Prioritization interview question advice

Airway, breathing, circulation

What would YOU do?

Utilizing ABC initialism, I would care for:

#1 asthma attack

- Sit the child upright, reassure the child it is going to be okay.

- if unstable such as cyanotic, altered loc, difficulty speaking - call 911

- if stable, check if child has a plan for asthma. ie. albuterol inhaler

- encourage child to breathe in through nose and out in the mouth

- if stable and recovers, return to class.

- call parent or guardian

- follow up with child.

#2 major nose bleed

- encourage to breathe through mouth, and lean head forward

- pinch nostril below nasal bone

- utilize ice pack

- if persistent major bleeding continues - call 911

- if bleeding stops, monitor child, call parent and suggest medical attention as is major bleed

- follow up

#3 child throwing up

- offer something to throw up in

- have child lie down on left side

- offer water to sip on

- if unstable: altered loc or throwing up blood - call 911

- call parent - urge to seek medical care

- follow up

#4 parent

- assess for potential head injury

- if suspect head, neck or spine injury, keep head and spine aligned. do not move individual - call 911

- utilize ice pack and have parent rest

- discuss the possibily of delayed symptoms up to 2 hours. provide parent with print out discussing head injuries.

So, if i'm assessing patients, I utilize ABC. Once individual codes, I utilize CAB. Is this correct? Also, what is your feedback on my plan. I utilized this resource:

http://www.emsa.ca.gov/media/default/pdf/emsa_196-schoolguidelines_final.pdf

Depending on the job description, it might not be in the school nurses job description to care for parents. I would file an incident report, regardless. My priority

remains with the children.

I think that happened at my school last week.

Asthma -especially if showing signs of distress

Nose bleed - next (until you can work with them, have student pinch)

Vomit- tell them to sit up and put their head in the trash can and stay there until you tell them to move.

Instruct another parent to use ammonia capsule on parent and keep them on the floor until you can assess.

I would not offer the vomiting child water to sip on, especially if they have just vomited. The risk of dehydrating for vomiting x 1 is pretty slim, so they are NPO at least until everything else gets straightened out.

#1 I would be on my walki-talki or the overhead calling for help in the health office!

2) Assess the asthmatic

3) assess the parent

4) tell the vomiter to get in the bathroom

5) tell the nosebleed to sit and hold still and tell them to grab some gauze and a wastebasket

Chances are the vomiter has a virus (get them away from everyone else), the nosebleed (unless they are a von Willebrand) will be OK for a few minutes

Have the help call 911 for the parent if indicated.

Be glad that summer is almost here!!!!

#1 I would be on my walki-talki or the overhead calling for help in the health office!

2) Assess the asthmatic

3) assess the parent

4) tell the vomiter to get in the bathroom

5) tell the nosebleed to sit and hold still and tell them to grab some gauze and a wastebasket

Chances are the vomiter has a virus (get them away from everyone else), the nosebleed (unless they are a von Willebrand) will be OK for a few minutes

Have the help call 911 for the parent if indicated.

Be glad that summer is almost here!!!!

Yes, me too, to all.

#1 I would be on my walki-talki or the overhead calling for help in the health office!

2) Assess the asthmatic

3) assess the parent

4) tell the vomiter to get in the bathroom

5) tell the nosebleed to sit and hold still and tell them to grab some gauze and a wastebasket

Chances are the vomiter has a virus (get them away from everyone else), the nosebleed (unless they are a von Willebrand) will be OK for a few minutes

Have the help call 911 for the parent if indicated.

Be glad that summer is almost here!!!!

Lol on the last part!

I don't have a walki-talki, but asthmatic, parent (especially if I think they hit their head on the way down, the floor in my office is concrete), and directing vomiter to my bathroom and handing nosebleed gauze with instructions to hold pressure until I can take a closer look.

"Major" nose bleed is so subjective in the real world. Every nosebleed that happens is considered major by a teacher or student. The worst I've seen took 10 minutes of pressure, but blood loss was minimal overall and student was fine. I suppose if blood were "gushing" out of nose, usually due to some other underlying issue, I'd have 911 on standby for a double pick-up with my asthmatic :).

#3 child throwing up

- offer something to throw up in

- have child lie down on left side

- offer water to sip on

- if unstable: altered loc or throwing up blood - call 911

- call parent - urge to seek medical care

- follow up

I'm curious- what's the rationale behind a vomiting person laying on the left side? I've not heard that outside of cardiac issues.

I offer water to rinse if they are vomiting, but no drinks.

I also give baby wipes for them to clean up until it is ok for them to wash up in the BR.

I generally do not have pukers lie down unless I am pretty sure the "storm" has passed.

Lol on the last part!

I don't have a walki-talki,

"Major" nose bleed is so subjective in the real world. Every nosebleed that happens is considered major by a teacher or student. The worst I've seen took 10 minutes of pressure, but blood loss was minimal overall and student was fine. I suppose if blood were "gushing" out of nose, usually due to some other underlying issue, I'd have 911 on standby for a double pick-up with my asthmatic :).

A radio has its plusses and minuses....I can go anywhere and they can reach me, the only place I do NOT bring it is to the restroom!!!! (the echo due to the concrete walls is brutal, plus everyone knows where you are!!!

Most "major nosebleeds" in my experience are just huge clots, that once expressed, are over and done with!

Which of these people might die if you don't tend to him first? The asthmatic is the priority. Unless the nosebleeder is a hemophiliac or a child with cancer with a platelet count of 10K, he'll clot and be just fine. You will likely know who your asthmatics are and have rescue inhalers available within reach, if your school doesn't allow the children to carry them on their person. Tend to the asthmatic, while doing so tell the nosebleeder to grab a tissue and hold pressure and direct the vomiter to the bathroom or the trash can. Once the asthmatic has used his albuterol inhaler or you have him set up with a neb and he seems to be improving, you can move on to the parent. You know the parent fainted from the sight of blood, so she'll probably be more embarrassed than anything when she comes to. I doubt 911 will need to be called for anyone in this case but if it does, it's probably for the asthmatic. Unless the vomiter has hydrocephalus with a VP shunt, he's unlikely to need any kind of urgent care. Most schools send kids home for vomiting so once things are settled with the rest you can call the parent to pick him up.