Scenario

[Ddoyle]

hello all

new member. While I am not a nurse our school employs certified EMT's in each location that works under the supervision of a head nurse. I have a scenario that recently happened and wondering what your input is on how to handle it.

A random parent informed me at the beginning of the day that a student was lying on the concrete just outside the office door.

I find my patient lying on his side, alert and oriented with normal breath rate and quality. No bleeding. I ask the student what happened and his response is "I feel sick, my mom wants me to have a good day."

I then ask the student to sit up and come with me, which he does.

At this point I have him lie down in my office and give him water as he is very hot and sweaty. At this point I'm not ruling out heat-related sickness, as it is 100 degrees here.

upon asking what was going on he gives me a complaint of "I feel sick, my stomach hurts."

I take a temperature and stick the pulse ox on him. 98.6, SpO2 of 75% and pulse of 60.

I ask if he has asthma and he states yes. I do not have an inhaler.

I immediately call parents and they pick him up. If I could not get a hold of parents I was prepared to immediately call 911.

I talk him through breathing. in through nose and out through mouth as well as checking lung sounds. Bilateral wheezing posterior and anterior.

after talking through breathing SpO2 improves to 85% and dad picks up.

I notify him that he should be immediately taken to an emergency room.

What are your thoughts? I'm debating my choice to call parents instead of 911, but his SpO2 was improving and parents have medicine on hand.

First year Health Tech, just looking for what else I could have done.

Thanks!

[OldDude]

Always remember to make decisions based on the patient assessment....don't treat the monitor. If the student was alert, oriented, respiratory effort non-labored, able to complete a sentence, mucus membranes pink, cap refill less than 2 seconds, yadda yadda, there was no reason for emergency transport. I don't recall reading the kid's age but, regardless, I wouldn't expect a pulse rate of 60 with an O2 sat of 75; Unless the kid was bradying into a death spiral and then it would be obvious you'd need to dial 911. Under the circumstances you describe those two numbers don't correlate....don't treat the monitor. With what you are relating in the description I think your action was appropriate.

[Ddoyle]

Yes, makes sense.

Being a possible first time emergency situation my training kicked in with the monitor and the SpO2 sats. Lesson learned about treating the monitor rather than the patient.

[Wave Watcher]

Always remember to make decisions based on the patient assessment....don't treat the monitor. If the student was alert, oriented, respiratory effort non-labored, able to complete a sentence, mucus membranes pink, cap refill less than 2 seconds, yadda yadda, there was no reason for emergency transport. I don't recall reading the kid's age but, regardless, I wouldn't expect a pulse rate of 60 with an O2 sat of 75; Unless the kid was bradying into a death spiral and then it would be obvious you'd need to dial 911. Under the circumstances you describe those two numbers don't correlate....don't treat the monitor. With what you are relating in the description I think your action was appropriate.

BAM! This is exactly what I do. I look at the patient first and the numbers last. I have a small population of kids so I know my drama queens and kings......in those cases I will look at my numbers such as BP, HR, O2, Temp and make a decision or just call parents and let them spend 5 minutes on the phone with their kid debating whether or not they go back to class. :-)

So, yes, I agree you made the right choice given the situation. I would have acted the same way.