What was your most urgent emergency?

bergren · Mar 5, 2005

I have worked in 4 school nurse jobs. Only my boarding school position of 250 middle and high school students was low key, and even that job had its moments.

My most recent position was not low key. We had 2 children on ventilators on my caseload of 125 Early Special education and medically fragile students. The ventilator malfunctions were a bit tense! I made frequent home and hospital visits. Except for the speech kids, every kid had a IHP, and many had Emergency plans.

Another early childhood intervention position held previously was not low key either, lots of Child protective service cases with home visits to projects, rural abandoned shacks, finding resources for the homeless and poor, helping parents with the chronic grief that accompanies having a disabled or cognitively impaired child. We had one child who would deliberately herniate his brain stem (his form of tantrum) and code at school if he did not like doing his therapy for the PT. That kept us awake. The interview with the 15 year old mom with 3 kids that revealed all three kids were her fathers (How did no one else ever find this out??? Did no one ask, Who is the father????).

The typical job I had at a middle school averaged 90 - 96 visits a day in a school of 996 students. It was nonstop on top of all of the population prevention issues, the injuries and IEP meetings. Some "highlights" - the overnight 8th grade trip where 2/3 of kids and staff came down with food poisoning, the measles outbreak, finding extensive mold under the carpet in the math wing (investigating why a cluster of asthma exacerbations coming from that wing) and a similar incident with the science teacher bringing in some furred creature (investigating why a cluster of asthma exacerbations coming from that wing), etc.... Quoting Rosanna Rosanadanna - "it was always something!"

My acute experience has been in NICU, ambulance transport or med surg in teritiary level 3 children's medical centers - Altough I enjoyed that work also, I just find school nursing is more enjoyable due to the independence, and it is more "nursing" than a lot of what goes on in the acute setting.

Foxfour · Mar 5, 2005

Wow! You do have your hands full. I wasn't trying to upset anyone. I totally agree that we stay very busy, but what I mean by low-key is the small portion of emergencies we have as nurses compared to other aspects/avenues of nursing. As I mentioned earlier, I was only speaking of life threatening incidents for myself and my school. I realize that I can't speak for other school nurses.

Jeanine · Mar 6, 2005

This is a long story:

One March Friday, we had lots of snow. Our Middle and High Schools had a delayed opening, the elementary schools closed, and we (the MS & HS) had an early dismissal. The main office paged me and said a student fell on line in the cafeteria. I grabbed my emergency bag and started up the hall. As I passed a teacher, she looked pale and told me the student was having seizures. I still wasn't sprinting because we had a few students who suffered from seizures regularly, but I stepped it up a bit. When I got there, I saw the student in question. He was down on his back, had circumoral cyanosis, and didn't appear to be breathing. A PE teacher who was CPR trained told me he felt a heartbeat that was too fast to count. I was on the floor next to him, getting over the shock that it was someone that I knew personally and was friends with his parents. This was the first time in my 15 yrs of ER experience that I had a critical patient that I knew! So, I shook that realization off, and checked for breathing, NONE. I repositioned, still none. I gave him 2 quick breaths and checked for a pulse, NONE! I sent that same PE teacher to call 911 and tell them that I had a student down, no pulse and no breathing. I had taken ACLS many times over for my ER job and I just gave him a precordial thump to the chest. I know that they hadn't taught that in ACLS in years, but being an oldtime ER nurse, that was all I had!! No oxygen, defibrillator, pulse oximiter, monitor, etc..... I figured it couldn't hurt! I went to perform CPR, but he took a huge gulp of air. The police arrived with oxygen (no defib), and by the time the ambulance arrived, he was fully awake and alert. They took him to the local hospital (not the one I had worked in), evaluated him, and discharged him with "hypoglycemia" even though his glucose was 120! When I later heard this, I called the student's mom and told her that he DEFINITELY had no pulse and I was very concerned. She called a local peds cardiologist and he opened his office for him. Fortunately the believed my story, unlike the ER (since I must have been "just some stupid school nurse"!) and he put an event monitor on the student. I notified the staff that if this were to happen again that they were to press the button on the monitor (I sent around a memo with his picture on it). Sure enough, it happened the next week, except this time he still had an extremely rapid heartbeat when I got there. I still started CPR because he wasn't breathing but that was enough to revive him. They had it on tape! He had gone into V-fib, had an episode of toursades, and the local ER sent him directly to Columbia-Presbyterian in NYC. There, he was diagnosed with Hypertropic Cardiomyopathy (HCM), and was given his own defib/pacemaker. He is now an honors student, senior in HS, and awaiting his college acceptance letters. He can no longer participate in wrestling or other contact sports, but he is in the marching band and has flourished into an impressive young man who wants to become a doctor and help children!!

