MEDICAL EMERGENCIES and BASIC FIRST AID AT SCHOOL

1. MEDICAL EMERGENCIES and BASIC FIRST AIDAT SCHOOL A GUIDE FOR TEACHERS Presented by Firefighter Patricia Tassy, EMT-P

3. No matter how safety-conscious of a teacher you are, accidents and medical emergencies still occur. • In fact there is an increase in the number of children with special healthcare needs and chronic medical conditions attending school. • Most school related injuries are minor and require only first aid care, but it is highly possible that one day you may be required to handle a medical emergency. • Knowing what to do and having the confidence to do it may help save a life.

4. Potential Emergencies Asthma Diabetes Epilepsy / Seizure Disorders Allergic Reactions Basic First Aid Cardiac Arrest / CPR / AED

5. ASTHMA

6. Understanding Asthma • Chronic health condition • Swollen/constricted airways • Can be life-threatening • Causes breathing problems called asthma “attacks” or “episodes” that can range from mild to serious • Can affect anyone • Can be diagnosed at any age • Not “outgrown” • An estimated 23 million Americans have asthma, including 7 million children • Try not to single them out or treat them differently

7. Asthma

8. Asthma Triggers • Cold, Flu, Sinus Infection • Allergens • Pollen, mold, dust, dust mites, dander (fur or feathers), roaches, animal droppings • Irritants • Perfume, cleaning fluids, cigarette smoke, air pollution, wood smoke, kerosene heaters, chalk dust, carpets • Seasonal/Time/Weather • Exercise • Emotions • Crying, yelling, laughing, stress • Chemicals • Sulfur dioxide and sulfites (preservatives), new product “smell,” fresh paint, aspirin or other anti-inflammatory drugs • Smoking

10. Asthma Management • Peak flow meters • Green – 80-100% of personal best • Yellow – 60-80% of personal best • Red – below 60% of personal best • Long Term Control Medications • Anti-inflammatory Drugs/Corticosteroids • Long Acting Bronchodilators • Leukotriene Modifiers • Xolair Injection • Quick Relief Medications • Bronchodilators • Systemic Corticosteroids • Inhalers, Nebulizers, and Pills • Side Effects • Rapid or irregular heartbeat • Jittery or nervous feeling • Hyperactivity • Nausea/Vomiting • Diarrhea • Stomachache • Headache

11. Asthma Management (cont.) • Discuss the child’s condition fully with parents • Have a plan to deal with all levels of symptoms • Avoid triggers • Notify parents of changes in child’s condition • Believe the child / do not delay use or access to medications

12. Asthma Symptoms / Warning Signs • Inability to exercise • Hunched shoulders • Persistent, troublesome cough • Suddenly becomes quiet, pale, withdrawn • May or may not have wheezy or noisy breaths • May become unexplainably agitated • Chest tightness/chest pain • Medication not relieving symptoms • Difficulty breathing • Flaring of nostrils • Rapid and/or labored breathing • Muscles in neck and ribs pulling in with each breath • Bluish color around mouth, lips, nail beds, or ear lobes

13. Asthma Emergency Response • Summon school nurse or trained staff and check/follow student’s action plan • Contact parents/guardians • If symptoms appear suggest and/or assist with administration of medication/inhaler • Do not leave student unattended • Keep child as calm and comfortable as possible – breathing in through nose and out through pursed lips slowly • If medications are not working and/or severe symptoms appear, call 9-1-1 immediately • Provide CPR/AED if necessary When in doubt call 9-1-1

14. DIABETES

15. Understanding Diabetes • Type 1 • The body (pancreas) does not produce insulin • Type 2 • Either the body does not produce enough insulin or it is not used properly • Insulin • A hormone that is needed to convert sugar, starches and other food into the energy (glucose) needed for daily life • 1 in every 400 to 600 children have diabetes

16. Diabetes Symptoms • Type 1 • Frequent Urination • Unusual thirst • Extreme hunger • Unusual weight loss • Extreme fatigue and/or weakness • Irritability • Nausea / vomiting • Type 2 • Any or all of the above • Frequent infections • Blurred vision • Slow healing cuts/bruises • Tingling/numbness in hands and feet • Recurring infections skin, gums, bladder • Dark skin around neck or armpits • May have no symptoms

17. Diabetes Management

18. Diabetes Management • Diabetes management is 24/7 • Each student with diabetes is different • Constant juggling of insulin/medication, physical activity, and food • Recognize behaviors of “low” and “high” blood sugar • Discuss the child’s condition fully with parents • Have a plan to deal with all levels of symptoms • A child with diabetes can participate in the same daily activities as all the other kids.

