Contents
Introduction
Comforting an Injured Student
When to Call a Doctor
Your Health is In Your Hands
Remember to Wash Your Hands
Hepatitis: Understand the Virus A to E
Universal Precautions
Asthma
Epilepsy/Seizures
Diabetes
Anaphylactic Reaction Protocol
Bee Sting Reactions
Signs and Symptoms of Cardiac
Involvement
• Shunt Precautions
• Hemophilia Protocol
• Nosebleeds
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Injuries and Illnesses
Rashes
Staph Infections
Ringworm Protocol
Pink Eye
Lice Protocol
Eye Injuries
Cuts
Dental Emergencies
Broken Bones
Dislocations
Pulled Muscles
Heat Exhaustion
Chemical Burns
Head, Neck, & Back Injuries
Choking
Panic Attack Protocol
CPSB medication given at school
Field Trips
Introduction
Accidents can happen anywhere, anytime—even at school. Students do a whole
lot more than sit quietly behind desks. They play, go out for team sports,
participate in hands-on activities, and go on field trips. As a caregiver for these
young people, it’s likely that someday you’ll be at the scene of an accident at your
school. Would you know how to care for an injured student in those first few
moments after an accident happens, before help arrives?
For all it’s worth, basic first aid is not complicated. It’s a few simple rules and
procedures, combined with a lot of common sense. It’s remaining calm and
knowing how to give simple, basic help. You can do it. Follow along as we explain
how to give basic first aid for different injuries.
Comforting an Injured Student
Being injured is a frightening experience for anyone, but especially
for young people. As a caregiver for children and teenagers, it’s
important to stay calm and reassuring in order to ease their fears
and gain their confidence. Think of yourself as your students’
mirror—they will react to what they see in your face. So don’t panic
and overreact. Set an example by staying relaxed and confident, so
they will calm down and listen to you.
When giving first aid:
• Take a breath and relax.
• Take charge by asking for cooperation from the other students.
Send someone to get help and ask your students to quietly sit
down.
• Sit with the injured student while waiting for qualified help to
arrive. Just being there will be a big comfort.
• Tell the student that everything will be all right and that help is
on the way.
When to Call a Doctor
At some time you may need to call a doctor about an injury or other
medical problem. If the problem is a real emergency such as severe
bleeding, a possible heart attack or stroke, a diabetic coma, or severe
abdominal pain, call paramedics or an ambulance service to take the
victim to the hospital.
If you are unsure of the victim’s condition and the victim has severe or
prolonged symptoms such as pain, vomiting and/or diarrhea
(particularly with blood), difficulty in breathing, or high fever, call the
victim’s doctor—regardless of the hour.
It is very helpful when calling the doctor to give him or her specific
information regarding the victim. Be prepared to tell the doctor or
nurse the following:
•What has happened
•What the victim’s noticeable injuries, symptoms, or signs are
•When the accident occurred or symptoms or signs began
•If known, what medications the victim has taken
•If poisoning has occurred, what has been swallowed, and when
•Where you and/or the victim are
•Give the phone number of your location
•Ask what more you can do to help
Above all else—and especially in an emergency situation—try to remain
calm and follow the doctor’s or medical professional’s instructions. Your
first-aid measures could save valuable seconds and, possibly, the life of
the victim you are caring for.
Your Health is in
Your Hands
Call me Beta STREPTOCOCCI
Group A—I’m delighted to
give you a sore throat.
My name is BACILLUS
SPECIES and I’m a
normal contaminate.
I’m
STAPHYLOCOCCUS.
How would you like a big
zit or boil?
I am
CLOSTRIDIUM
DIFFICILE.
I cause colitis
I’m E. coli – short
for ESCHERICHIA
coli. I cause nice
things like diarrhea
or urinary tract
infections.
I go by the handle of
KLEBSIELLA. I can
cause wound infections.
Everybody likes me. I
cause diarrhea. My
name is SHIGELLA.
They call me
HAEMOPHILUS.
I can cause a
highly
contagious
conjunctivitis
(Pinkeye)
I’m known as
INFLUENZA A
among other
things. I love to
give you
pneumonia.
You can call me
BACTEROIDES. If you
don’t wash after a BM I
can give you many things.
How would you like an ear
infection or vaginitis?
I love people! To
show you how
much – I cause
urinary tract
infections. I’m
PROTEUS.
I’m tough!
The gang calls me
PSEUDOMONAS
AERUGINOSA.
I infect wounds
and produce
blue-green pus.
Universal Precautions
With today’s danger of AIDS and
hepatitis B, you have to be careful
when exposed to the blood of
anyone—even your students. But
don’t let this stop you from giving
first aid. Just take these, quick,
simple steps to protect yourself:
•Wear the vinyl rubber gloves that
should be included in your first-aid
kit.
•If your first-aid kit doesn’t supply
gloves, be creative and work with
what you have. Look for anything
waterproof like a piece of plastic or
even thick cardboard. Place this
material on top of any blood-soaked
bandages to act as an extra barrier
between you and the blood.
