Medical Emergencies in the Classroom

by Anita G. Kinser, MSN, RNC

In this section you will develop strategies for dealing with the most common medical emergencies such as: 

• Anxiety attacks
• Respiratory difficulties
• Seizures
• Loss of consciousness
• Diabetic reactions
• Heart attack

Be prepared: 

The first step in dealing with emergencies is preparedness. There are a few things that all instructors can and should do to be prepared to handle potential medical emergencies: 

• Know and practice CPR . Keep your certification current so that you are following the most current American Heart Association guidelines.
• Know first aid . Review the principles of first aid on a regular basis so you can remember what to do if an injury occurs.
• Know the emergency notification system for the room(s) you are teaching in. Most classrooms do not have telephones. Know where the nearest one is, and what the emergency medical system (EMS) response number is. In many areas this number is “911”, but not in all areas. Some campuses also have internal emergency numbers to use.
• Know the specific location of your room (ie-building and room number) and best directions to give someone to find it in case you need to call for emergency help.

What about liability?  

In California, as in most states, a person who renders emergency care is usually protected under the Good Samaritan Law as long as you acted in good faith and within your “scope of care” or abilities. In general, the Good Samaritan law says that 

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 (Margolis, 1999).

For more information about the Good Samaritan law and potential liability, go to: http://firstaid.about.com/od/medicallegal/a/07_no_good_sam.htm

A good thing to keep in mind is that there is usually very little liability for doing something to help. There is actually much more liability for doing nothing when you could have done something.

General principles: 

As in all emergencies, stay calm. Even if you’re shaking inside, you need to remain in control and demonstrate a calm exterior to the students in the classroom.

Protect yourself whenever possible. It’s not a bad idea to keep a ziplock bag of latex or vinyl disposable gloves in your desk drawer, briefcase, or other easily accessible place.

*Due to the growing number of people with severe allergies to latex, vinyl gloves are recommended.

Don’t move an injured person or severely ill person if you don’t know it is OK to do so. Wait for emergency medical help to do so.

If the person is conscious and alert, allow them to “assume the position of comfort”. Most people who are having difficulty breathing will do this naturally if allowed. 

Talk to the person in calm, firm, but reassuring tones. If a person is panicking, you may have to use a slightly louder, firm manner to get their attention, but shouting rarely helps.

Check their breathing . As CPR teaches, remember the “ABC’s”-airway, breathing, circulation. If the person is not getting air into their lungs, nothing else matters. Be sure to continue to monitor breathing until the person is alert, oriented, and appears to be no longer in distress, or until emergency medical personnel take over.

Look, listen and feel for breath. If they are not breathing, breath for them.

If the person isn’t breathing and you don’t know CPR call out for someone who does. In a college setting with adult students, there is a strong likelihood that there is someone in the class who knows CPR and can help.

Potential Emergencies 

While there is no way I can deal with all emergencies here, there are a few that are more likely to occur in the classroom setting. Those include

• Anxiety attacks
• Respiratory difficulties
• Seizures
• Loss of consciousness
• Diabetic reaction
• Heart attack

Anxiety Attacks

Anxiety Attacks are more commonly known as panic attacks. There are many misconceptions about anxiety attacks. The most common misconception is that it is “all in your head”. A person suffering from a panic attack is experiencing very real physical symptoms which can lead to serious consequences. As in all emergencies, what the person is feeling is most important and should not be taken lightly. Many people having panic attacks think they are having a heart attack. Symptoms are very similar and it takes a trained medical provider to diagnose the difference. As a lay person, you need to assume the worse and react as you would for any other emergency.

• Pounding heart
• Chest pains
• Lightheadedness or dizziness
• Nausea or stomach problems
• Flushes or chills
• Shortness of breath or a feeling of smothering or choking
• Tingling or numbness
• Shaking or trembling
• Feelings of unreality
• Terror

What to do:

Assess:

Are they breathing? If so, they are may be hyperventilating; breathing rapid and shallow. This will exacerbate their symptoms of dizziness, numbness/tingling and chest pain.

Place them in a position of comfort :

Usually people having difficulty breathing feel better sitting up. Try having them sit on the floor with their back against the wall. Allow them to position themselves the way that is most comfortable to them.

Talk to them.

Talk to them firmly, calmly, loud enough to be heard. Talk them into breathing slower and deeper. You will need to talk them through the steps over and over, possibly demonstrating the breathing with them to help them focus. Try the following:

• Breathe slowly through your nose to the count of 4
• Exhale through your mouth to the count of 4.
• Repeat over and over, Always breathing through your nose, slowly, until breathing returns to normal.

