Posted on 09/16/2006 9:25:30 PM PDT by 60Gunner
Being an ER nurse, I tend to fasten my attention onto cases such as this one.
According the the AP story, a 49-year-old woman came into the ER complaining of chest pain, nausea, and shortness of breath. (Okay, all you nurses out there: pipe down and let the laypersons catch up.) She is triaged, classified "semi-emergent," and instructed to wait for her name to be called. Two hours later, when the woman's turn to be seen had arrived and her name was called by the triage nurse, the woman did not respond, The nurse approached the woman and found her unresponsive and pulseless. (That's medical-ese for "dead.")
The ensuing coroner's inquest ruled the woman's death a homicide. No details are available at this time regarding exactly who is to be charged with this woman's death.
Here is my view of the matter.
At the emergency department in which I am employed, there is a simple standard of practice that governs the treatment of any person who complains of chest pain, shortness of breath, and nausea, whether the person is 18 or 90 years old, and it is as follows: Treat it as a heart attack. That means get them into a treatment room, Give them oxygen, stick a large-bore (20 gauge or larger) IV needle into them (two would be better), draw labs including troponin I (a marker for cardiac injury), slap cardiac monitor leads onto them and perform a 12-lead electrocardiogram. If their blood pressure is stable, we may also give a spray of sublingual nitroglycerine and four baby aspirin.
(One may say that 18 years old is a bit young to be having a heart attack, and it is. But it happens; not very often, mind you, but just often enough to cause us to keep our guard up. So we don't take any chances.)
The rationale for all of these drastic measures (all of which occur within minutes of admission) is that if we act on the assumption of the worst-case, we will already be ahead of the curve. We can always back off on treatment strategies if it turns out to be something other than cardiac-related. But if it turns out to be a heart attack, then time is of the essence. And if the ER staff was caught flatfooted, the patient can die and the staff can be in a lot of trouble, as is the case with this Illinois ER.
Now, I was obviously not there to see all that went on in this woman's case, and therefore I will not point fingers. But I suspect that the error occurred because of an inexperienced triage nurse. On the other hand, triage nurses as a rule have to be experienced nurses before given that duty, in order to avoid this kind of tragedy. I think that in such a case, the only thing that could throw off the triage nurse's assessment would be whether or not the patient drove herself (or was driven by a friend or loved one) versus calling 911 and being transported by ambulance. Even then, given the victim's symptomology and the fact that she showed up in an ER, I am having a very hard time giving this staff the benefit of the doubt.
The moral of this story for the nurses who read this is: chest pain + shortness of breath + nausea = heart attack until proven otherwise.
And the moral of the story for my non-nursing readers out there is: chest pain + shortness of breath + nausea = heart attack until proven otherwise. So if you have these symptoms, don't be stupid. Do not drive yourself to the hospital or even ask a friend or loved one to do it. Call 911 and sit tight. You will get there faster, and you'll be taken a lot more seriously than if you were to walk in under your own power like so many frequent flyers with anxiety attacks do. We are skilled and trained, but you have to help us out here.
Somebody in that Illinois ER is going to pay with his/her license and maybe even some jail time before this is over. The hospital will likely be out millions of dollars. I can't really defend that, and I won't even try. In my heart of hearts, I know that there is no excuse for allowing a patient who may be having a heart attack to sit for two hours when an EKG and labs can be done on a stretcher in the ER hallway in five minutes and the patient can at least be monitored.
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." -Manuel II Paleologus
Hey Freepers, if you ever go to the ER with a real emergency situation, either pass out in front of the reception desk, tell them you're on Medicaid or an illegal alien so you can get some service.
Excellent post, wish there were more like you.
Correction to my headline: "Room." I don't know how spellcheck missed that. Sheesh. Sorry, folks.
Yea I know about this. It happened in Chicago. Give the family the expected $900,000,000 and forget about it.
A few years ago, I went to the ER with chest pains. They treated me ASAP. Turns out my heart was/is great, but I had a gallbladder attack of the highest order. They took it out on the same visit. Sure glad I didn't have socialized medicine like Canada, UK.
Exactly my thoughts on the matter.
Good post and everything you said is right on.
This cannot be emphasized enough. Wednesday night my brother experienced this and called his girlfriend to get him some Tums. He refused to let her call an ambulance. A short time later he was DOA in the emergency room.
I had the same experience 10 years ago, when I was 33. As my Dad had died of a heart attack at 40, I was a bit freaked out. But my outcome was the same as yours. Gallbladder.
Worth repeating 100 times. I had these symptoms at work a few years back (age 39), decided to go to the emergency room down the street. 10 minutes later I'm having an angioplasty. Better safe than sorry is what I say. :)
Thanks for your post. Sad for those touched by this situation, but you maybe have saved a life here, could even be that of a looney lib that's lurking!
FR folks listen up.It feels like someone is leaning on your chest.You can't get comfortable, arm shoulder pain....
Happened to me 3 years ago and I was 36. I am a EMT ( emergency medical technition) so I knew the symptoms. I will say I still walked around denying it for 10 min. before I called 911. Screw embarrassment, when I called I knew who would be coming to my house! This is not a time to be prideful just call and let them take you.
I will tell you why, the faster you get in the less damage you will have. I went in on a monday, had a stint put in wednesday out thursday and went camping in yosemite on saturday. No joke. Cardiac medicine has changed so much in the last 20 years. If I decided to sleep it off most likely it would have been a funeral on saturday.
Dont be a prideful SOB, just call and if you are wrong everyone can be overjoyed... if you are right you will live to see another day, Lord willing.
Being in the medical field, I agree with your analysis, but I would rather think it "gross negligence". Doesn't homicide require some malicious intent beforehand?
I was only having palpitations one evening and being brought straight back in the ED immediately at the age of 38.
There is no excuse for what happened to that lady, the only other scenario I can think of is that she may have been a frequent flier in the ED , so they didn't take her complaints seriously. Still no excuse. You treat it as an MI unless the tests rule it out conclusively.
Doesn't this mean the Governments of France, UK and Canada should be tried for murder for all the poor folks who died waiting for medical treatment there?
Well, 308, normally if a person shows up complaining of chest pain and shortness of breath, they get a "get-into-the-ER-right-frigging-now" card. Insurance or legal status has nothing to do with it. EMTALA (Emergency Medical Treatment and Active Labor Act) requires ERs to assess and render emergent care to all comers regardless of condition or insurance status.
Feigning syncope (faked passing out) is likely to make a lot of very busy ER staff extremely unhappy with you, especially if there are a lot of genuinely sick people waiting to be seen. We get the "swooners" every now and then, and it's amazing how quickly their eyes snap open and they recover when they hear the words "Foley catheter" and "nasogastric tube" in connection with their name. It's a miracle, I tell you.
Not that I'd expect you to do such a thing, mind you- just that we have seen it all at least a thousand times before.
I still have a hard time understanding how this woman could present with those symptoms and be ignored. It just grates on my professional conscience.
DITTO that, with the exception of a trip to the doctors and a quicker trip to the hospital. Half hour later I was checked in.
This was pure negligence, and a sign of the times when our ERS are over filled with patients, mostly illegals to tell the truth. No excuse for this however.
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