•After giving care, do not touch your
mouth, nose or eyes, or eat or drink
until thoroughly washing your hands.
Asthma
Asthma is a lung condition caused by an increased reaction
of the airway to various stimuli. An asthma episode is a
series of events that narrows the breathing tube.
If a student has an asthma episode:
•Avoid drawing extra attention to the student.
•Stay calm and reassure the student.
•Don’t leave the student unattended to get medicine or a
prescribed inhaler.
Call for emergency help if:
•The student can’t talk.
•The inhaler doesn’t provide relief.
•The student’s lips or fingernails look gray or blue.
In any emergency always follow school policy.
NEVER send a student by himself/herself to the office
along when an asthma attack is occurring. NEVER!
Asthma Attacks
Sudden breathing problems like asthma can be very frightening. Signs of an
asthma attack include wheezing and coughing. As breathing becomes more
strained, the person may become panicky and may even have trouble speaking.
Students with asthma are responsible
for keeping an inhaler in school. Some
schools require students to keep a
second inhaler at all times in the health
office. Asthmatic students will
recognize their own signs of an
oncoming attack and should know when
to use their inhaler.
When a student is having an asthma
attack:
•Send someone immediately to get the
student’s inhaler.
•Get immediate medical help if the
student is having severe asthma for the
first time or if the student doesn’t feel
better after using his inhaler.
•As you wait for help to arrive, let your
student assume the position in which it
is easiest to breath.
•Remember, stay calm and reassuring.
ASTHMA
1.
2.
3.
4.
5.
6.
If you suspect a student is having an asthma
attack, send the child to the office with a buddy
and notify the office that the student is coming.
Give student medication prescribed by the
physician for school use ASAP.
Document the time medication was given.
Note the first signs of asthma may be mild.
Notify parent and school nurse if student needs
asthma medication several times a week.
If medication does not relieve asthma symptoms
and distress is noted, call 911 and parent.
If 911 is called and the student is not
transported, they do not charge for the visit.
Remember, they have equipment that
school personnel does not.
Calcasieu Parish School Board
Nursing Department
2423 6th Street
Lake Charles, LA 70601
Phone (337) 217-4260 Fax (337) 217-4261
ASTHMA PROTOCOL
Signs or Symptoms of Asthma
1.Onset may be sudden or gradual.
2.Respiratory difficulty, shortness of breath, cough, wheeze
3.Prolonged expiration
4.High-pitched whistling wheezes
5.Usually no fever present
6.Student breathes more easily sitting up
7.Symptoms may be aggravated by exercise
Prevention
1.Avoidance of dust, molds, animals, pollen, or other allergens
2.Preventive treatment such as inhalers and other medication prescribed by
physician
Management
(Acute Attack)
1.With shortness of breath, cough, tightness in chest, or any of the other signs
and symptoms listed above, follow the student's treatment plan.
2.Remain with the student and reassure him. Allow him to choose the position
which makes his breathing easiest.
3.If students does not respond promptly to his health care plan, call parent/
legal guardian.
4.If student's condition worsens in spite of treatment, and parent has not yet
arrived, call 911. (For example, increased difficulty breathing, blueness of the
lips or nailbeds difficulty talking)
Epilepsy
Epilepsy is the result of mixed electrical signals in the brain.
Students with known epilepsy usually take medications to control
or prevent seizures.
If you observe a student having a seizure:
•Stay calm.
•Tell others not to crowd around and explain that it will be over
shortly.
•Approach the student gently so you don’t frighten him or her.
•Protect the student from hitting hard or sharp objects.
•Put something soft under the student’s head.
•Do not move the student unless he or she is in danger.
•Do not place anything in the student’s mouth.
•Allow the seizure to take its course, but observe how long it lasts.
•Don’t leave the student alone until fully recovered.
•If the student loses bladder or bowel control, try to protect him
or her from embarrassment.
Some seizures are a medical emergency. Call for emergency help
if:
•The seizure lasts more than five minutes.
•The student is pregnant.
•The seizure follows a head injury.
•The student has no previous history of seizures.
Don’t send a student to the office if he/she is having a seizure!
NEVER!
Convulsions/Seizures
1.
2.
Symptoms
Victim utters short cry or scream.
Rigid muscles followed by jerky twitchy
movements.
3. Breathing may stop temporarily during
seizure.
4. Bluish color to the face and lips.
5. Eyes may roll up.
6. Possible loss of bladder and bowel
control.
7. Drooling or foaming at the mouth.
8. Sleepiness and confusion after the
convulsion is over.
9. Unresponsive during seizure.
10. Any one or all of the above symptoms
may be present.
Epileptic Seizure
The treatment for a known
epileptic seizure is the same as for
convulsions.
The primary aim is to prevent the
student from harming
himself/herself. Do not interfere
with the convulsive movements.
After the seizure, maintain an
open airway, and restore
breathing if the student should
cease breathing and not start
again momentarily.
1.
What to Do
If student starts to fall, try to catch him
and lay him/her down gently.