19. Diabetic Emergencies • Hypoglycemia = low blood sugar • Hyperglycemia = high blood sugar • Ketoacidosis = ketone build up in the blood due to lack of insulin

21. Hypoglycemia = Low Blood Sugar • Causes • Too much insulin • Skipping or delaying meals/snacks • Exercising longer than planned • Combination of above factors • Most likely to happen before lunch, at end of school day, or during or after PE • Can be mistaken for misbehavior

22. Mild Hypoglycemia • Symptoms • Sudden change in behavior (lethargic, confused, uncoordinated, irritable, nervous) • Sudden change in appearance (shaky, sweaty, pale, sleepy) • Complains of headache or weakness

23. Mild Hypoglycemia Response • Summon school nurse or trained staff and check/follow student’s action plan • Give student quick acting sugar • Must be able to swallow • 4 oz of juice, ½ can of regular soda, or 3-4 glucose tablets • Check blood glucose levels after 10-15 minutes • Repeat treatment if blood glucose is below student’s target range • Never leave the student alone or send them away with low blood sugar – must eat protein and complex carbohydrate. • When in doubt treat as hypoglycemia and recheck blood glucose levels • Notify student’s parents/guardians of incident When in doubt call 9-1-1

24. Severe Hypoglycemia • Symptoms • Inability to swallow • Seizure or convulsion • Unconsciousness (insulin shock / diabetic coma) • Most immediate danger to kids with diabetes • If not treated immediately can lead to coma or death

25. Severe Hypoglycemia Response • Summon school nurse or trained staff and check/follow student’s action plan • Position student on side recovery position to prevent aspiration • If available administer prescribed Glucagon (hormone that raises blood sugar levels) • Call 9-1-1 • Provide CPR/AED if necessary • Call student’s parents/guardians When in doubt call 9-1-1

27. Hyperglycemia = High Blood Sugar • Causes • Too little insulin • Illness, infection or injury • Stress or emotional upset • Decreased exercise or activity • Combination of above factors

28. Hyperglycemia • Symptoms • Increased thirst • Frequent urination • Nausea • Blurry vision • Fatigue • Sometimes fruity breath

29. Hyperglycemia Response • Summon school nurse or trained staff and check/follow student’s action plan • Allow free and unrestricted access to liquids and restroom • Allow student to administer insulin or seek school nurse or a trained staff person to administer • Encourage student to check blood glucose levels more often • Prolonged hyperglycemia can lead to ketoacidosis and coma or death • If symptoms persist, worsen, or student becomes unconscious call 9-1-1 • Position student on side recovery position to prevent aspiration • Provide CPR/AED if necessary • Call student’s parents/guardians When in doubt call 9-1-1

30. SEIZURES

31. Understanding Seizures • Occurs when the brain functions abnormally (abnormal electrical activity), resulting in a change in movement, attention, or level of awareness • May occur in different parts of the brain • Localized (affecting only part of the body) or widespread (affecting entire body) • 3% of all children under 15 will have a seizure

32. Types of Seizures • Febrile • Most common • Due to fever from an illness like an ear infection, cold, or chickenpox • Partial • Simple or focal • Involves motor movement of one portion of body – can progress or “march” to other parts • Child is awake and alert • Complex • Similar to Simple Seizures but child is not aware of what is going on • Generally repeat an activity such as clapping throughout the seizure • Will have no memory and will be disoriented and/or drowsy (postictal) • Generalized • Convulsive • Uncontrollable muscle jerking • Lasts less than 5 minutes • Followed by postictal period (about 15 minutes) • May be incontinent (lose urine or stool) • Tonic • Continuous muscle contraction and rigidity • Tonic-Clonic or Grand Mal • Alternating tonic activity with rhythmic jerking of muscle groups

34. Types of Seizures • Generalized (cont.) • Absence or Petit Mal • Short episodes of staring or eye blinking • No apparent awareness of surroundings • No memory of event • Reports of daydreaming, losing place while reading, missing instructions for assignment • Status Epilepticus • Lasting longer than 30 minutes • Repeated seizures without returning to normal in between • Most common in children under 2 years of age • Epilepsy • Pattern of chronic seizures of any type over a long period of time

35. Causes of Seizures • 3 out of 4 cases are of unknown causes • Infections • Metabolic disorders • Drugs • Medications • Poisons • Disordered blood vessels • Bleeding in the brain • Family history • Developmental problems • Cerebral Palsy • Head Trauma • Hyperthermia / heat exhaustion/stroke • Hyperhydration (too much water ingestion) • High alkalinity in blood • Pregnancy

36. Seizure Triggers • Hyperventilation • Heightened emotional stress • Excessive noise and/or bright flashing lights • 3-D movies and games • Intense concentration • Menstruation • Growth spurts • Lack of sleep / fatigue • Constipation

37. Mistaken for Seizures • Syncope / Fainting • Breath holding spells • Night terrors • Migraines • Psychiatric disturbances

38. Seizure Medication Side Effects • Drowsiness • Nausea • Clumsiness • Rash • Double vision • Weight gain • Hyperactivity • Sleep disturbances • Irritability • Gum displasia • Hirsutism (excess hair growth) • Changes in mood • Slurred speech • Depression / suicidal thoughts