His family and I fought for defibrillators in our schools for the next 4 years, and this year there is one in every school in the district. The community donated enough money to buy 8 of them. HOPEFULLY I'LL NEVER NEED TO USE IT!

bergren · Mar 6, 2005

What a story and good for you for being forceful and assertive. Thank goodness for your skills!

This is a long story:
One March Friday, we had lots of snow. Our Middle and High Schools had a delayed opening, the elementary schools closed, and we (the MS & HS) had an early dismissal. The main office paged me and said a student fell on line in the cafeteria. I grabbed my emergency bag and started up the hall. As I passed a teacher, she looked pale and told me the student was having seizures. I still wasn't sprinting because we had a few students who suffered from seizures regularly, but I stepped it up a bit. When I got there, I saw the student in question. He was down on his back, had circumoral cyanosis, and didn't appear to be breathing. A PE teacher who was CPR trained told me he felt a heartbeat that was too fast to count. I was on the floor next to him, getting over the shock that it was someone that I knew personally and was friends with his parents. This was the first time in my 15 yrs of ER experience that I had a critical patient that I knew! So, I shook that realization off, and checked for breathing, NONE. I repositioned, still none. I gave him 2 quick breaths and checked for a pulse, NONE! I sent that same PE teacher to call 911 and tell them that I had a student down, no pulse and no breathing. I had taken ACLS many times over for my ER job and I just gave him a precordial thump to the chest. I know that they hadn't taught that in ACLS in years, but being an oldtime ER nurse, that was all I had!! No oxygen, defibrillator, pulse oximiter, monitor, etc..... I figured it couldn't hurt! I went to perform CPR, but he took a huge gulp of air. The police arrived with oxygen (no defib), and by the time the ambulance arrived, he was fully awake and alert. They took him to the local hospital (not the one I had worked in), evaluated him, and discharged him with "hypoglycemia" even though his glucose was 120! When I later heard this, I called the student's mom and told her that he DEFINITELY had no pulse and I was very concerned. She called a local peds cardiologist and he opened his office for him. Fortunately the believed my story, unlike the ER (since I must have been "just some stupid school nurse"!) and he put an event monitor on the student. I notified the staff that if this were to happen again that they were to press the button on the monitor (I sent around a memo with his picture on it). Sure enough, it happened the next week, except this time he still had an extremely rapid heartbeat when I got there. I still started CPR because he wasn't breathing but that was enough to revive him. They had it on tape! He had gone into V-fib, had an episode of toursades, and the local ER sent him directly to Columbia-Presbyterian in NYC. There, he was diagnosed with Hypertropic Cardiomyopathy (HCM), and was given his own defib/pacemaker. He is now an honors student, senior in HS, and awaiting his college acceptance letters. He can no longer participate in wrestling or other contact sports, but he is in the marching band and has flourished into an impressive young man who wants to become a doctor and help children!!
His family and I fought for defibrillators in our schools for the next 4 years, and this year there is one in every school in the district. The community donated enough money to buy 8 of them. HOPEFULLY I'LL NEVER NEED TO USE IT!

Foxfour · Mar 6, 2005

Now, that is scary! As I'm reading your story, I remember a comment that our school administrator said. She said a school nurse's job is so easy that a monkey can do it. It would be pretty amazing to see a monkey get in there and do want you done. Spoken like someone who doesn't have a clue what she's talking about.