2. Remove any surrounding objects that
the student might strike during the
seizure, or remove the student from
dangerous surroundings. EX: stairs,
glass doors, desks.
3. If breathing stops and does not start
again momentarily after the seizure,
maintain an open airway. Check to make
sure victim’s tongue is not blocking his
throat. Restore breathing if necessary
after the seizure.
4. Do Not interfere with convulsive
movements but be sure that the
student does not injure himself/herself.
Don’t try to hold the student down, as
muscles tear or fractures may result.
5. Do not force any objects such as a
spoon or pencil between the student’s
teeth.
Do not throw any liquid on the student’s
face or into his/her mouth.
Loosen tight clothing around the
student’s neck and waist.
6. If necessary, shield the student from
crowds to prevent embarrassment.
7. After the seizure is over, turn the
student’s head to the side or place the
student on his side to prevent choking
on secretions, blood, or vomit.
8. Keep the student lying down after the
seizure is over as he/she may be
confused for a while.
9. Stay with the student while he recovers.
10. Seek Medical attention promptly,
especially if the seizure is followed by a
second seizure, or if the student is
pregnant.
**SEIZURES LASTING MORE THAN 5 MINUTES—CALL 911**
Calcasieu Parish School Board
Nursing Department
2423 6th Street
Lake Charles, LA 70601
Phone (337) 217-4260 Fax (337) 217-4261
PROTOCOL FOR MANAGEMENT OF SEIZURES IN THE SCHOOL SETTING
Absence or Petit Mal Seizures
1.For this type of seizure you need only to protect and observe the student.
2.Notify parent/legal guardian if there is a change in the seizure pattern.
Generalized Tonic-Clonic Seizures
(Grand Mal)
1.Remain calm. Begin timing the seizure. Remove furniture and other potentially harmful
objects from the student's immediate environment.
2.Lay the student down and turn his head to one side to allow saliva or vomitus to drain from
the mouth. Do not offer anything by mouth, such as fluids or medication.
3.You cannot stop the seizure; let it run its course. Do not try to restrain the student and do not
stimulate by rubbing the chest, face or arms or by loosening clothing.
4.Do not force anything between the child's teeth, such as a tongue blade or finger.
5.If the motor activity lasts less than 5 minutes and there is no post-convulsive drowsiness,
protect the student, observe him, and notify the parent/legal guardian. Student may stay at
school.
6.If the motor activity lasts less than 5 minutes and post-convulsive drowsiness continues,
protect the student, notify the parent/legal guardian to come and pick up the student.
7.If the motor activity lasts longer than 5 minutes, or if the student has multiple seizures that
follow each other in rapid succession and the sequence lasts longer than a total of 10
minutes, call 911.
8.Log seizure on the proper form. (Send log with student if he is transported.)
Complex Partial Seizures
(Psychomotor or Temporal Lobe)
1.Do not attempt to stop the seizures or to restrain the student.
2.Remove furniture and other potentially harmful objects from the student's immediate
environment and guide him away from potential hazards.
3.Use a calm, soft voice when talking to the student.
4.Re-orient the child to his surroundings following the episode and give him emotional
support.
5.Notify the parent/legal guardian if there is a change in the seizure pattern.
Diabetes
Diabetes is a condition where the body makes ineffective, little, or
no insulin to maintain proper amounts of glucose, or blood sugar,
cells need to function properly. Diabetics regulate their blood sugar
levels by diet and medications but still face two problems—high or
low blood sugar levels.
If a student has LOW BLOOD SUGAR, help him or her consume a
simple sugar such as:
Glucose tablets
Fruit juice
Sugar-sweetened soda pop
Call for emergency help if the student:
Is not conscious enough to consume a simple sugar
Lapses into a diabetic coma
NEVER leave a student with low blood sugar unattended or send him
or her to get help alone.
If a student has HIGH BLOOD SUGAR levels, help him or her
consume additional insulin or liquids without sugar. The best
choices are liquids such as:
Water
Diet Soda
Call for emergency help if the student:
Is not conscious enough to swallow water or diet soda
Lapses into a diabetic coma
NEVER allow the student to leave your presence without an escort
to the office or clinic.
Diabetic Episodes
Diabetes is a disorder that affects the level of sugar in the blood. Having too
little or too much sugar in the blood can cause diabetics to become
unconscious. When symptoms of a diabetic reaction occur, you will need to
react quickly in order to prevent a diabetic emergency.
Make sure you are notified if any students under your supervision have
diabetes so you can watch for these possible symptoms:
•When a person’s blood sugar is too low,
he will feel shaky. He may sweat or look
pale, be hungry, have poor coordination
and display angry or other “out-ofcharacter” behavior.
•To raise his blood sugar, give him a hard
candy, or some other form of sugar, such
as juice or a soft drink. His condition
should improve dramatically within ten
minutes. If it does not, send for help.
•When a person’s blood sugar is too high,
he may complain of a headache or
stomachache and extreme thirst. He may
have flushed skin and rapid breathing.
•If a diabetic student shows any of these
signs, send for help immediately.
