Transcript Project Overview - University of Pittsburgh

Emergencies in the
Classroom
Gregg S. Margolis, MS, NREMT-P
Assistant 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
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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 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.
…in fact there may be
more liability for doing
nothing.
There are 3 kinds of patients
Sick
Injured
I’m not sure
A few general principles
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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.
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Talk to them!!!
Recognize the emergency
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Trauma
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Falls
Cuts
Burns
Changes in consciousness
Breathing difficulties
Severe pain
Miscellaneous complaints
4 simple steps
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Get help
Start the Breathing
Stop the Bleeding
C.A.R.E.
Get help
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Call your local EMS
What they need to know
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Where you are
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exact location and phone number
What is the problem
Consider...
Sending someone to meet the ambulance
Start the breathing
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Breathing requires an airway
Airway=a way for air to get to the lungs
Start the breathing
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Make sure they are breathing
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Look, listen, and feel for breath
If they are not breathing, breath
for them
Start the breathing
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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
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Use direct pressure to stop bleeding
C.A.R.E
Communicate
Avoid Harm
Re-Examine
Encourage
Communicate
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Talk to the patient
Talk about stuff that matters
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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
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Do not move the injured patient
Allow conscious, sick patients to assume
their “position of comfort.”
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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”
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Lay them on their side
Allow fluid to drain from their mouth
Avoid harm
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Nothing to eat or drink
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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
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If they have medicine for this
specific problem, let them take it.
Re-Examine
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Do not leave them alone
Watch for changes
Constantly watch the breathing
Encourage
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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
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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
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Get help
Start the breathing
Stop the bleeding
Communicate
Avoid harm
Re-examine
Encourage
Send student to call 911
His breathing is fast and shallow
There is no bleeding
Get the story, talk to his friends
Do not move him
Monitor his breathing
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
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Get help
Start the breathing
Stop the bleeding
Communicate
Avoid harm
Re-examine
Encourage
Send a student to call 911
You think she is breathing
There is no bleeding
Get the story, talk to her friends
Protect her head
Protect the body and extremities
Place on her side if possible
NOTHING IN THE MOUTH!
Monitor her breathing
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
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Get help
Start the breathing
Call from your cell phone
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
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Get help
Start the breathing
Stop the bleeding
Communicate
Avoid harm
Re-examine
Encourage
Send a student to call 911
She is breathing very fast
There is no bleeding
Talk to her
Try to get the story
Keep her quite and calm
Monitor her breathing
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
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Get help
Start the breathing
Stop the bleeding
Communicate
Avoid harm
Re-examine
Encourage
Send the someone to call 911
His breathing is normal
There is no bleeding
Get the story
Do not move him, or let him move
Monitor his breathing
Talk to him
A few special cases
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Sudden decreased level of
consciousness in the known
diabetic
Seizures
Asthma
Decreased level of consciousness
in the diabetic
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If able to swallow, give anything
with sugar, immediately
If not, manage as any other
decreased level of consciousness
Seizures
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Protect the head
Protect the body
Place on the side if possible
NOTHING in the mouth
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No forks, spoons or knives
No hands
No tongue depressors
If a patient has Asthma
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Do not force them to lie down
Let them take their own inhaler
Remember:
You can do it!
Review this Lecture