911 call

Specialties School

Published

Hi all, I haven't really posted before, but I'd appreciate some feedback since school nursing is new to me and I'm really trying to grow and learn something from each experience. I like this position and really want to be successful. Today I was called on the playground by another teacher. The student was on the ground holding his head, not moving. Teacher says she did not witness fall, another student told teacher he fell and did not give many other details. When I get there teacher says his initial reaction was repeating "my head hurts", but when I got there to assess him, he wasn't following any commands (wasn't telling me his name, where he was, open eyes, squeeze fingers) just mumbling. Pupils were equal, dilated (approx.5 mm). Given all of this I did not feel I should move him so I made the decision to call 911. Last update I received he was now awake/alert and waiting results of a CT scan at the hospital. All other tests appeared normal. I did come to find out he does have a history of behavior problems, that he can be withdrawn. Did I overreact? Are there any other steps/assessment you would have done? Any other questions/commands you would have asked?

Specializes in kids.

My favorite response in this situation is this

" In my professional assessment, I made the best decision I could with the information I had"

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Specializes in ICU/community health/school nursing.
My favorite response in this situation is this

" In my professional assessment, I made the best decision I could with the information I had"

Filing that away for when I need it. That's brilliant!

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Specializes in Critical care, Trauma.

Not a school nurse but I find myself on your forum a lot. =) My $0.02 is to add that sometimes people with pre-existing behavioral problems don't get their changes in condition noticed as early because it's just written off as "oh, it's just him/her being crazy again". I learned this lesson when it was found that a patient on the floor I was working on, with severe mental illness, started screaming more than her normal. We thought it was just her being more frustrated with her extended hospital stay and we were having to keep her NPO for her particular problem, which she did not like or understand. Turns out she was screaming and acting out more because she was going septic. So in the case with this kid, yes, it's helpful to know that he can have behavioral problems but it can also potentially mask a real change in condition or the depth of an injury. Sometimes that means that things aren't "caught" until late in the game, when they lose consciousness or have other symptoms that can't be written off as something else.

Good job!

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Specializes in Cardiology, School Nursing, General.

Dilation of eyes, how would that present on a injury?

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Specializes in LTC, Rehab.

You did great. While I don't want to waste money and resources, at the same time, I'd rather err on the side of caution & take action than not call when I should've.

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Specializes in School Nursing.

I would have done the exact same thing. And probably would be here double guessing too. But like others have said, you have to err on the side of caution.

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Hi all, I haven't really posted before, but I'd appreciate some feedback since school nursing is new to me and I'm really trying to grow and learn something from each experience. I like this position and really want to be successful. Today I was called on the playground by another teacher. The student was on the ground holding his head, not moving. Teacher says she did not witness fall, another student told teacher he fell and did not give many other details. When I get there teacher says his initial reaction was repeating "my head hurts", but when I got there to assess him, he wasn't following any commands (wasn't telling me his name, where he was, open eyes, squeeze fingers) just mumbling. Pupils were equal, dilated (approx.5 mm). Given all of this I did not feel I should move him so I made the decision to call 911. Last update I received he was now awake/alert and waiting results of a CT scan at the hospital. All other tests appeared normal. I did come to find out he does have a history of behavior problems, that he can be withdrawn. Did I overreact? Are there any other steps/assessment you would have done? Any other questions/commands you would have asked?

Not an over reaction at all. Good job

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Specializes in Pediatric Critical Care.
Dilation of eyes, how would that present on a injury?

Dilated and/or unequally sized pupils can be an indicator of possible increased pressure inside the skull. It might be due to brain swelling, bleeding, or even some kind of tumor/mass. In someone who may have a head injury (and therefore possibly swelling/bleeding), pupil changes are an important part of the assessment.

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Not a school nurse but I find myself on your forum a lot. =) My $0.02 is to add that sometimes people with pre-existing behavioral problems don't get their changes in condition noticed as early because it's just written off as "oh, it's just him/her being crazy again". I learned this lesson when it was found that a patient on the floor I was working on, with severe mental illness, started screaming more than her normal. We thought it was just her being more frustrated with her extended hospital stay and we were having to keep her NPO for her particular problem, which she did not like or understand. Turns out she was screaming and acting out more because she was going septic. So in the case with this kid, yes, it's helpful to know that he can have behavioral problems but it can also potentially mask a real change in condition or the depth of an injury. Sometimes that means that things aren't "caught" until late in the game, when they lose consciousness or have other symptoms that can't be written off as something else.

Good job!

Similar to Rare diseases happen rarely. Maybe they are rare because no one thinks of them.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Unless the hospital gives out CT scans with their turkey sandwiches, that is the vindicator. As soon as I heard the child had been given a CT scan I would be high-fiving myself for having made a righteous call. Let's hope the CT scan didn't turn up anything too concerning, but the fact that they did one means you definitely did not overreact.

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Specializes in Cardiology, School Nursing, General.
Dilated and/or unequally sized pupils can be an indicator of possible increased pressure inside the skull. It might be due to brain swelling, bleeding, or even some kind of tumor/mass. In someone who may have a head injury (and therefore possibly swelling/bleeding), pupil changes are an important part of the assessment.

Thank you for the information! I'll make sure to keep that mind!

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