The diets of diabetics greatly affect their health. Older students living with
diabetes will know when to eat and what to eat. But, younger students may
not understand how profoundly food affects their blood sugar. Therefore,
you may want to supervise your younger students’ meal and snack
schedule:
•Monitor what they eat.
•Remind them when to eat.
•Watch closely to make sure they finish.
DIABETES
1.
2.
3.
4.
5.
If you know you have a student with
diabetes, make yourself aware of the signs
and symptoms of low and high blood sugar.
Post them in an easily accessible and visible
area.
If the student is exhibiting any signs and
symptoms of low or high blood sugar, send
them to the office with a buddy.
Document the time, what the symptoms
were (exactly what the student told you),
and how the student looked.
Every student will have different physician’s
orders regarding their diabetic care.
Notify parent and school nurse of repeated
signs and symptoms of low or high blood
sugar.
Calcasieu Parish School Board
Nursing Department
2423 6th Street
Lake Charles, LA 70601
Phone (337) 217-4260 Fax (337) 217-4261
PROCEDURE FOR BLOOD GLUCOSE MONITORING
IN THE SCHOOL SETTING
1.
2.
3.
4.
5.
6.
Wash hands.
Clean table area with alcohol and paper towels.
Get monitoring kit and sharp's container.
Open the lid on the sharp's container.
Wipe finger with alcohol prep and allow the finger to dry.
Puncture the fingertip with the lancet and gently squeeze the finger in a downward
motion to get a large drop of blood. Cover the test pad with the drop of blood. Do
not allow the fingertip to touch the test strip.
7. Hold the alcohol wipe to fingertip until all bleeding has stopped. Place a Band-Aid
on the fingertip.
8. Place the used lancet, alcohol wipe, and test strip into sharp's container.
9. Clean table area with alcohol wipe and paper towel.
10. Record reading on "Diabetic Record.“
11. Send the monitoring kit (Glucometer) home everyday.
Note:
The student should be encouraged to check his own blood sugar. If the student is
doing self-blood glucose monitoring, the above steps are still to be followed. The
designated staff person is to assist the student by observing for correct procedure,
assisting with the proper disposal of the lancet and other waste products. This same
staff person should also be able to implement the health care plan and emergency plan.
Calcasieu Parish School Board
Nursing Department
2423 6th Street
Lake Charles, LA 70601
Phone (337) 217-4260 Fax (337) 217-4261
ANAPHYLACTIC REACTION PROTOCOL
Definition
naphylactic reaction is a rare, extremely serious form of allergy. Onset is rapid, may be sudden, and
requires immediate action to prevent death. Students are known to be highly allergic to insect venom or
other allergens should receive medication as soon as sting or exposure to allergen is reported.
A
Causes
Extreme sensitivity to one or more of the following:
1.
Insect sting, usually a bee or wasp
2.
Medication or immunization, usually by injection
3.
Food or pollen
4.
Industrial or office chemicals or their vapors
Signs of Anaphylactic Reaction
Coughing
Wheezing
Shortness of breath
Hives, itching
1.
2.
3.
4.
5.
6.
7.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Swelling (especially face)
Diarrhea
Flushing
Faint feeling
Apprehension
Faint pulse
Rash (face or upper chest)
Pallor, bluish color
Management
Inject the EpiPen
Call CPR certified staff
Call 911
Call parent/legal guardian
Stay with child
Keep airway open
Elevate legs
How to Use the EpiPen
Remove the EpiPen or EpiPen Jr from the clear carrier tube.
Grasp the EpiPen in your fist with the orange tip (needle end) pointing downward.
With your other hand, remove the blue safety release by pulling straight up without bending or
twisting it.
Place orange tip on outer thigh (upper leg) at right angle (perpendicular) to the thigh.
Push the EpiPen firmly until it ‘clicks’. The click signals that the injection has started. If you are
administering EpiPen or EpiPen Jr to a young child, hold the leg firmly in place while
administering an injection. (May be injected through clothing if necessary)
Hold firmly in place for 3 seconds (count slowly 1, 2, 3).
Remove the EpiPen from the thigh.
Massage the injection area for 10 seconds.
Discard unit properly.
The EpiPen and emergency information will be kept in school's front office.
The EpiPen requires a doctor's prescription, which must be renewed annually.
Bee Sting Reactions
The minimal injection of venom from a honey bee, hornet, yellow jacket or
wasp is enough to send some people, especially children, into lifethreatening anaphylactic shock in minutes. Symptoms of this dangerous
allergic reaction include:
Weakness
Hives
Swelling of the eyes, face, or tongue
Nausea
Difficulty breathing and swallowing
Unconsciousness
If a student is having an allergic reaction, send immediately for the nurse.
The nurse should have medication to alleviate the symptoms. While you
wait:
Stay calm. Remember you are your
student’s mirror. If you appear anxious, he
will become anxious. If you appear calm,
he will stay calm.
Check to see if the stinger is still in the
student’s skin. An embedded stinger still
contains venom. If you see a stinger,
scrape it out with your fingernail or a stiffedged card. Do not squeeze the stinger.
