Calling EMS

[NutmeggeRN, BSN]

Ok, we have been here 4 weeks and the ambulance has been here 4X!!!

Holy Moley!

1 for seizure (unknown hx at the time of the call) with head injury - No brainer

1 for Epi admin- no brainer that is our protocol

Two incident of escalating chest pain,

1 has some chronic health issues, multiple meds, not great color to start with

I was concerned about an PE given the intensity of the pain, parents were at least an hour away

1 an athlete came out of a game complaining of sharp chest pain, not relieved with rest (30 min), use of his inhaler (expired) but at least he had his spacer!

In my heart of hearts, I was scared for the first one, not a wimp, not a complainer, in spite of being in a lot of chronic pain. Turns out to be a part of her chronic health condition. Whew! Parents were all good with it.

The 2nd one, I was sure it was a panic attack, but his form only said hx asthma and seasonal allergies, kid from visiting team, parents again more than an hour away. Vitals were good but I think he blew off every bit of CO2 in his body leading to contracture and spasm of his extremities, unable to speak, no wheeze, satting in the hi 90's...but...

So I called and he was transported and yea it was a panic attack.

I stand by the call, (so does my AD and principal) and no one is questioning it, but it feels like I knew it was a panic attack, yet....

I don't have the ability (or desire) to diagnose a panic attack. I feel bad EMS came 2x for what ended up being not a true emergency.

Oh well, it's a crap shoot I guess!

Good thing my fire guys like me and respect my decision making. They were completely fine and supported my decision on both questionable calls.

Thoughts?

[Cattz, ADN]

Nut- Yes, it is a crap shoot. But, when our "Nurse Brain/Gut" tells us. WE LISTEN. Good work!!

[JenTheSchoolRN, BSN, RN]

I had to call 911 last year two weeks in a row - for the same student. First one was a no brainer, second I went with my gut. I think one of the EMS guys was giving me side-eye, but the kid was admitted overnight for observation, so it confirmed for me to go with my gut. It just knows...

[Keepstanding, ASN, RN]

Sounds like to did exactly what was needed Nutmeg ! You Rock ! We make these life or death decisions some time and we do the best we can. Just know you did good my friend !!

[GdBSN, RN]

Great job, you did just what you needed to. Let EMS check out the kiddo and decide if he/she needs to be transported. Better safe than sorry. No need to second guess yourself.

[SchoolNurseTXstyle]

I would rather call 911 for a panic attack than not call for something that ends up being life threatening. Diagnosing is beyond our scope of practice anyway. We need to stop beating ourselves up ( I have done it myself) for not 100% knowing something. At the end of the day, you advocated for the safety of the students in your care and that is a job well done.

[chare]

[…]

…I feel bad EMS came 2x for what ended up being not a true emergency.

[…]

But you didn't know that when you called, and as they say, hindsight is 20/20.

Consider the patient with what you thought might have been a PE. For any patient in whom you think this is a possibility, call EMS. The fact that it turned out not to be a PE doesn't mean your decision was wrong. Consider the alternative, extreme though it might be. You didn't call EMS, and it was a PE. Patient acutely deteriorates and goes into cardiac arrest.

For the patient with the panic attack, a male athlete experiencing an acute onset of sharp chest pain, associated with tachypnea. Any other emergent conditions come to mind? Spontaneous pneumothorax would be well up on my list of differentials. Again, consider the alternative had you not called, and it been a pneumothorax.

[…]

Good thing my fire guys like me and respect my decision making. They were completely fine and supported my decision on both questionable calls.

Thoughts?

As they should, as neither of these was a questionable call.” You assessed both patients, and based upon these assessments you determined that in both cases potential emergencies, one of which could have been life threatening, existed.

[Flare, ASN, BSN]

my saying is that i'd rather explain why i sent them than why i didn't. Granted, not to say i'm not judicious and i certainly rely on my (ahem) years of experience to make a judgement call of who needs to go now vs who can get a call to home and if mom/dad/grandma/whoever says they can be there in 20-30 minutes then that will be fine (but the clock is ticking). But if i feel like it would be even a possibility i do offer to call - so that the parent can't say that i didn't.

[MrNurse(x2), ADN]

We admit suspected PE in the hospital that rule out. You need to evaluate symptoms and risk, why they have you there. You did your job, the doctors/ mid levels at the hospital did theirs. You rarely get criticized for overreacting, you will almost always get criticized for inaction.

[NutmeggeRN, BSN]

Thx!! Sometimes you just need a little affirmation and I knew where to turn to!!!

Carry on!

[rbytsdy]

I called the paramedics last year for an incident that turned out to be a panic attack. I knew the kid for 2.5 years. Sweet kid - never any trouble. She came in out of breath. I had her sit down and rest. Her breathing just got worse and worse until she was using accessory muscles and had a hard time exchanging air. I knew I wasn't hearing wheezing but a panic attack in a 3rd grader??? I was not about to ignore those symptoms. It was so bad that her parents (when they arrived couldn't calm her) and the paramedics were considering giving her Ativan IV. Once I was confident there was no other life threatening condition, I jumped in the middle of this and we did some lovely Lamaze breathing (since I'm also a certified Lamaze educator - ha!!). That is what got her breathing rate to stabilize.

[DEgalRN]

I have been told by those with more wisdom and experience than me, "Never be the last person to say a kid is fine." I keep that in mind anytime I "overreact" to a situation, especially where the outcome could be disastrous.