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My very first squad call

School   (787 Views 14 Comments)
by cjl_RN cjl_RN (Member)

5 Likes; 1,022 Visitors; 66 Posts

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I’ve been reading a lot your guys first squad call... fearing when would mine be... welp that was today!

 

Teacher walkie in a calm voice need the nurse student fell and wheel chair outside. Responded to scene student is lying on the ground and I could see through his denim jeans that his left knee had poppped out and was external rotated. Ask students his pain level and if he’s moved it or has feeling. Student has no feeling in leg. Immediately yelled for our SRO to get a squad here ASAP. Continued to assess gently lift pants up to make sure there was  no blood running down the leg. Jeans were pretty tight. Student was pale in color hollered for my emergency bag to take vitals. Soon as I got my bag the engine pulled up and he had moved his leg and popped back into place.

 

however the squad took him still to be evaluated to the closest hospital. Of course parents couldn’t be reached an admin had to ride with the child they finally got ahold of parents at the hospital. 

I will follow up with the child’s condition tomorrow. 

The student was outside there was some staff members wanting to move him inside due to cold weather temps, but I had a blankets on the way for him instructed we could not move him, got a pillow to support his head. Some were wanting me to splint it, but I didn’t see benefit of a split the knee cap was completely out of socket rest of the leg was straight, I didn’t feel comfortable moving him. 

 

looking back I should have brought my emergency bag with me, (put scissors in my bag) should have cut to jeans to ensure there wasn’t an open fracture. (Squad didnt cut jeans either).

 Anything else I should have done differently? 

 

 

 

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halohg has 25 years experience.

36 Likes; 2,075 Visitors; 174 Posts

You did amazing!

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laflaca has 5 years experience as a BSN, RN and works as a Public High School Nurse.

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Great job!  No need to be moving anyone around, especially if they're not in immediate danger and you can't rule out head or spine injuries.  You move him onto a wheelchair or bed, you might hurt something and they're just going to have to move him again, right?  No need to be using our Girl Scout skills to forage for splint materials in the ditch, either (EMS has really nice splints, backboards and c-collars, plus pain meds!)

Airway's good, breathing's good, circulation's good, nothing's immediately life threatening....you assessed, you kept things from getting worse, you got him to a higher level of care, and you'll follow up afterward to make sure he gets what he needs at school.  Sounds perfect to me.

And why are they always wearing those skinny, skinny jeans when they hurt their legs?  🙂 

 

Edited by laflaca

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MHDNURSE has 21 years experience.

188 Likes; 11,082 Visitors; 1,082 Posts

Nice job!  I have kids in here all the time with "super skinny" jeans and they tell me they have a cut on their knee or something similar and I can't even assess it b/c the jeans are so tight they don't roll up 🙄  I miss the days of boot cut jeans!

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157 Likes; 1 Follower; 4,490 Visitors; 428 Posts

Sounds like great intervention!

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ruby_jane has 10 years experience as a BSN, RN.

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You'll never forget you emergency bag again. This is how we learn. Whilst waiting for @OldDude to chime in - you did well. Don't listen to people who don't have medical expertise. EMS is on the way and they can "splint" or whatever. I have found that in a time of emergency my silence and focus on the patient shuts people up.

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Flare is a ASN, BSN and works as a School nurse firefighter.

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Great job!  That sounds so painful!  I am on team "no splint". There have been times that I have thought it would have been a great idea to use my former EMT (i ran with a squad for a while, now i'm just on a FD) muscles and splint something up only to have ems tell me they're glad i didn't because they want to assess too.  

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OldDude works as a School Nurse.

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Good on you for remaining in control and the voice of reason! Excellent assessment and intervention. Under the circumstances you describe I can't see a need for jean cutting/splinting since he's only going to be moved from one stable environment to another stable environment. If there was some long bone deformity or swelling...maybe. Plus, grabbing the cuff of a pant leg is an excellent way to support the leg for transfer; cutting the jeans would have taken that option away! 

It's good to second guess yourself and identify how you will prepare for a future incident but move on and let it go. You did a great job! They are lucky to have you there to take care of those kidlets.

 

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ruby_jane has 10 years experience as a BSN, RN.

880 Likes; 2 Followers; 6,678 Visitors; 1,957 Posts

As an aside - school nurses are generally a creative, make-do bunch and we routinely spin straw into gold every day.

You'll get varying answers about splinting, and about things that you "could" do which may or may not be scope of practice or best practice.

In my 8th year I am consciously aware that:

1) I will not do more with less. If I don't have something the student needs, the student will need to be sent out for that. Whether that is send out by parent at 3 PM or EMS in three minutes is up to my nursing judgement. I cannot fix everything.

2) I have a limited set of P&P and standing orders. Every time I'm tempted to go "above and beyond" (and that's daily) I reconsider my standing orders. Should I do something that I think is right (or best practice) if I have no backing and may be accused of practicing medicine without a license, or working beyond my scope?

3) In a real emergency all that goes out the window.

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62 Likes; 3,507 Visitors; 409 Posts

5 hours ago, MHDNURSE said:

Nice job!  I have kids in here all the time with "super skinny" jeans and they tell me they have a cut on their knee or something similar and I can't even assess it b/c the jeans are so tight they don't roll up 🙄  I miss the days of boot cut jeans!

I TOTALLY agree! these skinny jeans are killing me! 

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382 Likes; 1 Follower; 631 Visitors; 197 Posts

6 hours ago, ruby_jane said:

As an aside - school nurses are generally a creative, make-do bunch and we routinely spin straw into gold every day.

You'll get varying answers about splinting, and about things that you "could" do which may or may not be scope of practice or best practice.

In my 8th year I am consciously aware that:

1) I will not do more with less. If I don't have something the student needs, the student will need to be sent out for that. Whether that is send out by parent at 3 PM or EMS in three minutes is up to my nursing judgement. I cannot fix everything.

2) I have a limited set of P&P and standing orders. Every time I'm tempted to go "above and beyond" (and that's daily) I reconsider my standing orders. Should I do something that I think is right (or best practice) if I have no backing and may be accused of practicing medicine without a license, or working beyond my scope?

3) In a real emergency all that goes out the window.

SPOT ON!!!!! I love it all of it but #1 speaks to my soul. 

I see no sense in splinting if EMS has been called. As someone else, stated - they need to do their own assessment and have their own protocols (with appropriate equipment) in place.

I had a kid last year with 2 obviously deformed fractured arms laying stomach down on the tennis courts. As soon as I saw what an awkward position he was in with neck at a strange angle, I called 911. Just monitored ABC's and tried to keep him calm. PE coach kept wanting to flip him over and I stood my ground! 

It took 5 EMT's and lots of imaginative maneuvering to get him onto the stretcher. 

 

 

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ruby_jane has 10 years experience as a BSN, RN.

880 Likes; 2 Followers; 6,678 Visitors; 1,957 Posts

4 minutes ago, EnoughWithTheIce said:

I had a kid last year with 2 obviously deformed fractured arms laying stomach down on the tennis courts. As soon as I saw what an awkward position he was in with neck at a strange angle, I called 911. Just monitored ABC's and tried to keep him calm. PE coach kept wanting to flip him over and I stood my ground! 

It took 5 EMT's and lots of imaginative maneuvering to get him onto the stretcher. 

Sweet baby Moses. You're a great nurse!

 

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