Emergencies in the Classroom

Gregg S. Margolis, MS, NREMT-PAssistant Professor, Emergency Medicine

Program

University of Pittsburgh

School of Health and Rehabilitation Sciences

Today’s goal

Develop strategies to deal with emergencies that are most likely to occur in a classroom setting.

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!

Pennsylvania’s Good Samaritan Law8332. 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 omissions in 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 harm of the person receiving the emergency care, first aid or rescue or being moved to a hospital or other place of medical care.

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

There are 3 kinds of patients

Sick

I’m not sure

Injured

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!!!

Recognize the emergency

Trauma Falls Cuts Burns

Changes in consciousness Breathing difficulties Severe pain Miscellaneous complaints

4 simple steps

Get help Start the Breathing Stop the Bleeding C.A.R.E.

Get help

Call your local EMS What they need to know

Where you are exact location and phone number

What is the problem

Sending someone to meet the ambulanceConsider...

Start the breathing

Breathing requires an airway Airway=a way for air to get to the lungs

Start the breathing

Make sure they are breathing Look, listen, and feel for breath

If they are not breathing, breath for them

Start the breathing If you cannot get air in, clear the

airway If they are choking, clear the airway

with the Heimlich Maneuver

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

Stop the bleeding

Use direct pressure to stop bleeding

C.A.R.E

Communicate

Avoid Harm

Re-Examine

Encourage

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?

Avoid harm Do not move the injured patient 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, sick patients in the “recovery position” Lay them on their side Allow fluid to drain from their mouth

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.

Re-Examine

Do not leave them alone Watch for changes Constantly watch the breathing

Encourage

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

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.

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?

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

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?

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 extremitiesPlace on her side if possibleNOTHING IN THE MOUTH!

Re-examine Monitor her breathing Encourage Talk to her, protect privacy

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?

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

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?

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

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?

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

A few special cases

Sudden decreased level of consciousness in the known diabetic

Seizures Asthma

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

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

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

You can do it!

Remember:

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