Hi all. I'm wondering if any of you ever wrote up an Action Plan for a student with hyperventilation?
I had one student show up in one of the elementary school offices while I just happened to be on campus last week. The funny thing is I'd done the mandated training for our stock epi-pens the day before to the office staff and principal. (Long story about new law in CA about stock epi-pens and no volunteers stepping up to be trained).
I assessed the student; 02 Sat 97%. Lungs clear. HR 120. Resp 32. No signs of anaphylaxis and no history of asthma. I had her do pursed-lip exhalation/sucking on a straw inhalation and using her diaphragm to breath. Calming voice. Etc. It calmed her down and then she started up again. Couldn't get a hold of parents right away.
When dad showed up in about 15 minutes, she calmed down but then it started again. He ended up taking her to the ER per my advice. She was diagnosed with hyperventilation. Paper bag treatment and breathing techniques/calming atmosphere. It took about 30 minutes and she finally stopped.
My concern is the office staff said if I hadn't been there, they'd have given the epi-pen. I spoke with her doc and he doesn't want this as it will make hyperventilation worse. Parents don't want it either. Doc also said "Paper bag was an old treatment that had no real physiologic basis. In theory it may have changed some acid-base equilibrium but it probably has more of a psychological effect than anything. It is not the standard of care. I think if there is no history or exposure, no throat swelling, or other allergic signs, epi should not be used as it may make hyperventilation worse". (He's also an ER doc and Family Practice Doc).
Parents say this happens occasionally at home as well so she has a history of hyperventilation.
Anyhooo . . . .. .I want to write up an Action Plan using breathing techniques.
Anyone ever write one of those that I could look at and get some ideas for how to write it? It is fairly simple but thought I toss the question out.
I don't know about your epi-pen law, but we've had one for years, and it allows parents to sign a form to opt their student out of staff-initiated treatment.
Out of 1800 kids, I only had one parent opt her child out, and of course, she had asthma. Mom also wrote detailed instructions that her child was to go to a very distant hospital if EMS ever had to be called. Sigh....
Thank God we got thru the year without an incident.
I understand and appreciate your concern that this student may potentially receive an unnecessary epi-pen injection, but I seriously doubt that will happen. Most of the time, the staff is so hesitant to administer one that they call every possible person first to try to talk them out of it.
I don't know about your epi-pen law, but we've had one for years, and it allows parents to sign a form to opt their student out of staff-initiated treatment.
Out of 1800 kids, I only had one parent opt her child out, and of course, she had asthma. Mom also wrote detailed instructions that her child was to go to a very distant hospital if EMS ever had to be called. Sigh....
Thank God we got thru the year without an incident.
I bet that Mom would likely be the first to sue if her child died in route to said distant hospital .
As for Epi-pens, in the real world, I do agree with Jolie. I've taught the staff here, but I am really only certain a handful of them would actually use an Epi-pen even if the Epi-pen is in the student's bag and I am in my office. They would rather wait the 30 seconds for me to run to the classroom and hand me the Epi-pen to use on the student instead .
Out of 1800 kids, I only had one parent opt her child out, and of course, she had asthma. Mom also wrote detailed instructions that her child was to go to a very distant hospital if EMS ever had to be called. Sigh....
As far as I know, if it is an emergency situation (some form of acute distress) then closest hospital trumps preferred hospital.
I've dealt with this at another job at a nursing/rehab home. A patient with chest pains said they wanted a specific hospital but EMS said "no way" because it was at least 15 minutes further away.
I bet that Mom would likely be the first to sue if her child died in route to said distant hospital .
As for Epi-pens, in the real world, I do agree with Jolie. I've taught the staff here, but I am really only certain a handful of them would actually use an Epi-pen even if the Epi-pen is in the student's bag and I am in my office. They would rather wait the 30 seconds for me to run to the classroom and hand me the Epi-pen to use on the student instead .
Yeah but for me, I'm probably not going to be on campus . . . ... . I have 11 campuses 30 miles apart to monitor.
The fact that I was on campus for this incident is a major fluke. Which is why I needed some help with what to do with a staff who was trained in using stock epi-pens for anaphylaxis . . . and who were not happy about it. They don't like being a "medical clinic". They are secretaries dealing with school stuff.
They were very concerned about hyperventilation having the same symptoms as anaphylaxis and would have given epi if I had not been there.
I agree. But . . . . . . the bureaucratic nonsense that dictates how I am supposed to do things says otherwise.
And . . . I found out yesterday that all the schools in our county will be audited by the mean old government workers this fall.
If the "t's" aren't crossed and the "i's" not dotted, we will get fined.
I can't write up a policy willy nilly . . . .but just came from a stock epi-pen training at one of the elementary schools and the new law here in CA that went into effect states the person trained has to have a current CPR card. Only one person had one.
The law states the sup has to ask for 2 volunteers per campus. We didn't get many takers. So we decided to train office staff and principals/vice principals. At this campus today, a bunch of teachers wanted to come in to the training and I let them.
I also encouraged them to get their union involved in getting them CPR training.
Every year the school district gets audited. But a different department each time. Two years ago it was our dietary department and we got dinged for a bunch of things. However, the woman was pretty nice and helped us get on track with what we were supposed to be doing.
I got an email last week asking me to send someone in a state government office the flyer we are sending out with all registration packets (K-12) over the summer going over HIV/AIDs information.
What? There's a mandate for that?
I think we need a full-time person on campus just to follow all the government mandates . . . . . there are companies by the way that offer to do that.
As far as I know, if it is an emergency situation (some form of acute distress) then closest hospital trumps preferred hospital.
I've dealt with this at another job at a nursing/rehab home. A patient with chest pains said they wanted a specific hospital but EMS said "no way" because it was at least 15 minutes further away.
Yup. Our FD will transport locally unless it is a STEMI (not likely in a HS kid).
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Windchaser22
408 Posts
Having her focus on diaphragmatic breathing along with speaking calmly is the current standard of care.