school health office guidelines presented by wendy fahey rnc, bsn belleville school district nurse
Post on 25-Dec-2015
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Every year, more than 31 million children visit the emergency department due to an illness or injury.
Many incidents occur at school or on the playground when an adult or school nurse is not available.
The Lasting Problem
Belleville School DistrictBelleville School DistrictSchool Emergency Response TeamSchool Emergency Response TeamEMERGENCY RESPONSE PROCEDURE-FOR STAFF
1. Assess the situation. Do not move student! Be sure it is safe to approach.2. Under life and death circumstances, 911 should be called immediately3. The staff or student at the scene will contact the office (2 way radio, phone the
office, send runner to the office). Never leave the injured staff or student unintended.
4. If only one office staff is available call district nurse immediately. If two office staff are available, one office staff first responder brings the emergency response bag and 2 ways radio to scene. Second office staff will call District nurse and building principal.
5. Upon arrival of the office staff, he/she will take over and follow standard First Aid procedure and will call for more help, if needed. An administrator will also immediately head to the scene.
6. Shelter in Place will be initiated. Office staff will call emergency contacts of injured student or staff as soon as possible to determine appropriate course of action.
Infection ControlInfection Control
• Wash hands thoroughly with running water and soap for at least 15 seconds • Before and after providing first aid• Before dispending medications• Before and after physical contact with any student
• If soap and water are not available, hand sanitizer may be used• Wipe up any blood or body fluid spills as soon as possible• Wear disposable gloves when in contact with blood and other body fluids• Wear protective eyewear when body fluids may come in contact with eyes• Do not touch your mouth or eyes while giving any first aid
To reduce the spread of it is important to follow Universal Precautions. Universal precautions are a set of guidelines that assume all blood and certain other body fluids are potentially infectious.
Student’s life is at risk or risk of permanent injury Student is having difficulty breathing or unable to speak Student is unconscious, semi-conscious or unusually confused Student is coughing up or vomiting blood Student has seizure without a known history of seizures Student ’s skin or lips look blue, purple or gray Student has significant injuries to neck or back Student ’s condition is limb-threatening Student has sudden, severe pain anywhere in the body Student has bleeding that will not stop Student sustained an electrical burn Student showing symptoms of heat stroke Student choking with complete obstruction Student was administered epinephrine and/or glucagon
If any of the above conditions exist or if you are not sureCall 911
When to Call 911When to Call 911
Treatment of Students with Anaphylaxis?Treatment of Students with Anaphylaxis? Administration of EpinephrineAdministration of Epinephrine Call 911 Call 911 Monitor status of anaphylaxis Monitor status of anaphylaxis Monitor for relapse and administer 2Monitor for relapse and administer 2ndnd dose of epinephrine as dose of epinephrine as
needed may be given within 5 minutes of 1needed may be given within 5 minutes of 1stst dose given dose given Notify parents/physicianNotify parents/physician
Asthma:Asthma:Known Asthmatic having an attackKnown Asthmatic having an attack
1. Use their rescue inhaler
2. Encourage to cough to loosen the mucus in the airways
3. Encourage slow deep breathing
4. If symptoms do not improve quickly--seek medical attention
Call 911 if breathing does not improve after treatment.
BitesBites(Animal & Human(Animal & Human))
Parents of the biting student and thebitten student need to be notified that
their child might have been exposed to blood from another student.
Individual confidentiality must be maintained when sharing information.
BLISTERS (from friction)BLISTERS (from friction)
Do NOT break blister
Blisters heal best when kept clean and dry.
Dental InjuriesDental Injuries
Primary teeth:• Apply clean gauze to empty socket• Apply ice over injured area (on the face) if there is any swelling
Permanent teeth: • Handle by top of tooth• If tooth dirty gently rinse with water• Reinsert tooth back into socket if able• Transport tooth in milk• Apply ice over injured area (on the face) if there is any swelling
Dental attention ASAP 2 hours in the limit for reimplantation
ChokingChokingWe’ve all experienced choking, to varying degrees,
at some time in our livesCommon causes of choking are…
Obstruction of the airway by food Children swallowing an object Talking or laughing while eating Running whilst eating or drinking Not chewing food correctly Eating too quickly
ChokingChokingPartial obstruction… A partial obstruction occurs when something is stuck in
the student’s throat but is still able to breathe, with some difficulty
Food or beverage ‘goes down the wrong way’ causing us to panic while we try to cough it up
Generally this is over in a few seconds, or, until we cough it up Signs and symptoms…
•Can talk but with difficulty
•May have rattly voice
•More than likely coughing
•Some difficulty breathing
ChokingChokingComplete obstruction…A complete obstruction occurs when something is lodged in the student’s throat completely blocking it and stopping any air movement. This is life threateningRequires urgent treatment
Signs and symptoms…•No air movement (no breathing)
•Unable to speak
•Unable to cough
•No breaths sounds
•Blue (cyanosis) around lips
ChokingChokingComplete obstruction…
Treatment…
Up to five vigorous back blows between shoulder blades with heel of hand
If unsuccessful…If unsuccessful… Up to five chest thrusts
If unsuccessful…If unsuccessful… Continue sequences of back blows and chest
thrusts until successful or ambulance arrives. CPR may be required.