Help them try to focus on things outside of themselves. Internal focusing pumps them up. Attempt to have them

• Listen to what other people are saying
• Focus on things in the room around them
• Count backwards from 100 by 3
• Engage them in conversation with you
• Imagine themself in some pleasant place

Give them privacy  

Temporarily dismiss the class if you can’t find a quiet place to isolate them. The embarrassment of others crowding around and watching may make symptoms worse. 

Observe until help comes  

Even if they appear better, do not leave them alone until trained help arrives to take over their care. Continue to observe their breathing and color, occasionally encouraging and reassuring them.

Respiratory Difficulties

The most likely problem to occur is an asthma attack. Many variables can affect people with respiratory sensitivities and stress is definitely one of them. A student who is anxious about an exam or impending oral presentation may be more easily triggered into an asthmatic episode. If not controlled immediately, asthma attacks can lead to serious complications and even death.

Symptoms of an asthma attack:

• Difficulty in breathing.
• Rapid shallow and noisy breaths.
• Coughing and wheezing.
• Chest tightness.
• Distress.
• Difficulty in speaking.
• Blue lips / skin

What to do:

Assess  

How severe is their breathing difficulty? How is their color-are they pale, white, or blue around the mouth? This is the first place you will notice a change in color if a person is not getting enough oxygen.

Place them in a position of comfort  

They will be most comfortable sitting up, possibly leaning slightly forward. Never force a person having difficulty breathing to lie down. The pressure of internal organs on the diaphragm make breathing more difficult in this position.

Talk to them  

Talk to them firmly, calmly.

Instruct them to breath slowly, deeply as possible, and breath out slowly through pursed lips (as if they are whistling, or blowing out a candle).

Ask if this has ever happened before.

Call for help

If this is a first attack, or if the person does not have an inhaler, call immediately for emergency help.

Use their inhaler

Most patients with asthma carry an inhaler. Ask if they have an inhaler, help them get it and encourage them to use it as soon as possible. They should take 4 puffs initially. If after 10 minutes their condition hasn’t improved, have them take another 4 puffs and call for emergency help.

Seizures

A seizure is characterized by uncontrolled jerking or thrashing movements. Some people have an “aura” which is a warning sign that a seizure may occur. Even though they may have this warning, due to embarrassment, they may not alert you that a seizure is going to occur. Others have no warning before the event.

What to do:

Protect them from injury 

• The main focus is to protect from falls and from head injury.
• If they give you a warning that a seizure is going to occur, help them lie down in an open area of the floor away from obstacles.
• If they are sitting in a desk or at a table when the seizure occurs, assist them to the floor while protecting their head and clear the area. You may need someone else to help you move them.

Call for help

Position for safety

• Leave them lying on the floor, on their side. Lying on their side will allow for drainage of secretions/emesis and prevent choking.
• Protect their head: Clear the area of chair legs, table legs or other sharp objects.
• If something soft is available such as a small folded blanket, you may place it under their head. Do not use anything with sharp objects such as zippers or large snaps.

DO NOT 

• attempt to restrain the person in any way
• put anything in the person’s mouth

Protect their privacy 

Seizure patients are frequently embarrassed after they “come to”.

Some seizure patients become incontinent during the seizure, which will add to the embarrassment. It is a good idea to clear the classroom except for essential help needed. 

Monitor them  

o         Sometimes breathing may stop temporarily during a seizure, but it usually resumes without assistance. The best way to keep the airway clear is to keep them on their side. 

o         If they still are not breathing after the seizure stops, then follow the general rules for CPR and airway management. 

Loss of Consciousness 

Loss of consciousness can happen for many reasons, but the most common cause is usually fainting due to low blood sugar (hypoglycemia), dehydration, or severe emotional stress.  

What to do  

Assess  

• Are they breathing? If not, follow the “ABCs” of CPR
• Are they responsive to your questions? Most people who faint will “come to” fairly quickly.

Call for help

Position for comfort  

• If they are not alert, place them on the floor, lying on their side, with the upper leg bent at the knee. This will facilitate drainage of fluids from the mouth.
• If they regain consciousness, allow them to assume the position that is most comfortable for them. Do insist that they remain at rest until they can be assessed by medical personnel.
• Provide good air circulation. Remove “onlooker” crowds from the area. Open a window, door, or provide a fan. Loosen restrictive clothing from around the neck (ie-buttoned shirt color, necktie).
• Applying a cool, moist cloth to face, neck, and head is soothing and sometimes helps increase alertness.

Talk to them calmly and try to get more information.  

