Illinois EMSC1 Medical Objectives Upon completion of this lecture, you will be better able to:  Accurately assess a change in the health status of a student who has a chronic condition  Respond appropriately to an exacerbation of the student’s condition  Work with the student to prevent recurrences of medical emergencies  Help these students cope with their conditions and maintain optimum wellness

Illinois EMSC2 MEDICAL EMERGENCIES

Illinois EMSC3 ANAPHLAXIS SUDDEN, SEVERE ALLERGIC REACTION - Can be systemic - Can be fatal

Illinois EMSC4 INITIAL ASSESSMENT RECOGNIZE SIGNS AND SYMPTOMS INCLUDING: - Itching - Throat tightness - Hives - Edema

Illinois EMSC5 HISTORY OF ANAPHYLAXIS -ALLERGENS -Latex Allergies - CURRENT MEDICATIONS AND AVAILABILITY

Illinois EMSC6 INTERVENTIONS FOR ANAPHYLAXIS -Maintain ABCs - Administer epinephrine (EPIPEN) - Administer antihistamine or bronchodilator - Transport to ED

Illinois EMSC7 TRIAGE AND TRANSPORT FOR ANAPHYLAXIS EMERGENT - Symptomatic with known history, evidence of respiratory distress or shock URGENT - Generalized mild symptoms NON-URGENT - Localized reaction

Illinois EMSC8 EXPECTED OUTCOMES FOR ANAPHYLAXIS  Decreased symptoms  Decreased respiratory distress  Decreased anxiety

Illinois EMSC9 EVALUATION AND FOLLOW-UP  Record treatment on school health record  Review with student foods or allergens to avoid

Illinois EMSC10 PREVENTION OF ANAPHYLAXIS  Teach students to read package labels carefully  Have epinephrine available in school  Have student allergies documented  Have an IEMP for students with severe reactions

Illinois EMSC11 DIABETES MELLITUS  Type 1 most common, although Type 2 is on the rise in children and adolescents  Goal is to maintain adequate blood glucose levels  Hyperglycemia or hypoglycemia can occur

Illinois EMSC12 INITIAL ASSESSMENT  ABCs  LOC related to metabolic process

Illinois EMSC13 HISTORY OF DIABETES  CHIEF COMPLAINT-abdominal pain, headache  MEDICATIONS-insulin type, dose, frequency  DIET-last meal, amount, type of food  EVENTS-exercise, stress, infection  SYMPTOMS-cool clammy skin, hot dry skin

Illinois EMSC14 INTERVENTIONS FOR DIABETES  Assure ABCs  Determine blood glucose level  Use IEMP  Hypoglycemia  Glucose tablets/snack  Hyperglycemia  Insulin administered as ordered

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Illinois EMSC17 TRIAGE AND TRANSPORT FOR DIABETES  EMERGENT  Severe dehydration, seizures, Kussmaul respirations, lethargy  URGENT  Abdominal pain, nausea or vomiting, tachycardia, fruity breath  NON-URGENT  Polyuria without dehydration, minimal distress

Illinois EMSC18 EXPECTED OUTCOMES FOR DIABETES  Adequate ABC’s  Normal blood glucose level  Compliance with medication regimen

Illinois EMSC19 EVALUATION/FOLLOW-UP  Documentation of care/contact with health care provider  Reassess ABCs, neuro status, and blood glucose levels  Identify trends if poor compliance is suspected  Refer for health counseling

Illinois EMSC20 IMMUNOCOMPROMISED CANCER  Survival rates for children are increasing  Chemotherapy temporarily suppresses RBCs, WBCs, and platelets  Venous access devices are common  Monitor for increased ICP  Varicella exposure can be devastating

Illinois EMSC21 IMMUNOCOMPROMISED HIV/AIDS  Increased risk for opportunistic infections  Progression of disease varies significantly  Antiretroviral and prophylactic medication regimens available  Monitor for early signs of infection and developmental delays or loss of milestones  Student may not know diagnosis

Illinois EMSC22 ORGAN TRANSPLANT RECIPIENTS  More common  Transplanted solid organs include: heart, liver, kidney, bowel and lung  Incisional scars identify transplant location  Immunosuppressive agents needed to prevent rejection