Doing so could release more venom.
Summary
Learning first aid is just one more way to show your students that you care.
Now, you can confidently provide immediate care to anyone who has been
injured. But remember, don’t try to go beyond your own abilities. Just apply
these simple rules, use your common sense and stay calm.
Calcasieu Parish School Board
Nursing Department
2423 6th Street
Lake Charles, LA 70601
Phone (337) 217-4260 Fax (337) 217-4261
SIGNS AND SYMPTOMS OF CARDIAC INVOLVEMENT
1.
2.
3.
4.
5.
6.
7.
8.
Change in activity tolerance
Increased problems breathing
Cyanosis (blue discoloration of lips, extremities, nailbeds)
Chest pain or discomfort
Irritability
Malaise/lethargy
Unusual tiring
Dizziness or fainting
With the presence of any of the above possible signs and/or
symptoms of cardiac involvement, have the student lie down
and stop all activity. Call the parent at once. Should the
condition of the child worsen and the parent has not yet
arrived, call 911.
Calcasieu Parish School Board
Nursing Department
2423 6th Street
Lake Charles, LA 70601
Phone (337) 217-4260 Fax (337) 217-4261
PROTOCOL FOR THE MANAGEMENT OF HEMOPHILIA IN THE SCHOOL SETTING
Management
1. Minor injuries, small cuts, abrasions, and nosebleeds are usually not serious, but must be observed
to determine if the bleeding has stopped.
2. Internal bleeding into joints, muscles, abdomen, head, neck, eye, lower back, and groin require
immediate medical attention. Some signs of internal bleeding may include, but are not limited to,
the following:
•Muscles and joints—tingling sensation, pain, warm and tender to touch,
swelling, stiffness or limitation of motion, numbness or loss of sensation in limb
•Intracranial (within the head)—headache, dizziness, visual disturbances
•Subcutaneous (below the skin)—large, purplish areas firmer than the surrounding skin
What to Do
1. Treat all bleeding episodes as promptly and adequately as possible.
2. Use Universal Precautions and give proper first aid for bleeding.
First Aid for External Bleeding
1. For skin lacerations or abrasions, apply firm, direct pressure with your gloved finger or hand. A
pressure dressing may also be used. Do not remove the dressing once it is applied but reinforce it
as necessary.
2. Apply ice pack. This relieves pain and limits the amount of bleeding.
3. Notify parent or emergency contact.
4. Notify physician if parent or emergency contact is not available.
5. Notify the principal and document appropriately.
First Aid for Possible Internal Bleeding
1. Direct someone to call parent or emergency contact. Call 911.
2. Have the student lie down quietly. Elevate the lower extremities about 12 inches. Keep him warm
and remain with him until help arrives.
3. Notify the principal and document appropriately.
Nosebleeds
A nosebleed can be caused by a blow to the nose, scratching
the nose, repeated nose blowing that irritates the mucous
membrane, or by an infection. Most nosebleeds that occur in
children are not serious. Those that occur in the elderly,
however, may be serious and may require treatment at a
hospital emergency room.
What to Do:
1. Have the victim sit down and lean forward,
keeping the mouth open so that blood or clots
will not obstruct the airway.
2. Squeeze the sides of the nose together for
approximately 15 minutes by the clock.
(Squeeze the nose below the bone, not on the
top of the nose.) Release slowly. Do not allow
the victim to blow or touch the nose. If
bleeding continues, squeeze the nose closed
again for 5 minutes. Be sure that the victim is
not swallowing blood.
3. Place a cold cloth or ice in a cloth against the
victim’s nose and face to help constrict blood
vessels.
4. If bleeding continues, seek medical attention.
5. Seek medical attention if an injury is involved or
if you suspect a broken nose.
6. Do not let the victim irritate or blow the nose
for several hours after bleeding stops.
Communicable Diseases and CPSB Policy
•Please be aware of CPSB communicable
disease letters regarding skin conditions and
medical conditions.
•The principal must sign the letter and needs
to be made aware of the student and also the
front office.
•The student can be asked to bring a note
from a physician stating they can return to
school if this is a recurrent problem.
•They must be free of the symptoms for 24
hours. (Fever, vomiting, diarrhea, etc.)
Injuries and Illnesses
Vomiting:
Vomiting may occur with many conditions. It is particularly common with
viral infections of the intestines, excessive eating, excessive drinking of
alcoholic beverages, and emotional upsets.
Vomiting may be present with more serious conditions such as appendicitis,
bowel obstruction, asthma, animal bites, allergic reactions to insect stings,
black widow or brown recluse spider bites, marine life bites, scorpion bites,
poisonous snake bites, withdrawal from drugs, heart attack, heat exhaustion,
shock due to injuries, diabetic coma, food poisoning, and head injuries.
Vomiting associated with intestinal viruses, excessive eating or drinking, and
emotional stress usually does not last a long time. Any vomiting, however,
that is severe or lasts longer than a day or two needs medical attention, as
dehydration (loss of body fluids) or a chemical imbalance (loss of body
chemicals) can occur. This is especially true in infants, the elderly, or
chronically ill persons.
