I want to share my experience hoping it can help someone else, and to review for myself what I learned today.
Got a call a student was choking in the classroom, and when I said "choking?" the TA said "well, coughing and she cannot stop." I get to the room to find the 17 year old holding her stomach, drooling, very mild cough, and constant sneezing. Eyes are closed, she is special needs and has a seizure disorder, but this does not look like seizures to me. Staff says she was just finishing her rice meal when this started, and she has not history of allergy and this is a meal she eats all the time.
I first try to talk to her to see if I can calm her, assess her alertness . . . she can follow instructions to squeeze my hand. Lips and nail beds pink, no swelling, no wheezing, no retractions around neck or clavicle area. As I talked to her the coughing intermittently slows and honestly, at times, sounds forced, so there is a part of me that is wondering if there is something behavioral going on (it has happened) but I know the sneezing is real. I wonder if it's some kind of reflex reaction and is the cough and sneezing are related.
After 5 -7 minutes it is not stopping, so I ask office to call 911 for a teen student in respiratory distress. I then start to wonder if this is an unknown allergic reaction. I ask someone to retrieve the EPI pen from my office.
Myself and the teacher continue to try to keep her calm, and while it all continues, there is no worsening or improvement.
At the 15 min mark I tell the teacher I am giving EPI - I don't know what this is but I am concerned about some kind of throat swelling. 30 sec after EPI the cough slows a little, again at the 1 minute mark, and by 2-3 minutes all symptoms stop. In the meantime, EMS arrives. O2 sats are good and lungs are clear. They suspect she started choking and had airway narrowing, and the EPI opened her up.
I am going to have a meeting of all my EPI trained staff next week to share with them the signs I saw, and use this as a teaching moment for all of us. If I was having a hard time deciding what to do, it gave me insight into what it will be like for a lay person. I need to reinforce that better to give it if there is any question than not give it.
I will be honest . . . I think I waited too long to give it. I was trying to be systematic in my assessment and other than the coughing, no signs of respiratory distress. But I kept thinking that if this goes on, it's going to progress to respiratory distress and then I will have a bigger problem.
Off to the hospital she went. I am sure she will be fine. But if anyone has any comments to contribute (and please feel free to offer constructive criticism . . I want to use this as a learning opportunity), please do. Mostly, at what point would you have given it? That is what I am struggling with. I know if there were any signs of worsening, noisy resp., retractions, color change, it would have been an no-brainer. Without any of those signs, it was the longevity of the situation that became concerning to me.