Illinois EMSC23 INITIAL ASSESSMENT  ABCDs Respiratory distress First time seizure, severe HA Uncontrolled bleeding  Oral bleeding, lymph node tenderness, abdominal pain, weakness, skin integrity, temperature, HA, nausea/vomiting, and lethargy

Illinois EMSC24 TRIAGE AND TRANSPORT  EMERGENT  ABCD compromise  URGENT  Fever, malaise, vomiting or diarrhea, bleeding  NON-URGENT  Consider all changes in status as urgent until diagnosed

Illinois EMSC25 HISTORY  Chief complaint (fever, pain, bleeding)  Isolation/immunizations  Medications (immunosuppressive, regimen, last dose)  Past history (diagnosis, acute episodes)  Events (infection, recent rejection episode)

Illinois EMSC26 EXPECTED OUTCOMES  ABCs will be maintained  Infection/rejection determined and treated  Psychosocial support will be maintained

Illinois EMSC27 EVALUATION AND FOLLOW-UP  Document all care and health care contacts  Follow-up to determine if rejection or infection is present  Update the IEMP as necessary

Illinois EMSC28 PREVENTION  Avoid unnecessary exposure to infectious diseases  Follow immunosuppressive regimen to avoid rejection episode for transplant student  Avoid contact sports to decrease chance of organ injury or bleeding episodes

Illinois EMSC29 SICKLE CELL ANEMIA  A hereditary disorder that is inherited as an autosomal recessive trait  Caused by an abnormal type of hemoglobin called hemoglobin S  Occurs primarily in students of African decent

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Illinois EMSC32 SICKLE CELL CRISIS SYMPTOMS OF CRISIS  Pain (usually severe)  Tenderness and edema over the bony infarcts which are producing the pain  Moderate to severe abdominal pain

Illinois EMSC33 INITIAL ASSESSMENT OF SICKLE CELL ANEMIA  ABC’s  Level of consciousness  Presence of pain or fever

Illinois EMSC34 HISTORY OF SICKLE CELL CRISIS  Chief complaint fever joint/back pain  Past health history last crisis cause duration  Events recent infection or stress

Illinois EMSC35 SICKLE CELL DISEASE COMPLICATIONS OF SICKLE CELL DISEASE: Orthopedic abnormalities Delayed growth and sexual maturation Eye problems Liver dysfunction Stroke Priapism

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Illinois EMSC38 TREATMENT FOR SICKLE CELL DISEASE  TRANSFUSIONS  PROPHYLACTIC PENICILLIN  FOLIC ACID  IMMUNIZATIONS  OXYGEN  HYDROXYUREA ADMINISTRATION  NOTE: Studies are still being done with this medication

Illinois EMSC39 TRIAGE AND TRANSPORT  EMERGENT Student with sickle cell disease presenting with fever, severe pain, seizures/neurologic deficits or dyspnea  URGENT Fever, mild to moderate pain  NON-URGENT Mild pain, no dehydration

Illinois EMSC40 EVALUATION AND FOLLOW-UP WITH SICKLE CELL CRISIS  Recurrent care and contact with health care provider  Revise IEMP as necessary  Follow-up with the cause of crises

Illinois EMSC41 Students with Special Health Care Needs When managing special needs students, remember to utilize "age appropriate" guidelines. In addition the following tips are helpful:  Concentrate on the student’s abilities, not disabilities. Promotes self-esteem and a positive self-image.  Communicate in a manner appropriate to the student’s ability. Presence of a physical disability does not mean that the student is also cognitively impaired.  Meet with the parent or caregiver and obtain a careful detailed history. Their assistance in interpreting behaviors and responses can give a better understanding of the student’s needs.  Develop an individualized health care plan for these students.  Become familiar with respiratory emergency adjuncts and interventions. Respiratory problems are the most common emergency encountered with these students.

Illinois EMSC42 PREVENTION  Assure adequate nutrition and hydration  Avoid exposure to infections or stress

Illinois EMSC43 SUMMARY Thanks largely to improved treatment modalities, more children with significant health problems are living in the community and attending school. Through your understanding of their unique health conditions, you can help these students accept and adapt to medical challenges they may face at school.

Illinois EMSC44 ANY QUESTIONS??