Jeanine · Mar 7, 2005

My friends and I continue to joke about "the moon was in the seventh house, and Jupiter aligned with Mars" that day. At the time it happened, I was going to school to become a certified school nurse in NJ, working part-time nights in the ER, and subbing for the middle school nurse who was out on disability. It really is amazing how some things are just meant to be! I was just glad that I was there to be used as the instrument in the bigger picture! I tease the student that when he becomes a famous doctor some day, he can be there for me. I truly belive that some things are just MEANT TO BE!

poodlehead · Mar 19, 2005

Your School and the boy are very fortunate to have you there. I am a school nurse in a school with early childhood through 5th grade. We have approx. 800 students. My PTO last year purchased my office a Heart Start AED. Two different set of plug in chest pads automatically reduces the amount of joules need from adult to child.

I'll probably use on one of the teachers, but you never know. Grandparents day is also coming up. A few of the teachers have voluntarily went through CRP and AED training. Although, I do not have suctioning, I do keep a large, 6 ounce, bulb syringe in my emergency bag. The big push now is ramping up our general emergency preparedness from natural disaster to terrorist attacks. Last year we went on lock down becuase a bank robber was lose in out immediate area.

dianer · Apr 18, 2005

I work in an elementary school with only 200 children. We were able to purchase defibrillators a few years ago. One day following a staff picture a parent came running into the office and told us to call 911, our social worker had fainted by the elevator. When I got to her she was purple, no pulse, no breathing. I yelled for someone to go get the defibrillator and began CPR. We shocked her 3 times before the paramedics arrived. They shocked her several times and said they got a pulse. She was transported to the hospital and lived for two weeks. She had major heart damage and some brain damage. She had a history of heart problems and a parent who died young from a heart attack. I was so glad to have the defibrillator and other staff who were trained in its use. We at least gave her the best chance we could.

Your School and the boy are very fortunate to have you there. I am a school nurse in a school with early childhood through 5th grade. We have approx. 800 students. My PTO last year purchased my office a Heart Start AED. Two different set of plug in chest pads automatically reduces the amount of joules need from adult to child.
I'll probably use on one of the teachers, but you never know. Grandparents day is also coming up. A few of the teachers have voluntarily went through CRP and AED training. Although, I do not have suctioning, I do keep a large, 6 ounce, bulb syringe in my emergency bag. The big push now is ramping up our general emergency preparedness from natural disaster to terrorist attacks. Last year we went on lock down becuase a bank robber was lose in out immediate area.

Chad_KY_SRNA · Apr 18, 2005

Our school district has one nurse for four schools K-12 and she will drive back and forth to the different schools. No AED, no BLS bag, just a cabinet full of bandaids and a collapsible stretcher. They had a child go into respiratory arrest once, special education student with genetic disorder was sick and quit breathing. Needed suctioning STAT. Nurse, Special Ed teacher, and principal all jumped into the principals car and drove this child to the local clinic, while doing rescue breathing, where the doctor bagged and suctioned her. I am pretty sure she may have recovered from this incident but she did die in the end. I have seen (as a student) broken legs, deep lacerations, people pass out, kids get hurt in gym or at basketball games, car accidents in the parking lot, a grand mal seizure, the superintendant had a massive heart attack in his office and was taken from his office via EMS to the other clinic in town where he coded twice and was resuscitated. Then flown to university medical center. This was the day before thanksgiving break, he was back at work by new years. I have begged and pleaded with the school district to buy a BLS kit and AED. It hasn't happened yet. The two clinics I have refered to are open Monday-Thursday and Monday through Friday, after that you have to drive 26-27 miles to the nearest emergency room. The county is building a new clinic but they are really vague on what services will be offered. At one point they were discussing a 24 hour urgent care center type of place. It is desperately needed.

menetopali · Apr 21, 2005

pt with fever of 106.4, 132bpm, 24RR, 76/32, SpO2 96% with language barrier and deteriorating LOC that presented with no specific complaints besides feeling 'no good'.

i used to work in a hospital and all i could think about was how totally unable i was to manage this patient with the supplies, equipment, and standing orders i had in the office. all i could do was ice her down and wait for the ambulance. that was my scariest as a campus nurse. had other interesting cases, blunt force traumas, seizures, and alcohol problems; but nothing scared me like that did. turned out ok, but wow.