911 Debrief

GdBSN, RN · Oct 31, 2016

Don't second guess yourself. You did everything correctly. You had no way of knowing it was an anxiety attack. What would have happened if you hadn't have called 911, and it wasn't an anxiety attack. It is always better to err on the side of caution and let the paramedics tell you that their is nothing wrong. We don't have the benefit of all the fancy equipment at school, so when a student tells you they can't breathe, we do what we need to do. This happened to me twice last year with the same student, and it turned out to be anxiety also, but I still think calling 911 was the right choice.

MrNurse(x2), ADN · Oct 31, 2016

Better to err on the side of caution than not to act and have an emergency situation without proper equipment.

NanaPoo · Oct 31, 2016

You absolutely did the right thing, IMO. She had a hx of asthma and no rescue inhaler on hand and the closest one roughly 20 minutes away. Even though her sats were ok, her audible wheeze, pale skin, inability to slow her resps, and saying her throat was closing would have me dialing 911 faster than you could say, well, "911."

With someone else's child, I'm always going to err on the side of caution.

I had a student last week (no history of any chronic condition-well, except for long term status dramaticus) reportedly "collapse" in a classroom and become "unresponsive." I found her with 48 resps per min and O2 sat of 84. She'd hyperventilated herself quite well by the time I arrived. Heart rate mildly elevated but regular and lungs clear. Great attempts to drool on herself. I called her mom who said to let her rest on my cot. This was a "not 911" situation because of the "girl who cried wolf" scenario but she did have me questioning myself for almost 3 seconds. Oh, and her attempt at unresponsiveness was sad, at best.

But, again, I completely agree with your decision to call 911. I would have completely done the same. Stop questioning yourself and, instead, pat yourself on the back and move on with your day. That's why they have you.

Supernrse01, BSN · Oct 31, 2016

I think you did exactly what you should have done based on your assessment findings and the way things were playing out. You did what you could to help get things under control and those things didn't seem to be working. Even if it was what turned out to be an anxiety attack, you were dealing with an asthmatic child who was definitely exhibiting signs of distress. You informed her Dad your findings and what your plan was moving forward and acted accordingly. Better safe than sorry, in my opinion. If this had been something other than anxiety/panic attack and you hadn't called EMS, the ending could have been so much worse. I think you did a great job!

Nurse_JackieVA, BSN, RN · Oct 31, 2016

Better safe than sorry.

Bottomline it was a resp issue and our clinics are not able to handle emergenices like that. I bet the parents will make sure she's got her inhaler from now on.

You made the right choice. Good job.

Flare, ASN, BSN · Oct 31, 2016

I agree -call to 9-1-1 was warranted. Kids do a really great job of compensating until they don't and then it all goes to hell in a handbag. I don't want to be the one holding that bag, neither do you.

SchoolNurseTXstyle · Oct 31, 2016

I would have called!!!

allnurses Guide · Oct 31, 2016

Yes, you did the right thing! Absolutely!

Good for you!

chasinRT · Oct 31, 2016

You did the right things. Kids can nosedive rapidly. Better to err on the side of caution, especially where someone else's kiddo is concerned.

OldDude · Oct 31, 2016

Don't even go there with second guessing yourself!! Besides, if EMS was all knowing and said it wasn't asthma and she would be OK, why the #### did they take her for evaluation?????

bbyRN, BSN, RN · Oct 31, 2016

I agree with all the posters who said that you thought through the situation correctly and did the right things. My colleagues and I in TCU/LTC have similar questions on the situations that we are faced with. At least we can call over to another unit to get the experience of another nurse, but it sounds like in a school you don't have that luxury to have another nurse, much less a physician on hand. A second set of experienced eyes. I am constantly learning and looking things up in order to determine what is emergent, what is urgent, what is less urgent, and how to triage. Just because we can call an on-call physician does not mean we do not have to triage because the on-call is dependent on our observations and ability to clearly communicate situations in which our people have serious co-morbidities. [Added edit:] Also, the on-call has little or no history with the pt/resident even if she has the chart open in front of her - the on-call is at a severe disadvantage and the good ones err on the side of carefulness, like you did [end edit.] This maybe is not true at the school-age level, though it may be becoming more complex. Moreover, if things go south from some intervention, you/we do not have resources to address, get labs and assess, the new situation in a timely way when there is already an airway/respiratory situation occurring - like earlier posters said.

As for pulse oximeters, I think we all need to learn more about exactly what the readout means. Just because a pulse ox reads >90% does not mean everything is OK. Also, anyone having dyspnea, tachypnea, SOB, etc is going to have anxiety and that anxiety is just going to feed back on the dyspnea. So, which is it? You heard adventitious/abnormal lung sounds - that's what you have to go on. You cannot doubt your assessment. Later, you can learn and practice more. That's another thing, it is great to work with other nurses and physicians in order to have our own experiences/understanding/thinking validated or improved in a way that works for us.