Just not sure........

You assessed her and recognized the need for prompt medical attention. Good for you!

I think you are allowing the terminology used by the transport team to intimidate you. Life Flight sounds dramatic. And it is. But the truth is that she was transferred because she had a condition that out-stripped the expertise of the admitting facility. That is not an indication of inadequate nursing care on your part, or anyone else's.

You recognized that your student had active bleeding and inadequate tissue oxygenation, as evidenced by bleeding gums, conjunctival hemorrhage, and ghastly color. Her vital signs were still WNL, which was good, but not an indication that she was stable, since children tend to compensate very well until their ability to do so simply is overwhelmed, at which time they tend to crash.

Given that assessment, I might hae called her parents and given them the option of picking her up immediately for a trip to the ER, calling the hospital to notify of her impending arrival, or callling 911 and accompanying her to the ER to be met by her parents.

Generally speaking, I am not a fan of ER treatment, and usually err on the side of the primary care provider's office, but few medical offices are equipped to treat rapidly decompensating children, and it was 100% likely that this child would need IV access for meds and/or blood products, so transfer to a hospital was going to be necessary.

That is NOT to say that your decisions harmed her care, but just perhaps delayed it a bit. Take it easyon yourself :)

What was the cause of her condition? ITP? Sepsis? Something else?

Her parents did not have a phone, so we decided to take her home. Her house was like 5 miles or so from the school. I was more concerned with the Life Flight, because an ambulance ride between the two hospitals would have been an hour and a half...two tops, and they didn't want to wait that long. I haven't heard the definite diagnosis yet, but last I heard they were testing for Leukemia.

Her parents did not have a phone so we decided to take her home. Her house was like 5 miles or so from the school. I was more concerned with the Life Flight, because an ambulance ride between the two hospitals would have been an hour and a half...two tops, and they didn't want to wait that long. I haven't heard the definite diagnosis yet, but last I heard they were testing for Leukemia.[/quote']

Oh my. I hope she's ok.

i think you acted appropriately given the recources that are on hand for a school nurse's office. Yes, I am sure that if you were given a set of fresh labs to look at you may have decided that a call to 9-1-1 was more in order than a call to the student's parent's and an eventual transport to home via school staff - but this wasn't an option. You work with what you have.

Now I'm with Jolie on the ER bit. I'm not a big one to ship kids right off to the ER. I will offer it in cases when i think it may be a possibility that a parent may take a child there and obviously in cases where there are no choices but to send a child out (or staff member ). Don't get hard on yourself because they ultimately ended up flying the child to a different facility. These types of decisions are often made due to a lot of reasons like distance between facilities, evidence of active bleed, poor oxygenation, available transport method, and in reality how good your insurance is (sadly)...

I am grateful that the little one had an experienced nurse that looked at this child as a whole picture. A lesser experienced nurse may have become more focused on the fact that the vitals were ok may have focused attention in a different direction.

They are saying pancytopenia. Better then Leukemia I guess.

Thx for the update.