Called 911 - anything I could have done better?

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Specializes in School Nursing/Med-Surg.

I was called to a PreK class today. During naptime, a student apparently started "convulsing" per teachers. (I only add the "" because I did not see this -  both of the teachers were adamant that it looked as though he was seizing). When I arrived, he was standing up and unconsolably crying. His neck was angled to the side like he was unable to move it, and so that it looked like he was convulsing. I tried to get him to calm down and talk to me, but he just anxiously pointed at his throat. He can't move his neck, cant talk, and is anxiously crying. So I call 911 right away, we carry him to the clinic. Spo2 was okay, < 96%. Slowly he is calmed down and says "I can't talk." The paramedics get here right when mom calls back. It turns out, this happened to him a year ago and the doctors didn't think it was a seizure. Vital signs were normal at this point, and he was responsive and talking - just seemed a bit lethargic. Mom ended up taking him to the doctor herself. 

Has anyone seen anything like this before and did I do everything okay? I kind of felt silly that he was okay once the paramedics get here, but I don't regret calling 911. This is my first pediatric job though, I do have insecurities about my assessment skills and I rather just be overly cautious. 

Thanks!

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Specializes in Geriatric Home Health, High School Nurse.
2 minutes ago, EmileighDiCosta said:

I tried to get him to calm down and talk to me, but he just anxiously pointed at his throat. He can't move his neck, cant talk, and is anxiously crying.

This tells me that you did exactly the right thing.  This could have gone south in a hurry and your timely activation of EMS would have made all the difference.  Good job!  

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I'd rather feel silly when the paramedics arrive than feel deep regret when a child is in critical condition (or worse) because an ambulance wasn't called.  You listened to your gut and the child is safe!

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Specializes in ICU/community health/school nursing.
1 hour ago, EmileighDiCosta said:

I was called to a PreK class today. During naptime, a student apparently started "convulsing" per teachers. (I only add the "" because I did not see this -  both of the teachers were adamant that it looked as though he was seizing). When I arrived, he was standing up and unconsolably crying.
He can't move his neck, cant talk, and is anxiously crying. So I call 911 right away, we carry him to the clinic. Spo2 was okay, < 96%. Slowly he is calmed down and says "I can't talk."

Yes. 100% right there. You did not see the "convulsion" but what you saw was alarming.

1 hour ago, EmileighDiCosta said:

The paramedics get here right when mom calls back. It turns out, this happened to him a year ago and the doctors didn't think it was a seizure. Vital signs were normal at this point, and he was responsive and talking - just seemed a bit lethargic. Mom ended up taking him to the doctor herself. 

 

And mom chose not to alert y'all to this kind of important piece of info? Because if you'd known this - no need to call EMS, right? BUT YOU DIDN'T.

It is normal once the dust has cleared on an emergency for us to want to troubleshoot our response. I would likely have called EMS as well. Because of what Brisket said. Good job. Old Dude would be patting you on the back with a hearty "BAM! Another child snatched from the brink." (I miss Old Dude).

Incidentally, this makes me think of epiglottitis, which is a life-threatening pediatric emergency. Do we have a diagnosis to go with this event? Please share if you do.

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I would have called EMS for this significant, unexplained change from the child's baseline - especially since the parent didn't share the history with you, and she wasn't immediately available when you called.  I'd be interested to know what the PCP thought it might be. 

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Specializes in kids.

Absolutely!

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Specializes in ICU/community health/school nursing.
14 hours ago, laflaca said:

I would have called EMS for this significant, unexplained change from the child's baseline - especially since the parent didn't share the history with you, and she wasn't immediately available when you called.  I'd be interested to know what the PCP thought it might be. 

You always say things so concisely. Yes, that's what I meant!!

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I had a VERY similar situation about 3-4 weeks ago. These episodes had happened several times at home but parents had never given me a heads up. 

You can only make decisions based on the info you have and your assessment. Never doubt it!

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Specializes in School Nursing.

So Yes! A similar thing happen.

Event:

Called by PreK teacher and staff of a student c a possible seizure. I went down to the classroom with my emergency bag and basket of diastat. When I arrived the student was on his mat on the floor due to just waking up from nap. The student was pale, refused to speak and shaking. I called 911 and notified administrative staff. I requested the teacher to call the mother and request to come to school. I carried the student to the clinic and had the medical assistant present with me. I was unable to get a good pulse oximeter reading but managed to get all other vitals which were all in normal range. The student was still very quite and refused to speak but became more alert after speaking to him. The shaking stopped after less than 1 minute in clinic. EMS arrived and I notified them of the incident, assessment and student with out a history of seizures or medical problems. The teacher arrived and was able to notify that the student had no head injuries at school. Vitals were taken by EMS which were in normal limits. The parents finally arrived and the student was signed AMA with EMS by parents but the student was taken by car to ER by parents. The mother did state the student had a history of night terrors and does shake during and after them. I did a f/u and received discharge paperwork stating the student with night tremors and referred to neurologist for further evaluation. Also, the CT scan came back normal. The student returned to school and has had no episodes again. 

I believe you made the best judgement for your student. Do not second guess or doubt your skills. Improve your skills. Always review but never let the event dwell as it will make you have anxiety and cause you to doubt yourself. 

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Specializes in School Nursing/Med-Surg.
23 hours ago, ruby_jane said:

Incidentally, this makes me think of epiglottitis, which is a life threatening pediatric emergency. Do we have a diagnosis to go with this event? Please share if you do.

I thought about that as well, but thankfully that's not what it was. By the time EMS arrived the "episode" was calming down and there were no signs of respiratory distress. 

I did a lot of research last night and I read about Todd's paralysis - paralysis (usually of one side of the body) which can last a few seconds to a few hours after a seizure and sometimes causes the inability to speak. I have a feeling this might have been what happened. If the poor baby suddenly couldn't move his head or speak, he was probably extremely frightened. 

AND It did happen again today though, so I'm pretty sure it was a seizure. There was no "paralysis" this time, but the same seizure-like activity. Mom is taking him to a neurologist tomorrow. 

Here is an article about Todd's paralysis: https://www.ncbi.nlm.nih.gov/books/NBK532238/

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Specializes in ICU/community health/school nursing.

OK wow @EmileighDiCosta ! That's some interesting research.

I am glad a neurologist is in the offing.

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did mom ever tell you what the similar event was, and what the docs thought it was, if not a seizure?

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