39. Seizure Emergency Response • Summon school nurse or trained staff and check/follow student’s action plan • Keep the student safe until seizure stops naturally by itself • Keep calm and reassure students/people nearby • If sitting in a chair gently guide them to the floor • Do not hold the student down or try to stop movements • Time the seizure with a watch • Clear the area around the child of anything hard or sharp • Place something flat and soft, like a folded sweater, under the head • Loosen any clothing that may be tight around neck • Gently position student on side recovery position to prevent aspiration • Do not place anything in the child’s mouth (the tongue cannot be swallowed) • Do not leave the child alone • Be friendly and reassuring as consciousness returns • Notify parents/guardians of any episodes and/or change in behavior When in doubt call 9-1-1

41. Seizure Emergency Response (cont.) • Call 9-1-1 if… • Repeated seizures occur • A single seizure lasts more than 5 minutes (or based on student’s medical reports/plan) • Child remains unconscious or does not fully recover • There is an injury from the seizure (like head trauma from fall) • Result of Diabetic Emergency • Child has seizure in the water • Child has never had a seizure before / no seizure history • The seizure is different from other seizures • Check breathing immediately following seizure activity • Provide CPR/AED if child does not resume breathing • Call student’s parents/guardians When in doubt call 9-1-1

42. The postictal state is the altered state of consciousness after an epileptic seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures, and is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting symptoms.

43. ALLERGIC REACTIONS

44. Understanding Allergies • Inappropriate or exaggerated reaction of the immune system to certain substances • Can affect the skin, respiratory system, and/or digestive system • 4% of US population have food allergies • Anyone can suffer an allergic reaction and/or anaphylaxis without having a history of allergies • Identify the students with allergies and have a plan for all levels of allergic reactions • Avoid triggers and/or allergic substances • Severe allergic reactions can lead to anaphylaxis or anaphylactic shock which is serious and life-threatening • Most regular allergy sufferers will carry and emergency auto-injector with epinephrine (adrenaline) to reverse allergic reactions (EpiPen, EpiPenJr, Twinject)

45. Types of Allergies • Extrinsic Asthma • Allergic Rhinitis (“hay fever”) • Pollen, Dust mites, Mold, Animals (dander), Cockroaches • Eye allergies • Skin allergies (urticaria and atopic dermatitis or eczema) • Foods, Solar, Physical contact with allergen, Cold / Heat induced • Food allergies • Peanuts, Tree Nuts, Fish / Shellfish, Eggs, Cow’s milk / Dairy, Soy, Wheat / Gluten • Venom and stinging insects • Drugs / Medications • Latex • Gloves, balloons, some stickers

46. Allergic Reactions • Runny nose, postnasal drip, nasal congestion • Watery, red, itchy eyes • Sneezing / coughing • Chronic ear problems / infections • Urticaria / rashes / hives / warm skin / welts • Itchy skin • Abdominal cramping • Nausea / vomiting / diarrhea • Asthma attack • Bronchitis • Swelling of body parts • Wheezing or other breathing problems • Tightness in chest or chest pain • Difficulty swallowing • Anaphylaxis – drop in BP, unconsciousness, cardiac arrest

47. Allergy Emergency Response • Summon school nurse or trained staff and check/follow student’s action plan • Identify allergen • Allow administration of or assist with self-administration of medications • Allow free and unrestricted access to restroom for digestive reactions • Follow emergency response for Asthma episodes • Administer or assist with administration of an antihistamine like Benadryl • Mild localized hives and/or itchy skin • Hay Fever symptoms • Sneezing / sinus symptoms • Itchy / watery eyes • Notify parents/guardians of any allergic reactions • Monitor for delayed reaction for up to 2 hours When in doubt call 9-1-1

48. Allergy Emergency Response (cont.) • Administer or assist with self-administration of Epinephrine (EpiPen / EpiPenJr / Twinject) and call 9-1-1 if… • Severe hives and/or itchy skin • Swelling of the tongue, throat, and nose • Difficulty speaking • Mild symptoms worsen • Antihistamine /Benadryl does not relieve symptoms • Wheezing and/or difficulty breathing / persistent coughing • Change in color of face, eyes, lips, nail beds • Dizziness or a sharp drop in blood pressure • Unconsciousness or cardiac arrest • Give second dose (if available) after 5 minutes if symptoms persist or new symptoms appear • May want to follow up with antihistamine/Benadryl When in doubt call 9-1-1

49. Allergy Emergency Response (cont.) • Place student in position of comfort • Upright if breathing difficulty • On side recovery position if vomiting • On back with legs raised if faint or dizzy • When in doubt give the epinephrine shot – it will not harm the child if it was not needed, but if not given when needed the child may die • Always call 9-1-1 if emergency auto-injector is used. • Call 9-1-1 immediately if no medication is available • Call 9-1-1 if you have any doubt or are unsure. • Provide CPR/AED if necessary

50. EpiPen, EpiPen Jr, and Twinject • Remove cap(s) • Do not put hands near black or red area – do not use thumb to press • Hold to middle, outer thigh muscle at 90 degree angle • Press down hard and hold for 10 slow seconds • Made to go through clothes • Be careful of exposed needle – dispose properly.