Vomiting can indicate a serious problem. Seek medical attention promptly if
vomiting occurs with severe stomach pain or after a recent head injury, or if
the vomit contains blood that looks like coffee grounds.
What to do:
•In treatment of simple vomiting associated with intestinal upsets,
replace lost fluids by frequent sipping of liquids such as carbonated
beverages (shaken up to eliminate fizz), tea, juice, or bouillon. After
vomiting has stopped, avoid solid food. Work slowly back to a regular
diet.
•If the victim is unconscious and vomiting, he or she should be placed
on his or her side with the head extended, as long as there is no head,
neck, or back injury. Doing this will prevent the victim from choking on
the vomit. A victim with a head injury should have his or her head
turned to the side to prevent choking.
Vomiting in Infants and Young Children:
Vomiting in infants and children is common. Some of the most common
causes include allergy, viral infections (flu), poisoning, car sickness, intestinal
obstructions, pneumonia, colic, head injuries, nerves, and appendicitis.
In newborns and infants, spitting up food after eating is common and is not
the same as vomiting. It is usually not serious. Be sure the infant does not
choke.
Vomiting in infants can be quite serious, particularly if vomited material is
expelled with such force that it shoots out of the infant’s mouth 1 or 2 feet
across the room (projectile vomiting). This type of vomiting always needs
prompt medical attention. It could represent a partially or completely
obstructed intestine.
Prolonged vomiting or vomiting with diarrhea can lead to dehydration (loss of
body fluids) and also needs prompt medical attention.
Other possibly serious symptoms to watch for in infants and small children
include vomit that contains blood, and vomiting with headaches or
stomachaches.
What to do:
In treatment of simple vomiting that accompanies intestinal
upsets, for example, the victim should drink fluids and avoid solid
foods. Give him or her small sips (approximately 1 teaspoon) of
carbonated beverages (shaken up to eliminate fizz), tea, or juice
(not orange) every 10 to 20 minutes. Gradually increase amount
if victim keeps fluids down. Slowly work back to a regular diet
once the stomach is settled.
Eye Injuries
Cuts or other direct blows to the eyes are serious. They can result in serious harm
to the surface of the eyeball or to the delicate inner eye. All eye injuries, even
minor ones, must be cared for properly or they can quickly lead to infection and
loss of sight.
•If you notice a “black eye”
developing, apply a cold compress
immediately to reduce internal
bleeding and pressure.
•Apply sterile gauze over a cut near
the eye to absorb blood. Never
apply direct pressure near the eye
to stop bleeding.
•Because the student’s eyesight is
at risk, always have eye cuts and
bruises looked at by a medical
professional.
If a student complains of stinging, tearing, and un uncomfortable sensation of
“something” being in the eye, she may have an irritant such as dirt or lint in
her eye. Do not let the student rub her eyes. This may push the irritant
under the eyeball. You will have to examine the eye to find out what the
problem is.
The irritant may not be visible, so
you will have to look for it:
•Have the student look all around
as you examine the eye. Look
inside the lower eyelid by having
her look up as you pull down the
lid.
•Flush out the object with water or
lift it off with a clean cloth.
Cuts
Most people are very disturbed by the sight
of their own blood. Be extra gentle and
reassuring so the victim will calm down and
let you help. Whether the victim has a
minor cut or a deep cut that bleeds
profusely, direct pressure and elevation of
the injury should quickly control bleeding.
•
•
•
•
•
•
•
Locate the source of the wound.
Place a thick, sterile gauze pad or a
clean absorbent material on it and
press with your whole hand.
If it’s a gaping wound, try to close the
sides of the cut together as you press.
Although it may be a little painful,
direct pressure will stop most
bleeding within 15 minutes.
It’s important not to remove bloodsoaked material because this can
disrupt any blood clots that have
already formed.
If a cut continues to bleed, just add
additional gauze or cloth on top of the
original material and continue to
apply pressure.
If bleeding is heavy, raise the injury
above the level of the heart while
continuing to apply direct pressure.
Elevating the injury will help slow
blood flow to the cut.
If bleeding occurs because an object is
actually impaled in someone’s skin,
control the bleeding carefully.
•
•
Don’t pull the embedded object out.
This will only cause heavier bleeding.
Apply light indirect pressure around
the object to control bleeding.
Dental Emergencies
Toothache:
Cavities and infections often
cause toothaches. Home
treatment offers only temporary
relief from pain but is often
helpful if a toothache occurs in
the middle of the night or before
you can seek professional
attention. A trip to the dentist is
necessary to find the exact cause
of a toothache and to treat it
effectively.
What to do:
1. Give the victim aspirin,
acetaminophen, or
ibuprofen. Aspirin should be
swallowed and not applied
directly to the affected areas.
2. Place cold compresses or ice
packs on the face over the
affected area. For some
victims, warm compresses
may be more comforting.
This varies for each
individual.
