Safety Plan ideas, anyone?

[J-lynn]

(EDIT)

ADMIN NOTE: Per the TOS, to which you agreed when you joined, this is a public board and fully searchable.

So the young lady that I called an ambulance for last Friday fainted again today. They called me and she was sitting in a wheelchair pale & with a headache. I immediately got her on the floor with her feet up & her B/P was 120/48. Called mom who said the doc said follow the care plan. The plan states she is to rest until she feels better and then go back to class.

So while she was resting, one of the AP's pulled up the video of her fainting in the hallway. It happened between classes. She and a friend were leaning over the school store counter. The video shows her first sitting down with her head between her knees--this is the plan for when she feels faint. Then she gets up, leans over the counter to look into the store again. Then she stands up straight, falls back, hands at her side, hits her but & head HARD. No hands reflexively reaching out to stop the fall.

It was a horrifying thing to watch. A picture really is worth a thousand words. So I said that her mom really needs to see what is happening. When I checked on her again, she was still pale and with a headache. She has had a headache for weeks now & is not sleeping due to the pain. A PA saw her in the ER last Friday after I had her transported for the fainting, headache, and super low B/P & could find nothing. He said don't send her back unless something different happens. Just follow the care plan

The family pushed for a CT but it showed nothing. She is scheduled soon for a full body MRI & has an appointment with a neurologist after that.

I called mom back & said that she needed to come see the videos we had of her fainting--we also had one from last week when she fainted in the hallway...I told her we can't keep having her hit her head like this & I didn't feel comfortable keeping her at school after hitting her head like that again... I said she needed someone to monitor her for concussion symptoms--NO ONE has mentioned a concussion after all of this!! Or even the possibility of it!!

She took her daughter to see the NP after she left. Our SRO sent the video to the NP. I don't know the results of that visit yet.

ANYhow...I just got a message from her AP who has set up a safety meeting with me, mom, and the principal in the morning. But seriously, I am at a loss!!! What else can we do? This young lady is trying to take steps to sit down & rest, but she isn't always able to predict it and is feeling so badly that I question whether she should be in school right now.

Thoughts anyone? I don't feel like I have much to offer for the safety meeting except please keep her home or get her a helmet until something is done for her medically to stop this!!

BTW, she has had these fainting episodes for a couple of years. But iit was rather infrequent & has now ratcheted way up in the past month. Parents thought she was doing it for attention. But no way in MY mind a person could fall backward like that and not reflexively reach out your hands to stop your head from hitting full force.

[NutmeggeRN, BSN]

Were you able to get orthostatic BPs on her? I'm thinking along the lines of POTS.

Has she had a cardiac work-up? The whole situation sounds stressful and scary for all. I hope they figure out what is going on soon.

[J-lynn]

Nutmegge...I have not done that. Thanks for mentioning it. MHDNURSE, no one has mentioned the cardiac workup. My husband is an ER doc, formerly FP. He said the same. She needs a cardiac workup. He said he would have her being a literal couch potato--NO exercise--until it comes back clean. I will be requesting an elevator key for her & someone to accompany her on the elevator. Going to talk with mom today about the cardiac workup & driving....My husband said also that whoever said don't come back to the ER is making a big mistake. He said they broke a cardinal rule---if a person comes to the ER 3 times, he says you admit them & find out what the heck is going on...

[OldDude]

Sounds like you're on it...you didn't tell us you have an ace in the hole...ER doc husband - Nice resource!!

I'm thinking along the line of Nutmegge...POTS

[scuba nurse, BSN, MSN, RN]

I second the cardiac workup. Also, have they done any blood tests? Anemia? Low electrolytes? Does she eat and drink enough? Does this happen at home or outside of school as well? There is something going on here, and I wouldn't feel comfortable having her walk around alone at school, she needs someone with her at all times.

[NutmeggeRN, BSN]

How old? Any chance she is pregnant?

[UrbanHealthRN, BSN, RN]

I agree with having her see cardiology- POTS, heart defect, something else?

I'd also consider neuro, because 1) a constant headache for weeks sounds like a possible concussion from one of her falls, and she should be evaluated for that; 2) it doesn't sound like she's having a seizure during these episodes, but I've seen pedis make sure to rule that out as part of the work-up.

[MrNurse(x2), ADN]

I beg all my parents to demand an MD see their child. I have had really bad experiences with midlevels diagnosing. They are very inconsistent, and I live in arguably the best health care in the world. I would pass this on to the parent, explaining that physicians have years of being tested on diagnoses, as opposed to months for a midlevel.

[UrbanHealthRN, BSN, RN]

I beg all my parents to demand an MD see their child. I have had really bad experiences with midlevels diagnosing. They are very inconsistent, and I live in arguably the best health care in the world. I would pass this on to the parent, explaining that physicians have years of being tested on diagnoses, as opposed to months for a midlevel.

To add to that, a good primary care pediatrician will usually want to see their patient after an ER visit like she had. Does this child's pedi want to follow up with the family?

[EnoughWithTheIce]

Has she had a cardiac work-up? The whole situation sounds stressful and scary for all. I hope they figure out what is going on soon.

yes, this was my first thought!

[J-lynn]

Thanks everyone! I got more information at the safety meeting this morning. Apparently she has had a workup by a pediatric cardiologist who has completely cleared her cardiac-wise. Her BG was tested during one of my ambulance calls & it was 100. I feel the same about her not seeing an MD with something so serious--my husband said my attitude was not right about that, but an MD gets SO much more training.

As for pregnancy, I haven't asked but this has been an ongoing issue for a couple of years that just recently increased dramatically in frequency. The NP did see the video which the mom said really did give her more insight. After seeing it, she really felt even more certain that it is neurological in nature. She thought the way this student jerked back as she fell was indicative of a neurological cause. Thank goodness for that video!!!

Also---the NP said no concussion. She thinks her body is taking the brunt of the force of the fall. Another detail from the student today was that her headache never improves until she faints. But, as I mentioned before, her headache has now been ongoing for weeks...

I haven't had much experience with POTS, but hopefully that is something else they are considering. She doesn't seem to have the weakness that I saw with a previous student with POTS. But it just seems that SOMETHING is dropping her B/P??

We are going to try getting her to the office in a wheelchair when she feels it coming on & see if lying down with her feet up will get her feeling better and prevent the fainting. But if she continues to feel like she could faint, we will keep her in the office to do her work for now. She will have an elevator pass & use a buddy system for now as well. Next Tuesday is her MRI & one week later is her appointment with the pediatric neurologist.

I am so glad her mom got to see the video....It really lit a fire in her to keep trying to get help!!

OldDude--yes, I am extremely fortunate to be able to have my husband to ask questions! But I have learned many things he has no idea about from you guys as well!