Medical Urgencies In The Classroom

1. Medical Urgencies In The Classroom Lori Christopher, RN, MSN, CNP Certified Nurse Practitioner/Nurse Manager University Health Services *Adapted from the American Academy of Pediatrics 8/03

2. University Health ServicesEastway Dr. • We are a large multi-disciplinary facility with over 30, 000 patient encounters per year. • We have 15 clinicians, 4 psychologists, 1 physical therapist, 10 nursing staff members and many ancillary staff members. • We have a general medical clinic, urgent care clinic, women’s clinic, psychology clinic, pharmacy, laboratory, x-ray department, immunization department, physical therapy and a health promotions department.

3. Seizures/Convulsions • Seizures can range from mild to severe – brief blackouts, involuntary movements, sudden falls, periods of confused behavior, and involuntary muscle contractions. • Severe seizures may involve uncontrollable muscle movements (jerking or spasms) and rigidity, loss of consciousness, loss of bladder and/or bowel control, and in some cases, breathing that stops temporarily.

4. Seizures/Convulsions • Have another student call 911 while you stay with the student who appears to be having a seizure • Protect the person from injury • Move all furniture or equipment that is nearby • Do not hold or restrain the student • Do not put anything in the student’s mouth • Loosen clothing • Roll the student on his/her side if vomiting occurs After the seizure activity has stopped: • Perform rescue breathing if person is blue or not breathing (if CPR certified) • If breathing, lay person on side

5. FAINTING • Lay person on back with head to the side and legs elevated • DO NOT give anything by mouth • Send the student to the health center with another person, if the student has recovered and is able to walk across campus without difficulty • If person doesn’t wake up right away, call 911

6. NOSEBLEEDS • With person sitting, squeeze nostrils together between thumb and index finger for 10 minutes • If bleeding persists, call the student health center or send the student to the health center.

7. Cuts • Apply pressure with a clean cloth to stop the bleeding • If the cut is large and deep, call or send the student to the health center and maintain pressure • For minor cuts, wash with soap and water and cover with dressing. • If cut may need sutures, seek medical care as soon as possible

8. Puncture Wounds • DO NOT remove large objects such as knives or sticks, call 911 • For minor wounds, wash with soap and water and call the student health center • The person may need a tetanus booster injection

9. StingingInsects • Remove the stinger with the scraping motion of a fingernail • DO NOT pull the stinger out • Put a cold compress on the bite • If hives, paleness, weakness, nausea, vomiting, tightness in chest, breathing difficulty, or collapse occur, call 911. • For spider bites, call the student health center or Poison Control Center

10. TEETH • If knocked out, find the tooth and rinse it gently without touching the root • Insert and gently hold the tooth in its socket or transport the tooth in cow’s milk • If broken, save the pieces. Gently clean the injured area with warm water. Place a cold compress to reduce swelling. • Send the student directly to the dentist or an emergency room. Time is important!

11. Choking • Partial airway obstruction with good airway exchange • Partial airway obstruction with poor airway exchange • Complete airway obstruction

12. Choking • Partial airway obstruction with good airway exchange • Forceful cough • Wheezing in between breaths *Stay with the student and encourage them to cough

13. Choking • Partial airway obstruction with poor air exchange • Weak, ineffective cough • High-pitched noises while breathing * This type of obstruction should be dealt with as if it were a complete obstruction

14. Choking • Complete airway obstruction • Unable to breathe, speak or cough • Clutching at his/her throat (universal distress signal for choking) * If the student is still conscious, perform Heimlich maneuver * If the student becomes unconscious, call 911 and continue helping if familiar with FirstAid/CPR

15. Heart Attack • Signs/Symptoms • Chest discomfort or pain (it may be described by the student as pressure, squeezing, fullness, tightness, aching, crushing, constricting or heavy) • Radiation of the pain to the neck, jaw or back • Sweating • Nausea • Shortness of breath

16. Heart Attack • A quick response in case of a heart attack requires that you: • Recognize the symptoms of a heart attack and take action. • Have the victim stop what he or she is doing and sit or lie down in a comfortable position. Loosen constrictive clothing. Do not let the victim move around. • Have someone phone 911 for help.

17. Depression • More Americans suffer from depression than coronary artery disease, cancer and AIDS combined • Symptoms of depression include: • Sadness or feeling down • Loss of interest or pleasure in usual activities • Poor appetite or overeating • Trouble falling or staying asleep or sleeping too much • Feeling tired or having little energy • Feelings of worthlessness, self-reproach or guilt • Trouble concentrating • Moving or speaking very slowly, or the opposite, being fidgety or restless • Thoughts of being better off dead or of hurting oneself in some way

18. Depression/Suicide • Suicide is the second leading cause of death among all youth 15-24 years old. In the US, only accidents and homicides claim more young lives. • Nearly 4,000 people aged 15-24 die by suicide each year in the US. • A person dies by suicide about every 18 minutes in the US and an attempt is estimated to be made once every minute. * American Foundation for Suicide Prevention

19. Depression • Depression is a major problem for college students, not only because it can lead to suicide, but also because it is associated with poor physical health, substandard academic performance and irresponsible risk taking behaviors

20. Depression • Over 90% of youth who die by suicide had at least one psychiatric illness at the time of death; in about half such cases, the psychiatric illness was present, although often unrecognized, for two years or more. • American Foundation for Suicide Prevention

21. Psychological Emergency • If you suspect someone is in psychological crisis and/or suicidal: • Take it seriously • Be willing to listen • Voice your concern/Let the person know you are concerned and understand • Encourage the student to get professional help immediately • In the case of suicidal/homicidal behavior –Call 911

22. When to dial 911? Warning signs of a Medical Emergency • Fainting or convulsions • Chest or upper abdominal pain or pressure • Sudden dizziness, weakness, or change in vision • Difficulty in breathing, shortness of breath • Severe or persistent vomiting • Coughing up or vomiting blood • Bleeding that won’t stop after applying 10-15 minutes of pressure • Change in mental status (confusion, unusual behavior, difficulty in staying awake) • Suicidal or homicidal feelings

23. When an Emergency Occurs: • Be prepared: Keep the numbers of emergency services near your phone • When you call for help, speak calmly and clearly • Give name, address, phone number, location of victim and nature of problem • Don’t hang up until the dispatcher tells you to do so because they may need additional information

24. KSU Nurse Help Line • After-hours nurse information line • Service is provided by the Rainbow Call Center which is housed in University Hospitals of Cleveland • (330)672-2326 • During regular business hours, line is answered by a nurse working at UHS

25. IMPORTANT PHONE NUMBERS • Fire, Police or Ambulance……………………..911 • University Health Services........................672-2322 • University Nurse Help Line…………………672-2326 • University Psychological Services………….672-2487 • Poison Control Center………………………..1-800-222-1222 • Kent State Police (non-emergent)………………………672-2212 • Crisis Hotline/Townhall II…………………..678-HELP • Coleman Professional Services……………… 673-1347 • Robinson Memorial Hospital………………..297-0811 • Med Center One…………………………………678-4380

26. Sick Notes • We, at University Health Services, DO NOT give sick notes unless we truly feel the patient should not be going to class. • We DO NOT give notes for an illness that has resolved or is getting better once the student is actually seen at the health center. • Please do not send students to the health center for a sick note AFTER their illness has resolved. We are no better than you at detecting if someone WAS sick. • Every student that sees a nurse/nurse practitioner/physician/psychologist, has diagnostic tests performed or buys medication (prescription or over-the-counter) is given a walk-out statement when they leave the facility. This statement in no way means the student was given permission by someone at the health center to miss class because of their illness.