vents and cpr

[smartnurse1982]

i am sorry i asked this question again but i get so many conflicting idea. the quesstion was about this: i have a vegetable like 11 yr old client whom i go to school with who is on a vent ltv 950. settings are simv mode br 6 pc 18 pc 18 sensitivity 3 . if her heart rate starts plummeting down to 20 (and assuming there is nothing wrong with vent or trach) should i turn vent up to 15 and begin chest compressions, wait till heart stops beating then do compressions, or take off vent then bag and do chest compressions? i looked all over internet have pals and bcls cert and still cannot find single answer. supervisor says turn up vent and start compressions but that he isnt sure and actualy stated this is called natural death? huh

[Thornbird]

Although you have received many good answers here and have looked elsewhere, you haven't looked in the right place: orders. The child will have a medical plan with all MD orders on file in the Special Ed office and with the school nurse. It appears that you work for an agency contracted to provide a nurse for this child. What you are legally, in the eyes of the school, is a "related service" required for the child to receive an education. Although your have a nursing supervisor through the agency, the person responsible for the overall plan of care for a child in school is the school nurse.

I have worked 1:1 with children in school many times. Sometimes hired directly by the school, other times through an agency contracted to the school and sometime an agency contracted to the parents. Usually the kids allowed to go to schools (especially public schools) are quite stable in their condition even if on a vent. The school must have MD orders for all meds and treatments. There must be an emergency plan. You should have been provided with the school medical and nursing plan. These plans are developed by the school in conjunction with the school nurse, primary physician and the parents.

If the child has a medical emergency, the school nurse should be summoned immediately. Calling 911 may not always be the next course of action. I have worked in rural areas where the local hospital could not handle the emergency problems of such a child. The protocol was to call for a helicopter for transport to the Children's Medical Center. IF you call 911 make sure that a paramedic unit is dispatched. If a BLS unit is sent, you will have to go and continue treatment since BLS ambulance personnel can't do what is needed.

For more questions you have, you might try the school nurses forum.

Please do not use the word "vegetable" in any context when referring to the medical condition of a child with disabities.