911 Debrief

[DEgalRN]

Can I debrief this situation please?

I had a student come into my office. Audible wheeze, stating she needed to use her inhaler. Thought it was in her backpack, not there. No inhaler at school. Called mom, left a message, called dad, told him we needed an inhaler. She started to hyperventilate (RR 56). 02 from 98-100, congestion in the lower lobes. Pale coloring, no blue color though.

Called dad back, he said he was 15-20 minutes away. Told him I would continue to monitor but if she got worse I would need to call 911.

She was unable to talk in between breaths. And pantomimed that she felt her throat was closing. Said she felt light-headed and dizzy and would not, could not slow down her breathing. 02 still fine.

Call 911. EMS comes. Takes VS, they're all fine, O2 is 100. Put her on oxygen take her down. Paramedic gets there does her thing. EMS basically tells dad it's an anxiety attack, not an asthma attack and she'll be OK, EMS says lungs are clear, but she's got a bad cough.

They still take her out on the ambulance to be fully evaluated.

I know I can only go on my assessment and I could not get her calmed down, but I'm second guessing whether I should have called 911 or waited a few minutes until dad got there (not knowing how long it would actually have taken).

I just feel like there wasn't a good decision that I could make.

[SororAKS, ADN, RN]

You made the right call. She's fortunate to have a good school nurse. Good job.

[bbyRN, BSN, RN]

I have far greater latitude in my hospital job than at school. My pt. vasovagaled the other night, I attempted to revive her while a new nurse with me was freaking. I knew I had a minute or two before I needed to escalate care, I would not have done that in a school setting.

This understanding of the context/scope in which we practice in is really important. MrNurse knew he had a minute or two before escalating care and he knew he could really escalate care effectively - not just make a phone call or something similar. He had the experience and knowledge, was in a particular environment, and probably other contextual things, to attempt care before escalating. All these things had to be present. It is unfair, by management or others, and unsafe, (and incompetent) to demand action in circumstances/context/experience that does not positively support either or both the action and the possible outcomes.

[Flare, ASN, BSN]

Now, let's consider the end of my day of Friday. I had a student come in saying he didn't feel right. RR of 44, vs were all ok otherwise, bp 113/76, pulse 85 spo2 99, afebrile - 97.7. Lungs clear. I asked him if anything was troubling him and of course the answer was no (the answer is ALWAYS no). I lead him in some deep breathing exercises anyway. I even brought up a visual on my computer screen that he told me was helpful. A few moments later an aide from the room comes down and sits and we discuss the fact that he has some big project that i guess he got uncomfortable about. A few minutes later the three of us begin discussing calm blue oceans and where we'd be if we all struck the lotto. Then We were all laughing. Point is, this anxiety attack was a bit more clear cut because didn't have the asthmatic history on the child, the clarity of the lungs, and the fast resolution. But as we all know nothing around here is textbook and we can never base one experience off another's.

[bsyrn, ASN, RN]

You absolutely did the right thing! kids can compensate and maintain their saturation levels until all of a sudden they can't and they crash. Asthma can kill kids. It's a shame this had to happen before the parents took notice.