• What happened?
• What are they feeling?
• Has this happened before?
• If it has happened before, what caused it? What helped?
• Are they taking any medication?
• Did they forget to take their medication?
• Are they allergic to anything?
• When did they eat last, and what?

DO NOT  

Give them anything to eat or drink until they have been cleared by medical personnel, unless they are diabetic. If the person is diabetic, see below.

Diabetic Reactions

There are two types of abnormal diabetic reactions; hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). Either one can cause a person to change behavior or exhibit an altered level of consciousness, though hypoglycemia is probably more common.

Hypoglycemia occurs when the diabetic patient  

• Takes too much insulin or oral diabetic medication
• Forgets to eat or doesn’t eat enough after taking their medication
• Exerts more energy than usual. Energy exerted may be physical activity or emotional.

Symptoms of hypoglycemia 

• Weak, shaky, trembling
• Cold, clammy, diaphoretic (sweaty)
• Dizziness
• Groggy, confused
• Headache
• Hunger
• Change in behavior

An easy way to remember the symptoms is to memorize “cold and clammy, need some candy”.

What to do

Assess

Look for the signs mentioned above.

Are they unconscious, or unable to talk? If so, call for help immediately. They need an injection of dextrose (sugar) or glucagon, which requires medical personnel.

If they are still able to talk, ask them if they are diabetic.

• Did they take insulin today?
• Did they take other diabetic medication today?
• Did they eat like they were supposed to?

If the diabetic is able to swallow, they need sugar in their system. “Need some candy” is actually incorrect. What they need is complex carbohydrates, such as milk or bread. However, those things are not usually readily available in a classroom. In a pinch, anything with sugar will do to help them temporarily. Soda, juice, candy are more likely to be available from another student or a nearby vending machine. Remember, diet soda has no sugar and will not help.

Monitor them

If they don’t feel better within 10-15 minutes, give them more sugar. Watch for difficulty breathing or decreased consciousness. If these occur, call for help immediately.

Hyperglycemia occurs when  

• A diabetic patient fails to take their insulin or oral diabetic medication
• A diabetic patient eats too much, or the wrong foods
• A diabetic patient experiences severe stress, trauma, or infection.
• A diabetic patient has too little or no exercise

Symptoms of hyperglycemia 

• Hot, flushed, dry skin
• Reddened face
• Extreme thirst
• Frequent urination in large amounts
• Headache
• Fatigue
• Changes in behavior
• Difficulty concentrating
• May have fruity, acidic odor to breath (sometimes mistaken for alcohol odor).

An easy way to remember the symptoms is to memorize “hot and dry, sugar high”.

What to do

Assess  

Look for the above signs.
Assess their breathing and respond accordingly.

Call for help

Are they responsive? If so, ask if they have insulin with them and allow them to administer the insulin if able. If not, wait for someone trained in administration of insulin. They need to follow up with medical personnel to determine the reason behind the hyperglycemia and to manage the symptoms/causes.

Heart Attack

Hopefully heart attack will never happen in your classroom, but it can happen anywhere, and stress can definitely be a predisposing factor, which increases the chances of a heart attack occurring in a college classroom.

Symptoms/warning signs of a heart attack

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
  
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  
• Shortness of breath. This feeling often comes along with chest discomfort. But it can occur before the chest discomfort.
  
• Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness.

As you can see, these symptoms are similar to panic attacks. All symptoms must be treated as an emergency until diagnosis is made by a medical professional.

Call for help

As mentioned earlier, it is a very good idea to know CPR. If you do not, call out to the class and ask for anyone who knows CPR to come forward immediately.

Basic steps:

Place the patient flat on the floor, face up.

ABCs:

A-Airway . Open the airway with a head-tilt chin-lift or jaw-thrust maneuver .

B-Breathing: LOOK-LISTEN-&-FEEL for breaths. CHECK BREATHING FOR 5-10 SECONDS.

If they aren't breathing VENTILATE TWICE. Remember to cover nose and mouth to make a good seal.

C-Circulation: Check for a pulse by palpating (feeling) the carotid artery (in the neck, right below the jaw). CHECK THE PULSE FOR 10 SECONDS.

If there is no pulse BEGIN CHEST COMPRESSIONS at a rate of 15 COMPRESSIONS to 2 BREATHS.

Recheck the pulse after ONE MINUTE

CONTINUE UNTIL HELP ARRIVES, OR UNTIL YOU FEEL TOO TIRED TO CONTINUE

**It is a good idea to carry a “pocket mask” with you, or have one in the classroom. Inexpensive, disposable, keychain size masks are available.