First Emergency Scare

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So I had my first real emergency scare in the school nurse setting. A fifth grade student walked into my office with a very small paper cut (and minimal blood) requesting a band aid. I finished putting a band aid on her and she then said she did not feel good. I asked her what was wrong and she said she had a headache. I asked herif anything else was bothering her and she said no. Unfortunately, I did not realize what was happening, and I checked her temperature which was normal. As I was putting the thermometer away, she fainted and fell backwards hitting her head and started to have seizure like activity for about 10 seconds. No history of seizures and no past medical history that we knew of. Her pupils were very dilated. She stopped and came to and started crying because her head hurt of course. We had her lay there. She was dazed, but knew her name, who the principle was, and where she was. I yelled for someone to call 911 as soon as the seizure like activity happened. The paramedics came and took her vitals which were normal. Of course, they doubted there was a seizure. Mom came and said she has fainted before from seeing blood. And she did say afterwards that the blood made her feel queasy. She did take her to the ER though. I did some research and apparently this is called vasovagal syncope and can cause what looks like a seizure, but really is not a seizure? Just wondering if anyone else has seen this, especially in the school setting? What did you do? I have seen NUMEROUS seizures in the hospital setting on a psych unit. Both epileptic and pseudoseizures.

Edited by basketball13

KKEGS

KKEGS, MSN, RN

Specializes in School Nursing. Has 9 years experience. 723 Posts

I have not seen it in the school setting but a friend's daughter has vasovagal syncope from having her hair brushed! :nailbiting:

SassyTachyRN

SassyTachyRN

Specializes in Peds, Oncology. Has 4 years experience. 408 Posts

I get vasovagal syncope anytime I have bad stomach cramps or diarrhea, that kind of thing. One time I passed out while on the toilet and my husband ran in, pants around my ankles, after he heard the thud. Being a non-medical person, he scooped me up and started yelling and slapping my face. I started to seize in his arms and froth at the mouth. My thinking was that the seizure was from his propping me upwards and the lack of blood/oxygen to my brain. I told him to never prop me up again!

uthscsa2011

uthscsa2011

Has 5 years experience. 106 Posts

Hello basketball13,

wow that is a scary situation! I have not had any students with that condition at my school, but a few with seizure conditions. I myself experience Vasovagal Syncope. Mine happens anytime I vomit. The last time was a few months ago when I had food poisoning. One second I was running to the bathroom to vomit, next I woke up on the floor bleeding from my cheekbone, eyebrow and lip. I try to always assume a sitting or kneeling position as to avoid falling and injury. So weird though. I don't know how long I'm out, I assume for a minute or less.

I think parent should have notified you that this student has this response prior, like at the beginning of the school year.

Cattz

Cattz, ADN

Specializes in School Nurse. Having conversations with littles.. Has 36 years experience. 1,026 Posts

It probably isn't this. But, I do want to share this, just in case. I would be asking if there is any other family members that do this or something similar.

I have seen this first hand, as my brother in law and several of his family members do it. Some of them at the site of their blood and some to sudden extreme pain. Theirs if due to Long QT Syndrome. One of my brother-in-laws brothers had one of these fainting episodes in the hospital after an accident (he had rib fractures and movement caused extreme pain, which caused him to faint). He happened to be on the heart monitor, his heart stopped for 7 seconds. Pretty scary stuff. (I had this guy's son as one of my students. The son fainted at the site of his own blood. Worse than that, he had a tendency to run and hide because he knew what was going to happen. Luckily, he never did this at school! )

Here is the link to a great website SADS - SADS Foundation There is a lot of information and a Risk Assessment Form.

This has made me much, much more aware of "fainting spells" and to do a little more digging when/if they happen. My brother-in-law quit having these spells after his bypass surgery a few years ago...thankfully!

Happy Wednesday Friends-

a.

SchlNrsKrn

SchlNrsKrn

Has 26 years experience. 37 Posts

I have had 2 syncopal episodes that looked like seizures-arms postured. Big ways to tell-if there was precipitating event...first one of mine was immediately after Hep B shot, 2nd one was when I was 26 weeks pregnant and hadn't eaten. There was a reason to pass out. Length of episode is another-something lasting "seconds" is more likely to be syncopal. Return to consciousness is the other-syncopal are generally fully aware and "with it" immediately after.

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma. 5 Articles; 4,427 Posts

I had a kid that had her fingertip severed and began to get a little willowy. I didn't need to guess why. I was glad for my long legs as i pulled a chair from across the room for her to sit in while i finished bandaging. She was fine once she didn't see it. Don't know how she did in the ER when they unwrapped my handiwork though.

NutmeggeRN, BSN

Specializes in kids. Has 39 years experience. 8 Articles; 4,532 Posts

well you did just what she needed. And I'm glad she was seen in the ER. May not have been a seizure, but who knows. 911 was the right response and I'm glad it looks she will be OK. Please keep us posted

JenTheSchoolRN, BSN, RN

Specializes in School nursing. 3,027 Posts

I have a student with exact same presentation at my school. All from seeing blood, reading about it, hearing about it, talking about it. Luckily the first time did not happen at school (it was at a doctor's office just after having blood drawn) and student's mom let me know what happened, but it has happened a few times at school since. Sometimes it is delayed and 20 minutes after being exposed to the idea of blood in some way.

Student has actually been working on improving the symptoms through therapy/prep. And he has worked up to being able to recognize an episode prior to it happening and get himself into a safe position (seated usually and resting head on a desk). The seizure like activity does not occur in any of the more recent episodes.

I ended up setting up 504/IHP plan for it, as he is approaching science classes that can be more descriptive. The science teacher and his mother prep him for lessons that may involve more graphic reading/discussions. We're thinking through options that can have him learn from dissection without triggering fainting.

kidzcare

kidzcare

Has 5 years experience. 3,393 Posts

well you did just what she needed. And I'm glad she was seen in the ER. May not have been a seizure, but who knows. 911 was the right response and I'm glad it looks she will be OK. Please keep us posted

Better to have called 911 and everything be OK than to wait too long and wish you had called.

We had a similar episode a few years ago during rehearsals for the spring concert, too long standing on stage under hot lights, small child goes down. Thankfully he did not hurt himself in the process. In our case I called mom and she brought him to the ER just to be checked. The rest of the school was more freaked out (and the adults too!) than the student who fell. Now I always remind him during those long rehearsals to bend his knees and sit if he feels funny at all.

Creamsoda

Creamsoda, ASN, RN

Specializes in ICU. 728 Posts

Its almost certainly vasovagal syncope. Especially if its happened before. They usually drop their HR and BP after a precipitating event. Pass out from what I imagine is from low BP and HR, not perfusing the brain which is where you see the "seizure". They will roll eyes back in the head and it can look just like one. Difference is they will wake up pretty quickly (within a min or so) and won't really have a post ictal state like a true seizure. Usually laying them down will wake them up. Their BP may be low for a bit but it will come up. If she hit her head still a good idea to go to ER.