3. Seek dental attention.
Knocked-Out Tooth (Avulsed
Tooth):
What to do:
1. Treat for bleeding.
2. Wrap the tooth in a cool wet
cloth or place it in whole milk
(not skim milk). Milk has
nutrients that will keep the
tooth alive. Do not put the
tooth in tap water. The
minerals in water may cause
further harm. Saline (salt)
water may be used, however.
Take the victim and the tooth
to the dentist or hospital
emergency room as soon as
possible.
Broken Bones
It’s often difficult to tell whether an injury is a fracture,
dislocation, sprain, or strain. These injuries can all display a
range of similar symptoms—pain, swelling, deformity, and
loss of motion. Remember, broken bones don’t always
break through the skin or even show evidence of deformity.
As a general rule, if you have any suspicion that a bone
might be broken, assume it is and get medical help.
•Do not move the student. Send someone to tell the nurse
what happened. The nurse will come to the student to put
the splint on.
•Keep the student sitting where you found her.
•Gently hold or have the student hold the injured limb in
the position where the student feels most comfortable.
Immobilizing the injury will keep any possible bone
fragments from moving, worsening the break and painfully
piercing the skin around it.
Dislocations
A dislocation occurs when the end of a bone is displaced from its
joint. It usually results from a fall or a blow to the bone. Common
areas of dislocations include the shoulder, hip, elbow, fingers, thumb,
and kneecap.
Symptoms
Any or all of the following may be present:
Swelling
Deformity at the joint.
Pain upon attempting to move the injured part or inability to move
the part.
Discoloration of the skin around the area of the injury.
Tenderness upon touching the area.
What to Do:
1.
2.
3.
4.
DO NOT try to put a dislocated bone back into its place.
Unskilled handling can cause extensive damage to nerves and
blood vessels. The bone may also be fractured and any
movement may cause further tissue damage.
Place the victim in a comfortable position.
Immobilize the injured part with a splint, pillow, or sling, in the
position in which it was found.
Seek medical attention promptly, preferably at the nearest
hospital emergency room.
Pulled Muscles
While pulled muscles don’t pose any real emergency, they should not
be overlooked. If pulled muscles aren’t allowed to fully heal, they can
easily be re-injured and linger on as recurring pain. A pulled muscle
should be allowed at least 24 hours to heal. Be lenient with students
who have pulled muscles. Allow them to sit out of activities until their
injury has healed and is no longer painful.
When a student injures a muscle, apply a cold pack at once:
•First, wrap an elastic bandage around
the injury. The compression created by
the bandage slows internal bleeding
and swelling.
•Second, place a cold pack on the
bandage. Since you should never put
ice directly on bare skin, this bandage
makes a good foundation on which to
place the cold pack.
•Third, put a second layer of bandage
around the cold pack to hold it in place.
•And last, slightly elevate the injury.
•Advise the student to reapply the cold
pack for at least ten minutes every
three to four hours for the next 24
hours.
Heat Exhaustion
Heat exhaustion happens on hot, humid
days, especially during exercise. It is
brought on by heavy sweating and a
substantial loss of body fluids. The
body’s temperature regulators are
overwhelmed and the victim’s
temperature can skyrocket above safe
levels. Symptoms are dizziness, nausea,
extreme thirst, headache and cool,
moist skin or hot, red skin. Heat
exhaustion needs to be cared for
promptly before it leads to lifethreatening heat stroke.
If you notice any signs of heat
exhaustion in your students:
Get the student out of the sun into a
cooler place.
Cool him by applying wet towels to
his skin and fanning him.
Replenish his liquids slowly by giving
him a half a glass of water every 15
minutes.
Children are especially susceptible to
heat exhaustion and can go from
feeling fine to sudden collapse. When
your students play or exercise outside
on hot days, monitor them to make
sure they don’t overexert themselves.
Insist that they take frequent breaks.
Chemical Burns
When a person’s skin is exposed to a chemical, you must act fast. To halt the
chemical’s burning effects, immediately flush the affected area under cool,
running water.
•A chemical can continue to burn
long after its initial contact with the
skin as it reacts to different skin
layers, so a burn must be flushed for
at least 15 minutes.
•Have the person remove any
jewelry or clothing covered with
chemicals after a few minutes of
initial flushing.
•As you provide first aid, take care to
avoid being contaminated by the
chemical.
The eyes are even more sensitive to chemicals than the skin. Immediately
begin flushing the eye under running water for 15 minutes.
•Do not let the victim rub his eyes.
•Be sure the student holds his or her
eyelids open.
•If the student wears contact lenses,
do not attempt to take them out.
Flush the eye with the lenses in.
•Protect the other eye from being
contaminated by tilting the victim’s
head so that the affected eye is down
when rinsed.
Head, Neck, and Back Injuries
Head, neck, and back injuries are serious. Sudden blows to these areas
can cause spinal cord damage, resulting in a loss of sensation and function
in the parts of the body below the site of the injury. If a student falls from
a considerable height or is struck hard by an object in the head, neck, or
back and is lying on the ground, he may have a spinal injury. To be safe,
treat him this way:
•Do not move him. Do not try to make him more comfortable and do not
pick him up. Keep him in the exact position you found him. One wrong
move, even a slight jostling, can further damage nerves, resulting in
paralysis.
