Facial Drooping in Adolescent

[Tencat25]

Hi all! I need some feedback. A student presents with facial drooping on one side of face, but no breathing problems, alert and oriented x4, no recent injuries, no vision problems. Parents are called and strongly encouraged to take student in ASAP to have it evaluated. Parents come and get student and take to ER. Now parents are coming unglued because and ambulance wasn't called. No mention of what is wrong with student, but apparently 'it's bad' according to principal. Should we have called 911? Nothing was wrong that we could see other than the facial drooping with no history of anything. What would you all have done?

[Tencat25]

Thanks for all the replies! Apparently they ruled out Bell's Palsy, and parents refused MRI, though a CT scan was clear. Student was in school today and was running a fever and had to go home because of that. I wonder if Flu virus might cause issues.....the flu is currently going around. Hmmm....

Around my school we're damned if we do and damned if we don't. Last week we called the ambulance and got reamed out for doing so. Yesterday we didn't call and we got reamed out.......our administration is very quick to toss us under the bus whenever it suits them....Ugh.

[ohiobobcat]

So what was "really bad" per the principal then? (Sorry I can't quote anything. If I try to reply to a quote, then I can't use my space bar for some reason- thatwouldbereallyhardtoread!)

[Tencat25]

Who knows? They tend to be drama queens in the admin office.

[NutmeggeRN, BSN]

Me too, but still not worth an ambulance ride with the symptoms the student was presenting with.

Totally agree!

[nursetlm, ADN]

Had he gotten his flu vaccine recently?

[AliNajaCat]

I

I can see how that would affect CN XII temporarily. Good call.

BTW, the way I remember that CN with Bell's Palsy is Edgar Allen Poe's poem "The Bells." It's said 7 times. "The Bells, bells, bells, bells, bells, bells, bells."

That would be CN VII, facial nerve. But good memory aid!

[AliNajaCat]

So what was "really bad" per the principal then? (Sorry I can't quote anything. If I try to reply to a quote, then I can't use my space bar for some reason- thatwouldbereallyhardtoread!)

IsTHATwhat'sgoingon!Metoo,andwhatapainitis!

But I did discover that if you hit "return" and start over on the next line, it heals spontaneously-- it's a miracle! (Is there a patron saint for typists?). You can also add a period at the end, and then put your cursor inside it, and things work normally from then on, and you can go back and put in the missing spaces. The trick, though, is to catch it before you've typed more than a word or two.

[Julius Seizure]

IsTHATwhat'sgoingon!Metoo,andwhatapainitis!

But I did discover that if you hit "return" and start over on the next line, it heals spontaneously-- it's a miracle! (Is there a patron saint for typists?). You can also add a period at the end, and then put your cursor inside it, and things work normally from then on, and you can go back and put in the missing spaces. The trick, though, is to catch it before you've typed more than a word or two.

You can also "heal" it by typing 2 or 3 characters, highlighting them, and cutting and pasting them back into the text box. Then, somehow, space bar again!

[middleagednurse]

if he can walk, talk, and breathe, and he's not hemorrhaging, he doesn't need an ambulance

[mattfd37]

This happened to me 2 months ago while at school, it was Bells. I waited til school was over and went to ER and got tons of Prednisone for 10 days. As far as EMS, we would just take vitals and drop off in triage.

[LessValuableNinja]

We can all make guesses as to the cause, but at the end of the day, determining cause is someone else's schtik. You are neither paid to accept the liability for determination nor trained to do so. At least not officially. If your administration has a damned if you do, damned if you don't attitude towards emergent transport, I would recommend asking, in writing, for a written policy on when to call 911. Personally, in the absence of policy, I would have informed the parents of the symptoms if they were immediately available, disclaimed that I am not licensed by the state to diagnose, asked them to decide if they want you to call for an ambulance or if they would like to transport, let them decide, then document the conversation. I would then request that policy for future cases, and request it in writing.

[MrNurse(x2), ADN]

So what was "really bad" per the principal then? (Sorry I can't quote anything. If I try to reply to a quote, then I can't use my space bar for some reason- thatwouldbereallyhardtoread!)

Same here, I go back and add the spaces.