Current Situation: Symptomatic Asthmatic

[jnemartin]

Advice please - I have an asthmatic student who has labored breathing, was wheezing but no longer, dizzy, fatigued. BUT sating at 98-99% RA. He's used his flovent and proair several times so HR was high but is currently down to 120s.

Yesterday he was same, but also pale and tripoding, mom picked up and took to hospital for RT and steroids. He's been in my office today, symptomatic, for an hour and mom can't come to p/u for another hour.

As long as he's sating ok, is it ok to keep him here, or at what point do I call an ambulance?

Of note: he is a bit of a "flopper," so I have to put a lot of weight on my assessment of good/improved vitals, decreased wheezing after TX.

[jnemartin, BSN, RN]

Just now, palli said:

All good, its hard when they de-sat so quickly, 2/3 of my sons had had respiratory issues, where me ,mom as a nurse even wondered if i need to do the ER at 2am...but then I thought,, what the heck am I questioning myself..

a little Racemic nebulized helps...

Yes, and I come from an acute care background, so it takes a LOT for me to call in backup. Once, this same student desated into the 80s but was asymptomatic and after using inhaler, vitals returned to normal... and I know many SNs would call out for that.

[ruby_jane, BSN, RN]

18 hours ago, jnemartin said:

Yes, and I come from an acute care background, so it takes a LOT for me to call in backup. Once, this same student desated into the 80s but was asymptomatic and after using inhaler, vitals returned to normal... and I know many SNs would call out for that.

I've thought a lot about what you wrote. In our current situation, in the absence of orders or a supervising doctor...just because we CAN doesn't mean we SHOULD. Three times a fire captain rolled his eyes at me in my last district because I chose to call him because I was out of options. All three times I was right (mental health crisis in a student, chest pain in a woman that he completely disregarded until I said "Do you at least want to put some leads on her before you tell her she's not having a heart attack," and what turned out to be a new-onset anaphyactic reaction to a bee sting in an adult).

It doesn't matter. We are the front line and the backup and there is zero shame in realizing we need more equipment, some orders, or transport. Essentially I have my super-tuned assessment skills, an AED, orders for an EpiPen for anyone with a new onset anaphylactic reaction, and ice. I have a handful of doctors' orders for emergency meds, and all those come with an EMS call.

Every time something like this happens we learn from it. I'm glad you asked the question.

[AdobeRN]

Sad to hear that it seems like alot of districts have a difficult relationship with their local EMS.

In the last few years our district and local Fire Department/EMS have really tried to work together and establish a good relationship with each other. The fire chief comes to our first nurse meeting of the year to introduce himself - tells us about any new fancy equipment they have and lets us know they are a resource for us if needed. They also make it a point to visit each campus - meet the administration, walk around campus so they kindof have a plan if something were to go down. Our principal and Assistant principal have the fancy expensive walkies that when they switch to a certain channel communication goes directly to whoever is in charge at the station so we can have direct communication with the truck that is on the way to help us instead of talking thru the 911 operator.

[ruby_jane, BSN, RN]

1 hour ago, AdobeRN said:

Sad to hear that it seems like alot of districts have a difficult relationship with their local EMS.

I the fancy expensive walkies that when they switch to a certain channel communication goes directly to whoever is in charge at the station so we can have direct communication with the truck that is on the way to help us instead of talking thru the 911 operator.

It bothered me the first time. It no longer does. And PRAISE and THANKSGIVING I am in a different district where the guys on the rig listened to me both times that I called EMS and had no issues transporting.

I want that walkie!! That's like the gauntlet with the Infinity Stones - snap your fingers and an ambulance is at your door!!

[palli]

I want that walkie!! That's like the gauntlet with the Infinity Stones - snap your fingers and an ambulance is at your door!!..

and when you snap your said fingers...can we make some people just disappear into dust????

6 minutes ago, ruby_jane said:

I want that walkie!! That's like the gauntlet with the Infinity Stones - snap your fingers and an ambulance is at your door!!

[T-Bird78]

Not a school nurse but an asthma/allergy nurse for several years here. Flovent is NOT a rescue/quick-acting inhaler. Using albuterol several times in a short time span is not okay either. Once student gets back to normal, talk to him/her about proper use of Flovent and when/how to use albuterol. Talk to mom to make sure they’re compliant at home and that they see an asthma specialist, not just pediatrician. So many PCPs don’t know how to educate asthma kids on inhaler usage. Also have mom check into getting albuterol nebulizer for such an emergency. My asthma MD had care plants for all his asthma and allergy kids.