Emergencies in the Classroom

1. Emergencies in the Classroom Gregg S. Margolis, MS, NREMT-P Assistant Professor, Emergency Medicine Program University of Pittsburgh School of Health and Rehabilitation Sciences

2. Today’s goal Develop strategies to deal with emergencies that are most likely to occur in a classroom setting.

3. A few things to consider • Emotions are normal • It’s not how you feel, it’s how you look! • It is OK not to know what is wrong • There is very little liability for doing something!

4. Pennsylvania’s Good Samaritan Law 8332. Nonmedical Good Samaritan Civil Immunity (a) General Rule. Any person who renders emergency care, first aid, or rescue at the scene of an emergency,or moves the person receiving such care, first aid and rescue to a hospital or other place of medical care,shall not be liable to such person for any civil damages as a result of any acts or omissionsin rendering the emergency care, first aid, or rescue, or moving the person receiving the same to a hospital or other place of medical care,except in acts or omissions intentionally designed to harm or any grossly negligent acts or omissions which result in harmof the person receiving the emergency care, first aid or rescue or being moved to a hospital or other place of medical care.

5. …in fact there may be more liability for doing nothing.

6. There are 3 kinds of patients Sick Injured I’m not sure

7. A few general principles • Protect yourself, whenever possible • Don’t move the “injured” or “I’m not sure” patient • Let sick patients assume the “position of comfort” • NOTHING IN THE MOUTH! …well, almost nothing. • Talk to them!!!

8. Recognize the emergency • Trauma • Falls • Cuts • Burns • Changes in consciousness • Breathing difficulties • Severe pain • Miscellaneous complaints

9. 4 simple steps • Get help • Start the Breathing • Stop the Bleeding • C.A.R.E.

10. Get help • Call your local EMS • What they need to know • Where you are • exact location and phone number • What is the problem Consider... Sending someone to meet the ambulance

11. Start the breathing • Breathing requires an airway • Airway=a way for air to get to the lungs

12. Start the breathing • Make sure they are breathing • Look, listen, and feel for breath • If they are not breathing, breath for them

13. Start the breathing • If you cannot get air in, clear the airway • If they are choking, clear the airway with the Heimlich Maneuver

14. It’s a good idea for faculty to learn CPR.

15. Stop the bleeding • Use direct pressure to stop bleeding

16. C.A.R.E Communicate Avoid Harm Re-Examine Encourage

17. Communicate • Talk to the patient • Talk about stuff that matters • Get the story • What happened? • What is wrong/what hurts? • When did it start? • Has it happened before? • Are you taking any medications? • Any allergies?

18. Avoid harm • Do not move the injuredpatient • Allow conscious, sick patients to assume their “position of comfort.” • Patients usually will usually assume this position themselves • Do not force a patient having difficulty breathing to lie flat • Place unconscious, sickpatients in the “recovery position” • Lay them on their side • Allow fluid to drain from their mouth

19. Avoid harm • Nothing to eat or drink • With one exception: a KNOWN diabetic that is fully conscious and thus able to protect their own airway • Foods high in sugar are good • Diet drinks don’t have sugar • If they have medicine for this specific problem, let them take it.

20. Re-Examine • Do not leave them alone • Watch for changes • Constantly watch the breathing

21. Encourage • Provide emotional support • Be calm and kind • Speak softly, but firmly • Do not threaten • Be honest • Let them know what is happening

22. The most likely scenarios • Sudden decrease in consciousness • Seizure • Airway obstruction • Respiratory difficulty • Falls and cuts Remember... The principles remain the same, no matter what the situation.

23. Classroom Emergency – Case #1 You are making your best attempt to keep the Kreb’s cycle interesting and a student, who did not look well all class, keels over when you get to acetyl co-enzyme A. He falls out of the chair and his head hits the floor with a dramatic ‘thud’. The whole class looks at you as if you are responsible for actually “boring a student to death.” What would you do?

24. Case #1 • Get help Send student to call 911 • Start the breathing His breathing is fast and shallow • Stop the bleeding There is no bleeding • Communicate Get the story, talk to his friends • Avoid harm Do not move him • Re-examine Monitor his breathing • Encourage Talk to him

25. Classroom Emergency – Case #2 In the middle of your famous astrophysics midterm a student begins to act funny. She slumps in her chair and begins to have herky-jerky movements reminding you of a bad acid trip that one of your roommates had in college. After the flashback, What would you do?

26. Case #2 • Get help Send a student to call 911 • Start the breathing You think she is breathing • Stop the bleeding There is no bleeding • Communicate Get the story, talk to her friends • Avoid harm Protect her head Protect the body and extremities Place on her side if possible NOTHING IN THE MOUTH! • Re-examine Monitor her breathing • Encourage Talk to her, protect privacy

27. Classroom Emergency – Case #3 While teaching a nutrition class you notice that a student has chosen to ignore your advice and is eating a bag of corn chips with reckless abandon. All of a sudden he gets a very worried look on his face and grabs his throat. He begins to run for the door. What would you do?

28. Case #3 • Get help Call from your cell phone • Start the breathing If he is breathing encourage him to relax If no or minimal breathing, perform the Heimlich Maneuver Perform rescue breathing after the air-way is cleared, if he does not start to breathe

29. Classroom Emergency – Case #4 While discussing euthanasia in a professional ethics class, a student gets very upset and a heated argument with a classmate ensues. After calling her colleague a “uncaring, inhuman, heartless scumbag” she begins to have difficulty catching her breath. Within a few minutes her difficulty breathing has become severe. What would you do?

30. Case #4 • Get help Send a student to call 911 • Start the breathing She is breathing very fast • Stop the bleeding There is no bleeding • Communicate Talk to her Try to get the story • Avoid harm Keep her quite and calm • Re-examine Monitor her breathing • Encourage Encourage her to calm down

31. Classroom Emergency – Case #5 A uninformed student is riding his bicycle through the halls. In an futile effort to avoid an innocent pedestrian, he attempts to duck into a classroom. Unfortunately, he fails to negotiate the turn and falls onto an outstretched arm. His wrist is immediately deformed and begins to swell. What would you do?

32. Case #5 • Get help Send the someone to call 911 • Start the breathing His breathing is normal • Stop the bleeding There is no bleeding • Communicate Get the story • Avoid harm Do not move him, or let him move • Re-examine Monitor his breathing • Encourage Talk to him

33. A few special cases • Sudden decreased level of consciousness in the known diabetic • Seizures • Asthma

34. Decreased level of consciousness in the diabetic • If able to swallow, give anything with sugar, immediately • If not, manage as any other decreased level of consciousness

35. Seizures • Protect the head • Protect the body • Place on the side if possible • NOTHING in the mouth • No forks, spoons or knives • No hands • No tongue depressors

36. If a patient has Asthma • Do not force them to lie down • Let them take their own inhaler

37. Remember: You can do it! Review this Lecture