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School Health Office Guidelines presented by Wendy Fahey RNC, BSN Belleville School District Nurse The Lasting Problem 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. Belleville School District School Emergency Response Team EMERGENCY RESPONSE PROCEDURE-FOR STAFF 1. 2. 3. 4. 5. 6. Assess the situation. Do not move student! Be sure it is safe to approach. Under life and death circumstances, 911 should be called immediately 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. 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. 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. 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 Control 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. 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 • When to Call 911 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 sure Call 911 Treatment of Students with Anaphylaxis? Administration of Epinephrine Call 911 Monitor status of anaphylaxis Monitor for relapse and administer 2nd dose of epinephrine as needed may be given within 5 minutes of 1st dose given Notify parents/physician Positioning Difficulty Breathing Faint/Dizzy Nausea Exercise Induced Asthma Asthma: Known Asthmatic having an attack 1. 2. 3. 4. Use their rescue inhaler Encourage to cough to loosen the mucus in the airways Encourage slow deep breathing If symptoms do not improve quickly--seek medical attention Call 911 if breathing does not improve after treatment. Bites (Animal & Human) Parents of the biting student and the bitten 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 heal best when kept clean and dry. Do NOT break blister Remove the source of burning Burns Dental 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 Choking We’ve all experienced choking, to varying degrees, at some time in our lives Common 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 Choking Partial 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 Choking Complete obstruction… A complete obstruction occurs when something is lodged in the student’s throat completely blocking it and stopping any air movement. Signs and symptoms… This is life threatening •No air movement (no breathing) Requires urgent treatment •Unable to speak •Unable to cough •No breaths sounds •Blue (cyanosis) around lips Choking Complete obstruction… Treatment… Up to five vigorous back blows between shoulder blades with heel of hand If unsuccessful… Up to five chest thrusts If unsuccessful… Continue sequences of back blows and chest thrusts until successful or ambulance arrives. CPR may be required. Ear Eye Injuries Usually from direct blow or collision Medical attention if direct blow causes: • • • • Black eye Redness Pain Blurred vision May be a sign of internal eye damage or swelling Dangerous First Aid DO NOT apply pressure to eye DO NOT apply any medicine, drops or ointment to eye Treatment for eye injuries • Apply ice pack to eye for 10-15 min, (rest on forehead and cheek) Treatment 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/Wound Prompt and proper cleaning reduce risk of infection Abrasions Gently clean with warm water & soap • Apply bandage Contusions: Apply cold compress for 10-20 min Lacerations: Apply pressure with gauze Gently clean with warm water & soap • Apply bandage Wounds 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 & Strains A 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 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 Strains Symptoms… •Pain and tenderness around joints or muscles •Swelling •Discolouration to injured part •Decreased function of the injured part Treatment-R.I.C.E Extremity Injuries: Bone May result from collision, fall, direct blow Fracture: 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 Tx Follow 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. Fainting If you observe any of the following signs of fainting, have the student lie down to prevent injury from falling: Extreme weakness or fatigue Dizziness or light-headedness Extreme sleepiness Pale, sweaty skin Nausea 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 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 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. HEAD INJURIES Watch student for 20 min. Do NOT leave student alone What is a concussion? Mild traumatic brain injury A disruption in normal brain function due to a blow or jolt to the head Centers for Disease Control A trauma induced alteration in mental status that may or may not involve loss of consciousness American Academy of Neurology Symptom relief for concussion Rest • Fluids • Pain Reliever’s • Nausea and Vomiting • Keep hydrated • • Medication(avoiding sedating meds) Post-Concussion syndrome Risk 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 Illness 1. Adequate water supply and frequent water breaks. 2. Proper supervision of at risk athletes 3. Awareness of environment Heat Exhaustion From exposure to high temperature and dehydration Symptoms: Weakness, malaise, headache, dizziness, nausea, vomiting, muscle aches, sweating, flushed skin, high heart rate, fast breathing Treatment: 1. Remove from heat 2. hydrate (avoid caffeine) 3. Rest 4. Fanning Heatstroke Progression from Heat Exhaustion Symptoms: 1. No sweating (usually), 2. Confusionseizuresunconsciousness 3. Body temperature > 104 degrees Requires immediate medical attention: 911 Treatment: extreme cooling measures • • ice packs wet sheet Heat Cramps Painful, involuntary contractions of muscles in those who have been sweating and not replacing electrolytes Usually occurs during rest period after activity Usually involve calves, thighs, shoulders Treatment/Prevention: • fluids, electrolytes (sports drinks) HYPOTHERMIA (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. Signs & Symptoms of Hypothermia (COLD) Confusion Weakness Blurry vision Slurred speech Numbness Shivering Sleepiness White or grayish skin color Impaired judgment Slow, irregular pulse Hypothermia can occur after being outside in the cold Spine 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 Fractured Nose- seek medical attention • Ice for pain management Nosebleed: treatment Control bleeding • Tilt head forward • Apply steady pressure by pinching nostrils for 5 min. • Apply ice to bridge of nose Rashes may have many causes including heat, infection, illness, and reaction to medications, allergic reactions, insect bites, dry skin or skin irritations. Rashes Some rashes may be contagious Wear disposable gloves to protect self when in contact with any rash Rashes include such things as: Hives Red spots (large or small, flat or raised) Purple spots Small blisters SPLINTERS & 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 STINGS 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 present Wash area with soap and water Apply cold compress STOMACHACHES & PAIN Stomachaches may have many causes including: Menstrual difficulties Illness Psychological issues Overeating Stress Diarrhea Constipation Injury Gas pain Hunger Food poisoning Allow student to rest 20 min. May provide comfort measures - Saltines - Peppermints - Water Encourage use of bathroom VOMITING Vomiting may have many causes including: Injury/head injury Illness Heat exhaustion Bulimia Overexertion Anxiety Food poisoning Pregnancy 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