Seizures! Diastat!!

[KH_RN6, BSN]

Hello!
I'm a preschool RN (kids ages 3-5)

I have a 3 year old, that has history of stroke, that is now having some new seizures. He had one Tuesday and stopped breathing for 3 minutes (at home- this was after he got off the bus).

I spoke with parents today when they dropped him off, they brought the emergency diastat for me to have at school.

Now here is my very (im sure :)) stupid question! Because I am from the hospital setting and 90% of my ped population that had hx of seizures were trached! If they stopped breathing we would bag them. SOOO if this kiddo were to have a seizure at school, and mom said he will stop breathing, after 3 minutes to go ahead and give diastat, but do you do mouth to mouth while their seizing? OR do you wait for them to come to?

I'm not used to being the sole medical professional making all the decisions and I think im just over thinking and nervous. ?

[ruby_jane, BSN, RN]

Hang in there. What do the orders say? If you have no orders, speak to the prescribing doctor.

When a parent says "they stopped breathing" - it may have looked like that. Their RR may have dropped. But I don't know that I'd freak out about it until I saw it or another medical professional saw it.

It's gonna be OK. You're not overthinking. You're planning for the inevitable.

[k1p1ssk, BSN, RN]

I'm assuming you don't have a BVM or at least a mask? I would probably start by asking admin if one could be purchased, and to have at least one other staff member who is likely to be near the child a lot be CPR trained. Because, yes, absolutely at least attempt to give rescue breaths if they are not breathing while seizing. Compressions only if they have no pulse... and then of course, diastat if it lasts 3 minutes....

[KH_RN6, BSN]

3 minutes ago, k1p1ssk said:

I'm assuming you don't have a BVM or at least a mask? I would probably start by asking admin if one could be purchased, and to have at least one other staff member who is likely to be near the child a lot be CPR trained. Because, yes, absolutely at least attempt to give rescue breaths if they are not breathing while seizing. Compressions only if they have no pulse... and then of course, diastat if it lasts 3 minutes....

ok! that's what I need to know! I figured I would give breaths but I didn't know if it would even be possible if they are seizing. His seizures though don't sound like their the full tonic clonic, so rescue breaths may be possible.

I do have some facemask/barriers that each teacher has in their emergency back pack. so I'll give this teacher an extra one.

Thank you

[KH_RN6, BSN]

another question, he is a bus rider.

We make bus cards for kiddos that have medical needs. I will inform them of what to look out for and what to do. Won't be able to send the diastat home on the bus. So I will just let the bus driver and aid know what to look out for, if he has seizure and stops breathing to stop the bus and call 911? Do I or should I provide a facemask and tell them how to rescue breathe or just tell them to stop and wait for 911. ??

[NurseHeatherBSNRN, ASN, BSN]

CDC recommends no attempt of CPR/rescue breathing during the seizure; only if s/he is still pulseless/not breathing after the seizure ends.

https://www.cdc.gov/epilepsy/about/first-aid.htm

As far as the bus, I would recommend CPR training for the bus driver/aide. Most 911 dispatchers are able and willing to give CPR instructions over the phone, so a face mask would also be excellent idea.

[COERRN]

I don't believe rescue breaths during seizure activity is the standard. You only need to do that if apnea is present after seizing has stopped. If he seizes just place him on his side and make sure he doesn't injure himself, start timing, and administer meds as prescribed. After seizing has stopped, assess airway, breathing, circulation and intervene as needed in those three areas. It is that simple.

As for the bus, I would follow policy/procedure. If the child cannot receive his meds, then I suppose calling 911 would be the bus driver's only option. If I was his parent I wouldn't have him ride the bus, to be honest. Usually kids with seizure disorders don't need an ambulance called with a "standard" seizure as long as a trained adult can appropriately manage their condition. I would try to avoid all situations where the only thing the adult can do is call an ambulance. It would be expensive and unnecessary for him to have a "standard" (for him) seizure and end up with a huge ambulance bill and ER visit.

In general, I think getting CPR certified is good for the bus driver. I don't think he needs to get certified for this specific kid.

[ruby_jane, BSN, RN]

38 minutes ago, COERRN said:

As for the bus, I would follow policy/procedure. If the child cannot receive his meds, then I suppose calling 911 would be the bus driver's only option. In general, I think getting CPR certified is good for the bus driver. I don't think he needs to get certified for this specific kid.

Our bus drivers cannot administer anything (maybe Epi IF the student carries it) so it would be EMS only. I love the rest of your response. Even hands only CPR is good. But not necessarily for this. @KH_RN6 how's it going now?

[KH_RN6, BSN]

1 hour ago, ruby_jane said:

Our bus drivers cannot administer anything (maybe Epi IF the student carries it) so it would be EMS only. I love the rest of your response. Even hands only CPR is good. But not necessarily for this. @KH_RN6 how's it going now?

It's been good. All this information transpired end of the last week, this kiddo only comes Tues and Thurs. He came back to school Thursday and looked great, we just had kept a watchful eye. The teacher didn't see anything alerting that day. I had given the bus drivers a bus card with information on the kiddo and what to do in the event of a seizure. They are just having the bus driver aid sit near him. They're prepared to stop the bus and call 911.