•Tell the student not to move. To help him stay still, put your hands on
either side of his head and hold his head as you found it. Immobilizing his
spine in this way is your number-one priority until medical help arrives.
•Keep the other students at a distance to protect him from movement
and activity.
If a child is up and running immediately after getting a serious bump on
the head, spinal injury is probably not a concern. But internal bleeding in
the skull may be. The student should be closely watched for the next 24
hours since symptoms of head injury can sometimes be delayed. Notify
the administration or school nurse, as well as the student’s parent of the
injury.
Choking
Abdominal Thrust
The abdominal thrust is the method of choice to use in an emergency situation
when a person is choking. Back blows—hitting the victim forcefully and repeatedly
between the should blades with the palm of your hand—are used on adults and
children only if the abdominal thrust has not been effective in dislodging a foreign
object from the windpipe (trachea).
Symptoms
1.
2.
3.
4.
The victim begins gasping or breathing noisily.
The victim grasps his or her throat.
The victim is unable to talk.
The victim has difficulty in breathing and begins coughing;
breathing may stop.
5. The skin becomes pale, white, gray, or blue.
6. The victim looks or acts panicked.
7. Unconsciousness eventually develops.
The Universal Choking Sign
A person who is choking will involuntarily grasp his or her neck.
For an Adult or a Child:
Immediate Treatment
If the Victim Is Conscious:
1. If the victim can speak, cough, or breathe (meaning that he or
she is moving air through the airway), do not interfere in any way
with his or her efforts to cough out a swallowed or partially
swallowed object.
Choking continued…
2.
If the victim cannot breathe, stand behind him or her and place your fist with the
thumb side against the victim’s stomach slightly above the navel and below the
ribs and breastbone. Hold your fist with your other hand and give 4 quick, forceful
upward thrusts. This maneuver increases pressure in the abdomen, which pushed
up the diaphragm. This, in turn, increases the air pressure in the lungs and will
often force out the object from the windpipe.
Do not squeeze on the ribs with your arms. Just use your fist in the abdomen. It
may be necessary to repeat the abdominal thrusts 6 to 10 times.
A
B
A. Correct placement of the fist, with the thumb side against the victim’s
stomach slightly above the navel and below the ribs and breastbone.
B. If the victim is standing or sitting, stand behind the victim with your arms
around his or her waist. Place your fist as shown in the illustration. Hold
your fist with your other hand and give 4 quick, forceful upward thrusts.
3.
If the victim is lying down, turn the victim on his or her back. Straddle the victim
and put the heel of your hand on the victim’s stomach, slightly above the navel
and below the ribs. Put your free hand on top of your other hand to provide
additional force. Keep your elbows straight. Give 4 quick, forceful downward and
forward thrusts toward the head in an attempt to dislodge the object. Doing so
will increase pressure in the abdomen, forcing pressure into the lungs to expel the
object out of the windpipe and into the mouth.
It may be necessary to repeat the procedure 6 to 10 times.
4.
If you get no results, repeat the abdominal thrusts until the victim coughs up the
object or becomes unconscious. Look to see if the object appears in the victim’s
mouth or the top of the throat. Use your fingers to pull the object out.
Choking continued…
Abdominal thrusts on a Victim Lying Down
Straddle the victim and put the heel of your hand on the
victim’s stomach, slightly above the navel and below the
ribs. Put your free hand on top of your other hand. Keep
your elbows straight. Give 4 quick, forceful downward
and forward thrusts toward the head.
If the Victim is Unconscious or Becomes Unconscious
1.
Place the victim on his or her back on a rigid surface, such as the ground.
2.
Open the victim’s airway by extending the head backward. To do this,
place the palm of your hand on the victim’s forehead and the fingers of
your other hand under the bony part of the chin. Attempt to restore
breathing with mouth-to-mouth resuscitation.
3.
If still unsuccessful, and with the victim on his or her back, begin the
abdominal thrusts by putting the heel of one hand on the victim’s
stomach slightly above the navel and below the ribs. Put your free hand
on top of your other hand to provide additional force. Keep your elbows
straight. Give 4 quick, forceful downward and forward thrusts toward the
head.
If these procedures fail, grasp the victim’s lower jaw and tongue with one
hand and lift up to remove the tongue from the back of the throat. Place
the index finger of the other hand inside the victim’s mouth alongside the
cheek. Slide your fingers down into the throat to the base of the victim’s
tongue.
Carefully sweep your fingers along the back of the throat to dislodge the
object. Bring your fingers out along the inside of the other cheek. Be
careful not to push the object farther down the victim’s throat. If a
foreign body comes within reach, grasp and remove it. DO NOT attempt
to remove the foreign object with any type of instrument or forceps
unless you are trained to do so.
4.
5.
Repeat all of the above steps until the object is dislodged or medical
assistance arrives. Do not give up!