Emergencies in the Classroom

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Emergencies in the Classroom

• Gregg S. Margolis, MS, NREMT-P
• Assistant Professor, Emergency Medicine Program
• University of Pittsburgh
• School of Health and Rehabilitation Sciences

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Todays goal

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

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A few things to consider

• Emotions are normal
• Its not how you feel, its how you look!
• It is OK not to know what is wrong
• There is very little liability for doing
  something!

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Pennsylvanias Good Samaritan Law
8332. 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.
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in fact there may be more liability for doing
nothing.
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There are 3 kinds of patients
Sick
Injured
Im not sure
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A few general principles

• Protect yourself, whenever possible
• Dont move the injured or Im not sure
  patient
• Let sick patients assume the position of
  comfort
• NOTHING IN THE MOUTH!
• well, almost nothing.
• Talk to them!!!

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Recognize the emergency

• Trauma
• Falls
• Cuts
• Burns
• Changes in consciousness
• Breathing difficulties
• Severe pain
• Miscellaneous complaints

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4 simple steps

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

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Get help

• Call your local EMS
• What they need to know
• Where you are
• exact location and phone number
• What is the problem

Consider...
Sending someone to meet the ambulance
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Start the breathing

• Breathing requires an airway
• Airwaya way for air to get to the lungs

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Start the breathing

• Make sure they are breathing
• Look, listen, and feel for breath
• If they are not breathing, breath for them

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Start the breathing

• If you cannot get air in, clear the airway
• If they are choking, clear the airway with the
  Heimlich Maneuver

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Its a good idea for faculty to learn CPR.
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Stop the bleeding

• Use direct pressure to stop bleeding

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C.A.R.E

• Communicate
• Avoid Harm
• Re-Examine
• Encourage

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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?

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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

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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 dont have sugar
• If they have medicine for this specific problem,
  let them take it.

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Re-Examine

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

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Encourage

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

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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.
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Classroom Emergency Case 1
You are making your best attempt to keep the
Krebs 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?
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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

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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?
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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 extremities
• Place on her side if possible
• NOTHING IN THE MOUTH!
• Re-examine Monitor her breathing
• Encourage Talk to her, protect privacy

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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?
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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

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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?
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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

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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?
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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

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A few special cases

• Sudden decreased level of consciousness in the
  known diabetic
• Seizures
• Asthma

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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

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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

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If a patient has Asthma

• Do not force them to lie down
• Let them take their own inhaler

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Remember
You can do it!
Review this Lecture