Emergencies

I have given two epi pens in two years. Called 911 immediately. Good outcomes both times. Called 911 multiple times last year for seizures over 5 mins, student had no md care plan or diastat. Not much we could do except place on side, time, monitor vitals and call 911 (eventually reported to cps also).

No diastat students for me this year, but I have given an Epi-pen pretty recently. Protocol was the same as schoolRNapril said above. Gave Epi while instructing an admin to call 911, then the student's parents. Wrote down time, put Epi-pen aside for EMS. Instructed another admin to grad the student's health form off the folder on desk. My school is in an urban area where EMS response is usually 10-15 minutes. It was the first time my school has seen an Epi-pen in action, and the next day the admin was impressed how calm I was. Sure, on the outside I was, but inside I was shaking :). Outcome was very good.

I have had a pretty symptomatic diabetic with high ketones I suspected might be bordering on DKA, but again called the parent, monitored student. Parent was only 10 minutes away and wanted to take student to the ED herself. If parent had been further, I would have likely called EMS. Outcome was good.

Really, as a school RN, staying calm and collected in a crisis is key and anything in your previous job experience (nursing/non-nursing) you can relate to that is awesome. You don't have the same tools for an emergency as you do in the hospital, so PALS is not really useful, just the basic CPR. Most schools (all schools in my state) have an AED.

I've had my fair share of emergencies here in this district - mostly seizures - i've given a boatload of diastat it seems, but i've had students with difficulty breathing / dizziness (turned out to be a panic attack, which was my suspicion at the time but i was glad i made the call -when i doubt i'd rather be overly cautious). I've had staff get injured by students and require transport. I;ve has staff having chest pains and argue with me over driving themselves until i rationalize with them that sometimes the medics can just come and run the ekg and then have them sign off if nothing's happening (had this happen just yesterday). Everyday is an adventure. school nursing is certainly never dull.

school nursing is certainly never dull.

Someday I need to get a t-shirt with that saying on it...

We had a HS student accidentally amputate a finger tip in the seam of a cafeteria table (like the fold-down style table, where the two pieces join when it folds open). EMS arrived to the cafeteria at exactly the same time that I did. Staff had already wrapped his hand in a towel, had him across the hall in an empty classroom and had the fingertip on ice. He was a ginger so his pallor was scary but there was literally nothing for me to do.

Ginger LOL! I'm a ginger, too!!

This was my first year as school nurse. I'm in a high school.

Emergencies:

2 SVT flares that wouldn't get better even with intervention that typically works for the students ( one had to have ablation)

2 lethargy/loss of consciousness ( with spice being a problem in our area, no way I'd take any chances.)

1 asthma flare

Teacher with symptoms of MI

1 student back injury---SOB ( she ended up being okay--but we were worried about how hard she was hit and exactly where

1 pregnancy

1 hyperventilation that would NOT stop

1 severe chest pain with extremity numbness/tingling

Good year I tell ya. I never ever hesitated for any of these. I'd rather the EMTs get here than not call.

2 more teacher workdays we have to be here---then I have 6 weeks off, then to training for my new job :)

I have had lots of "seizures" this year from the same 2 students. One I think (no official dx) was having pseudo-seizures. The other is graduating in 5 days and that's all I will say about that particular student.. I've also had a couple of respiratory emergencies (one with and one without a dx of asthma), and a dislocated/fractured shoulder.

I was a PALS instructor, and I haven't used ANY of my PALS skills. I don't have a code cart or code meds. I can do CPR and I can use the AED if I need to- just BLS measures until EMS get there. Our EMS response time is usually pretty good (3-4 minutes at the most).

Started a little over a year ago, in that time: 1. Severe fracture requiring 911 transport 2. Student with stroke-like symptoms- difficulty talking, one sided numbness, weakness (parents live across the street so they took her to hospital- turned out to be migraine) 3. One epi pen (actually had to give this on a field trip in the middle of the night- scary- called 911 and good outcome) 4. One possible peanut ingestion- no reaction (not really emergency but could have quickly turned into one) 5. Staff member with swelling of airway due to insect bite 6. Multiple asthma attacks, one severe with no inhaler at school- mom got here within 5 min to administer inhaler & took student home after stable 7. Seizure (non-emergency, student had IHP in place) 8. Large contusion near groin from student falling on monkey bars- student went to urgent care and referred to ED for CT scan- good outcome 9. Multiple concussions- follow up care important 10. Multiple sprains/strains/possible fractures- early communication with parents is important- do not need to be picked up but stress that you do not have Xray vision and they must follow up if pain/swelling/tenderness persists. Never say it is or it isn't broken- we do not diagnose. Sorry this was long, but these are the top 10 "events" that I learned the most from this year. Hope this helps!

In 3 years I've had to call EMS twice:

Once for a student in acute respiratory distress. (Severe asthma attack right off the bus.) Took the paramedics about 45 mins to even get him stable enough to transport.

Once for a grandparent who fell and broke a hip.

To be clear, we've had other "emergencies" like broken arms, but they were not EMS worthy.

Great posts! Good to know what kind of things to expect!

after 21 years where do I begin?

Asthma not relived w rescue MDI

Epi 4 times All good outcomes

Tib Fib fx

Finger stuck in picnic table..... ya it was on youtube before I got a hold of the parent!!!

Seizure with a HUGE chin laceration

Chest pain for teachers (turned out to be esophageal reflux and the flu)

I could go on....

We have a great relationship with local FD/EMS (small town)