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Current Situation: Symptomatic Asthmatic

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by jnemartin jnemartin (Member)

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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. 

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1,164 Visitors; 77 Posts

when in doubt , send out.

 

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1,976 Visitors; 188 Posts

Thank you, there has actually been a change in condition and I am calling now. 

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1,164 Visitors; 77 Posts

Good....The parent can meet at the hospital. You will be shocked to see just how quickly they can get there, but couldn't get to school.

sorry, I might sounded jaded.....

 

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OldDude works as a School Nurse.

7 Followers; 1 Article; 28,835 Visitors; 4,756 Posts

When I read, "he's used his Flovent..." I see red flags. Flovent shouldn't be used at school and has nothing to do with treatment of acute bronchospasm.

Regardless, you can't predict how this is going to unfold so assess the patient and not the monitor...don't hesitate to call EMS 

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ruby_jane has 10 years experience as a BSN, RN.

3 Followers; 7,984 Visitors; 2,264 Posts

24 minutes ago, jnemartin said:

Thank you, there has actually been a change in condition and I am calling now. 

Hang in there, darlin. 

It's the right call. You have nothing else (no emergency albuterol and Flovent is a preventive, not an emergency treatment as OD said). 

Never trust a pulse ox over your ears and eyes. My favorite pulmonologist says that he's seen kids tank satting 95%.

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Flare is a ASN, BSN and works as a School nurse firefighter.

2 Followers; 5 Articles; 33,693 Visitors; 3,945 Posts

if they have an audible wheeze, labored breathing, use of accessory muscles, tripodding, or other s/s that suggest that they are a blink away from decompensating, i am more inclined to send out, despite how their numbers look.  Kids are remarkable little creatures - they can do so well until they suddenly stop doing so well then everything goes down the toilet.  I agree with OD, flovent in school is just not done and hints to me that perhaps more teaching is needed or that the asthma is not being well managed at the very least.  

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1,976 Visitors; 188 Posts

So here's the update - as I said, he was vitals-stable, presenting better than yesterday but still symptomatic despite using his school-approved inhalers. 

He told me he was very fatigued (normal for an asthma attack) and then was squinting his eyes like he couldn't keep them open. I re-checked vitals and HR was up again and desat down to 84%. I called 911 (OF COURSE IT IS LUNCH TIME AND A MILLION STUDENT OBSERVERS) and they arrived in 10 minutes. In that time, I actually walked him to a more quiet area for them to eval him and that helped his sats and breathing I think (I was super worried about doing it, but it ended up being good). His sats were 95% when they arrived but BP and HR elevated. Mom met us all here and took him to hospital. 

 

omg. 

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1,164 Visitors; 77 Posts

you made all the right decisions. just document (just in case) mom stated she couldnt get to the school to pick him up for an hour.

Again, dont ever doubt. You know what to do, we all know what to do...

Proud of ya!

now go home and have some wine and pat yourself on the back for being a nurse.. 

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1,976 Visitors; 188 Posts

Thanks for the advice everyone - it was helpful to get the immediate feedback when I felt I was in a gray area. Of course when he had a "condition change" as described above, I knew I had to call, but before then I felt it was a toss up - he was stable, but could decline at any moment (and DID!). 

 

And yes, mom got there 5 minutes after the ambulance after telling me it would be another hour. ugh. I feel bad for them, though. It's been a rough couple days for their family. 

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1,976 Visitors; 188 Posts

50 minutes ago, palli said:

when in doubt , send out.

 

thank, you palli! as I read this the light switch clicked and I was like, No I cannot manage this here in school with no resources (other than those we have tried). 

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1,164 Visitors; 77 Posts

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...

 

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