Eye InjuriesEye InjuriesUsually from direct blow or collisionMedical attention if direct blow causes:
• Black eye• Redness• Pain• Blurred vision
May be a sign of internal eye damage or swelling
Dangerous First AidDO NOT apply pressure to eye
DO NOT apply any medicine, drops or ointment to eye
Treatment for eye injuriesTreatment for eye injuries•Apply ice pack to eye for 10-15 min, (rest on forehead and cheek)
Treatment for foreign object in eyeTreatment for foreign object in eye• If able to visualize object may remove with clean
wet gauze
• Irrigate eye with water, if symptoms persist, may have a corneal abrasion
Extremity Injuries: Soft Tissue/WoundExtremity Injuries: Soft Tissue/WoundPrompt and proper cleaning reduce risk of infection
Abrasions Gently clean with warm water & soap• Apply bandage
Contusions: Apply cold compress for 10-20 minLacerations: Apply pressure with gauze Gently clean with warm water & soap
• Apply bandage
Wounds that need medical attentionWounds that need medical attention
A wound that will not stay closed A wound the needs 5 min of direct pressure to stop
the bleeding A wound longer than ½ inch
Extremity Injuries:Sprains & StrainsExtremity Injuries:Sprains & StrainsA sprainA sprain is a stretching or tearing of ligaments. Ligaments are tough bands of fibrous tissue that connect one bone to another. Common locations for sprains are your ankles and knees.
A strainA strain is a stretching or tearing of muscle or tendon. People commonly call strains "pulled" muscles.
Hamstring Muscle tear
Hamstring and back injuries are among the most common strains.
Sprains and StrainsSprains and StrainsSymptoms…•Pain and tenderness around joints or muscles•Swelling•Discolouration to injured part•Decreased function of the injured part
Treatment-R.I.C.E
May result from collision, fall, direct blowFracture: a break in a bone; may be partial or complete
Dislocation: displacement of a bone (or bones) in a joint
6 cardinal signs:• Pain• Redness• Swelling• Warmth• Deformity• Loss of function
Extremity Injuries: BoneExtremity Injuries: Bone
Extremity Injuries TxExtremity Injuries TxFollow the acronym R.I.C.E.R…Rest the injured area. Have the athlete lie still and make them as comfortable as possible.I…Ice apply a cold compress, covered with cloth or paper towel. Ice in a plastic bag rapped in a cloth.C… Compression with the use of a roller bandage and in conjunction with the ice will help reduce bleeding and swelling.E… Elevation of the injured area above the level of the heart if the injury permits will also help reduce blood flow to the area and reduce pain.
FaintingFaintingIf you observe any of the following signs of fainting, have the student lie down to prevent injury from falling:Extreme weakness or fatigueDizziness or light-headednessExtreme sleepinessPale, sweaty skinNausea
Fainting may have may causes including: standing still for too long, illness, blood loss/shock,
heat exhaustion, diabetic reaction, severe allergic reaction, injuries. Most
students will recover quickly when lying down.
FEVER & NOT FEELING WELLFEVER & NOT FEELING WELL
• Have the student lie down • Student may lay down for 20 min without fever• Give no medication unless parents authorize and
board medication policy followed
HEAD HEAD INJURIESINJURIES
Many head injuries that happen at school are minor.
Head wounds may bleed easily and form large bumps. Bumps to the head may not
be serious. Head injuries from falls, sports and
violence may be serious.
