MEDICAL EMERGENCIES Anaphylaxis, Asthma, Epilepsy, Diabetes, CPR School trips Some afterschool activities not covered by nurses. Next week or so will be able to provide lists of students with asthma, allergy and chronic illness. Photo’s and care plan in staff room Will contact teaching staff

ALLERGY/ANAPHYLAXIS Allergies occur when the immune system becomes sensitive and overreacts to common substances that are normally harmless. Anaphylaxis is a severe, potentially life threatening allergic reaction Can occur within seconds Affects various organ systems including the skin, respiratory, cardiovascular and gastrointestinal. Food allergies; peanuts, tree nuts (walnuts, pecans), shellfish, fish, milk, soy, wheat, eggs. Insect Bites Latex Medication Food additives

SIGNS AND SYMPTOMS Skin hives/flushing of face and chest Swelling of face/tongue/lips Tightness of throat/chest/difficulty breathing/ cough/hoarse voice Pale/blue colour skin/weak pulse/loss of consciousness/feeling weak or dizzy Nausea/vomiting/abdominal cramps/diarrhoea Anxiety/irritability Effects multiple organs: skin, respiratory, cardiovascular, GI Why life threatening? Causes airway obstruction, lack of oxygen to brain. Risk of shock; leading to tissue damage, organ failure and death

The EPIPEN (Epinephrine/adrenaline auto-injector) Child/adult doses Pre-measured single dose No contraindications when used in a life threatening emergency If unsure, but the individual seems in distress – use the EPIPEN All staff are required to be able to give an EPIPEN when needed Short expiry dates. Room temperature, dark place. ***Child with an Anapen *** Not auto-injector

EPIPEN PROCEDURE Have someone call 999 Check EPIPEN solution is clear Remove grey safety cap Hold EPIPEN with black tip against the outer area of the thigh muscle Apply moderate pressure to hear a click and hold in place for 10 seconds (press the red button for Anapen)

EPIPEN PROCEDURE CONT. Remove EPIPEN and massage area for 10 seconds Be prepared to begin CPR Stay with the individual until help arrives Store the used EPIPEN safely and send with individual to hospital Effect will wear off 10-20 minutes May use through clothing Short duration of action. My need to repeat dose if ambulance does not arrive.

ASTHMA The muscles around the walls of the airways tighten. The lining becomes inflamed and sometimes there is the production of sticky sputum. Asthma is a condition that effects the airways of the lungs. Asthma triggers, pollen, exercise, colds and virus, emotions, hormones, dust mites, mould and funghi Causes; family history, allergies and eczema, smoking, environmental pollution No cure, aim to control symptoms

SIGNS AND SYMPTOMS Coughing Wheezing Shortness of breath Tightness in chest Unable to speak in full sentences Unusually quiet Skin pale or blue Confused/irritable RR>30/min HR>120bpm Use of accessory muscles Assessment Mild: walking, talking in sentances, can lie down Moderate; talk in phrases, prefers to sit, usually agitated Severe; breathless at rest, hunched forward, unable to complete sentences, agitated

THE SEVERITY OF ASTHMA Asthma UK stats (2009) 1,131 deaths on UK 12 under 12 years 1 in 11 children have asthma Most common long term medical condition On average 2 per classroom Every 17 minutes one child is admitted to hospital Unfortunately much more serious than people think “silent killer””. Sam died aged 12. Stockport school, Cheshire. Inquest 2010 found school staff members negligent. Not familiar with policy, no ambulance called. Sam Linton had an asthma attack and died at school. Inquest ruled that staff negligence contributed to his death.

ACTION – MILD/MODERATE Mild attack give 2 puffs every 3-4 hours. Monitor for 10-15 mins before returning to activity Moderate give 2 puffs and reassess after 20 mins. If no improvement give 2 more puffs, arrange transfer to hospital Asthma attack requires prompt action with a reliever inhaler (blue) Please see nurses if training is required Use of spacer important otherwise drug is swallowed rather than inhaled. Moderat: stay with child, continue to reassess and 2-4 puffs every 20 mins until transfer to hospital can be arranged.

ACTION-SEVERE ASTHMA Administer 2-4 puffs of reliever inhaler immediately Contact ambulance and parents and arrange transfer to hospital Stay with child If no improvement continue to administer 2-4 further puffs of inhaler every 20 minutes (max 10 puffs/hour) Focus is on getting hospital treatment. Child will need oxygen, steriods etc.

EPILEPSY Epilepsy is the tendency to have recurrent seizures. A seizure is caused by a sudden burst of electrical energy in all or some of the brain. Causes in children may be febrile, brain damage from injury or disease Grand mal Petit mal (absence seizures) Status epilepticus (potentially life threatening) Grand mal; The body becomes stiff, limbs jerk, eyes roll back, difficulty breathing, they may be incontinent. Last a few seconds or minutes – longer than 5 go to hosp. Allow to rest/sleep afterwards Status; prolonged or several fits without regaining consciousness in between. Potentially life threatening Triggers/aura Preventative medication given at home

FIRST AID FOR CONVULSIONS Protect the child from injury (remove harmful objects) Do not try and restrain the child Never attempt to put anything into the child's mouth or in between the teeth Time the length of the seizure. If more than 5 minutes call 999 When the seizure has finished stay with the child and reassure Place in the recovery position. Check the mouth to ensure that nothing is blocking the airway Clear classroom Medication PR diazepam Long term may effect learning

DIABETES Type 1 Type 2 Usually genetic, develops as a child Pancreas looses the ability to produce insulin Insulin dependent – individual has to inject insulin regularly to stay alive Frequently occurs in later life Pancreas cannot produce enough insulin to cope with the body’s blood sugar levels May be prevented or controlled by a healthy lifestyle Type 2 diet/oral meds

BALANCING DIABETES On going balance between food, insulin, and exercise

DIABETES Too much food Too little insulin Decreased activity Illness Hyperglycaemia is when the blood sugar is too high Hypoglycaemia when the blood sugar dips too low Too much food Too little insulin Decreased activity Illness Infection Stress Too much insulin Missed food Delayed food Too much or too intense exercise Unscheduled exercise Importance of regular meals Hypo sudden Hyper onset over hours/days

HYPERGLYCEAMIA SYMPTOMS Thirst Frequent urination Fatigue/sleepiness Blurred vision Flushing of skin Sweet fruity breath Nausea/vomiting ACTIONS NEEDED Allow free use of bathroom Encourage to drink water Contact trained personnel to monitor blood, urine and to administer insulin If symptoms severe arrange transfer to hospital

HYPOGLYCEAMIA ACTIONS NEEDED SYPMTOMS Provide quick sugar source snack or drink Re-check blood sugar Follow with a snack of carbohydrate and protein If severe do not attempt to give anything by mouth If decreased/loss of consciousness position on side Contact 999/parents Administer glucagon SYPMTOMS Hunger Shakiness/weakness Pale Anxiety/irritability Sweating Headache Behaviour change Confusion Blurred vision Slurred speech Drowsy/loss of consciousness seizure ***If in doubt e.g. found unconscious treat as HYPO***

CPR Ensure victim, bystanders and yourself are safe Check for response Check ABC Call 999 5 rescue breaths Compressions/ventilation 30:2 Recovery position Manikins available for practice in nurses room. Certified training available

LETS ALL STRIVE FOR A HEALTHY SCHOOOL YEAR