse." It will never, ever hurt to get a second opinion...especially when that second opinion comes with additional equipment and a medical director at the ready.

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    i would have done the same!!! Always better to overreact a little than under react. Also, I think as long as you follow your gut - your are good!!

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    My favorite response in this situation is this

    " In my professional assessment, I made the best decision I could with the information I had"

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