Watch student for 20 min. Do NOT leave student alone
What is a concussion?What is a concussion?Mild traumatic brain injury
A disruption in normal brain function due to a blow or jolt to the headCenters for Disease Control
A trauma induced alteration in mental status that may or may not involve loss of consciousnessAmerican Academy of Neurology
Symptom relief for concussionSymptom relief for concussion• Rest• Fluids• Pain Reliever’s• Nausea and Vomiting
• Keep hydrated• Medication(avoiding sedating meds)
Post-Concussion syndromePost-Concussion syndromeRisk factors for complicated recoveryRisk factors for complicated recovery
Re-injury before complete recovery Over-exertion, especially early after injury Significant stress
•Unable to participate in sports or exercise•Medical uncertainty•Academic difficulties
Prior illness or injury•TBI• Seizure• Migraine
Psychiatric History•Depression/Anxiety•PTSD
Prevention of Heat-related IllnessPrevention of Heat-related Illness
1. Adequate water supply and frequent water breaks.
2. Proper supervision of at risk athletes3. Awareness of environment
Heat ExhaustionHeat ExhaustionFrom exposure to high temperature and dehydrationFrom exposure to high temperature and dehydrationSymptoms: Weakness, malaise, headache, dizziness,
nausea, vomiting, muscle aches, sweating, flushed skin, high heart rate, fast breathing
Treatment: 1. Remove from heat2. hydrate (avoid caffeine)3. Rest4. Fanning
HeatstrokeHeatstrokeProgression from Heat ExhaustionProgression from Heat ExhaustionSymptoms:Symptoms:1. No sweating (usually),2. Confusionseizuresunconsciousness3. Body temperature > 104 degrees
Requires immediate medical attention: 911Treatment:extreme cooling measures
• ice packs• wet sheet
Heat CrampsHeat CrampsPainful, involuntary contractions of muscles in Painful, involuntary contractions of muscles in those who have been sweating and not those who have been sweating and not replacing electrolytesreplacing electrolytes
Usually occurs during rest period after activityUsually involve calves, thighs, shoulders
Treatment/Prevention:• fluids, electrolytes (sports drinks)
HYPOTHERMIA HYPOTHERMIA (EXPOSURE TO COLD)(EXPOSURE TO COLD) Hypothermia happens after exposure
to cold when the body is no longer capable of warming itself. Young
children are particularly susceptible to hypothermia. It can be a life
threatening condition if left untreated for too long.
Hypothermia can occur after being
outside in the cold
Signs & Symptoms of Hypothermia (COLD)
ConfusionWeaknessBlurry visionSlurred speechNumbness
ShiveringSleepinessWhite or grayish skin colorImpaired judgmentSlow, irregular pulse
Spine Injuries: First AidSpine Injuries: First Aid Call 911 immediately Immobilization:
If student is on the ground, keep them perfectly still If student is standing, gently help them to the ground, lying
on back Place objects around student to ensure
immobilization Place blanket/jacket over patient for warmth
Nasal Injuries & Nosebleeds Nasal Injuries & Nosebleeds
Fractured Nose- seek medical attention• Ice for pain managementNosebleed: treatment Control bleedingControl bleeding• Tilt head forward• Apply steady pressure by pinching nostrils for 5 min.• Apply ice to bridge of nose
RashesRashesRashes may have many causes including heat, infection, illness, and reaction to medications, allergic reactions, insect bites, dry skin or skin irritations.
Some rashes may be contagiousWear disposable gloves to protect self when in contact with any rashRashes include such things as:HivesRed spots (large or small, flat or raised)Purple spotsSmall blisters
SPLINTERS & IMBEDDED PENCIL LEADSPLINTERS & IMBEDDED PENCIL LEAD
Leave in place Do NOT probe under skin Remove with Splinter Out or
tweezers unless this causes student pain.
Do NOT probe under skin Wash again Apply clean dressing
STINGSSTINGS All school staff should know students with an allergy to stings. An emergency care plan will be developed.
Allergic reactions may be life threatening and may be delayed
up to two (2) hours after the sting
Remove stinger if presentWash area with soap and waterApply cold compress
STOMACHACHES & PAINSTOMACHACHES & PAIN Stomachaches may have many causes including:IllnessOvereatingDiarrheaInjuryHunger Food poisoning
Menstrual difficulties Psychological issues Stress Constipation Gas pain
Allow student to rest 20 min. May provide comfort measures- Saltines- Peppermints- Water Encourage use of bathroom
VOMITINGVOMITING
Have student lie down on their side in health room
Apply a cool, damp cloth to student’s face or forehead
Have a bucket available Give no food or medications Give small sips of clear fluids, if thirsty
Vomiting may have many causes including:IllnessBulimiaAnxietyPregnancy
Injury/head injuryHeat exhaustionOverexertionFood poisoning
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