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.
The first, my husband (35 at the time). He was having chest pains off and on all day...I had no idea. Finally at about 8:00 P.M. he told me he thought he needed to go to the hospital. Trust me, when HE said it I took it seriously....he has major hospital-aversion!
The E.R. also took it seriously (it was packed at the time). He no more than told them his symptoms and he had monitors slapped on his chest; a chest X-ray; and other tests. Fortunately, it turned out to be digestive-related.
OTOH, a school friend who actually has a disease that can cause imbalance in electrolytes went to the E.R. and told them: "I am having a heart attack."
They sent him home. He stubbornly went BACK, only to code right in front of them. He was unresponsive for 15 minutes; but miraculously woke up and is fine except for some slight kidney damage.
Amazing the difference in care depending on who you first see. I've always said "Someone had to graduate last in their med school class!"
One other thing, for those who may be reading this thread. Even if you are young, heart problems can be caused by a WIDE variety of things.
We had another family friend (early 30's) whose heart stopped because of an antibiotic allergy...which had never reared its ugly head prior to the near-fatal attack. Fortunately, an alert family friend had noticed the shock symptoms, threw him into the car, and rushed to the hospital...he was there when it happened.
Thanks. They do. It's not an option for me.
Why is it not an option?
LOL,,,Weather,,,Down in the 60's at night,,And I can go outside in the day,,;0)
LOL! My husband had spent the morning cooking a big family dinner. About midway through, he told me he thought he was having an appendicitis attack. Now, the only reason he thought so was because he was having "some" pain in the correct area to be his appendix. The pain was getting worse, but it still wasn't too bad. So, he went to the ER.
The docs weren't quite sure what to do with him. He really didn't seem to be having enough pain for it to be appendicitis (no fever, no nausea), but they decided that was what it was and then put him at the bottom of the surgery list because (I assume) he was the most comfortable. It took nearly 24 hours from the time he entered the ER until the surgery.
I wasn't at all surprised when the surgeon told me the appendix had nearly burst. My husband insisted that he wasn't being stoic. He just never really felt THAT bad.
<< The nursing staff should be charged with depraved indifference to human life and whatever other charges can be filed here. This should have received their immediate attention. >>
While, simultaneously, the entire United states congress should be charged with the depraved indifference to Civilized Human life it demonstrated with the passage of every act that ever incited a single inassimilable legal third world and/or hostilely-colonizing third world criminal alien to migrate to America and to then clutter up our emergency rooms. And that it demonstrates on a daily basis by permitting those here to remain and millions more, every year, to continue to pour in!
And whatever other charges can be filed.
It's just not. I will not sign over my remaining assets, which are keeping me alive, to the county.
Here is a more detailed article about it:
Coroner says patient's death is a homicide
http://www.chicagotribune.com/news/local/chicago/chi-0609150317sep15,1,1209480.story?coll=chi-newslocalchicago-hed
We're *almost there* here in the Big H - but not quite. Daytime 90s still. Humidity is the thing that keeps me from breathing, so I'm not out there in it. Dry high *coming* - so they keep saying!
The daughter DID try:
"As they waited, Monique Vance told Barrett, she twice asked nurses when her mother would see a doctor. The first time she asked, a nurse said her mother was next on the list to be called, Barrett said. The second time, a nurse told her that two ambulances had just arrived with more urgent cases.
"She said she was half-tempted to call 911 from the hospital just to get her mom back there," Barrett testified."
I heard that,,the Fall Bloom has got me sneezin',,;0)
Freepers in Waukegan, I suggest you avoid that Hospital!
CODs are generally either natural causes, accidental death, homicide, suicide, or undetermined. Within the general categories, there are other subsets.
What experience do you have with pulmonary thrombosis? It's been ages since I've looked up anything about it on-line, but back in 1999 I read that it was a very commonly-missed diagnosis. In at least one case I know of (late wife), progressive blood obstructions from blood clots were misdiagnosed as pneumonia. I would think that a lung-capacity test should have indicated that something other than pneumonia was at work (since it would show normal, despite patient's shortness of breath). Do you know what's being done in that area?
It's usually my best breathing time, all the way until spring. It's just not fall yet, drat.
Yep,,We got lots of mess bloomin' now,,Be glad to see a Frost,,;0)
Be sure to document those reports to the docs thoroughly, so if you do end up having a heart attack either you or your survivors (and some slimeball lawyer) will become very wealthy.
I'm sorry to hear this. This is terrible health care - your doctor should have run some tests to be sure you have no problems.
I had a reaction to some medication that made me think I was having a heart attack. I had to leave a business lunch and be taken to the hospital ER. Earlier this year I had an EKG and the big stress test thing w/the pictures just to make sure everything was ok (since 2 EKGs had been normal, but I was still feeling weird).
I am a student in my 50s, and even going to the little student health care, as soon as you say 'heart' they rush you right in for testing.
Please try to find another doctor who will listen to you. I don't care what male FReepers think, there is sexism in the medical profession and many women do not get the care they need. In addition, many women will suffer in silence until it is too late. I lost a co-worker this way, and have a cousin who suffers greatly from the results of a stroke. Had she acted on her physical complaints, I doubt she'd be in the state she's in now. If you think you have a problem, go find another doc.
I just wanted to say thank you for this thread.
We'll be lucky to have one - not sure we did last year. I know we did year before - the Christmas "snow." It might be 3-4 winters in a row we go without one.
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