Posted on 09/16/2006 9:25:30 PM PDT by 60Gunner
Also it is not uncommon for women having a heart attack to have NONE of these classic symptoms.
As plays out in the dark-comedy film Hospital.
IIRC, CT and Nuclear Medicine VQ scans can identify PEs. Ultrasound can look for possible source of clots (in legs most often, and arms - aka DVT) that can break loose and lodge in pulmonary vessels to cause PE.
I spent 5 years working in a hospital and more than enough ER time with accidents and illnesses.
That's where I learned my healthy distrust of doctors.
HAHAHAHA,,,Cajun,,,Means "Party" literally
Also means a pig roast,,
lol! Thanks bud! ;-)
So sorry about your brother.
I'd like to make several observations (RN for 17 years):
1. Our ED's are over-crowded because of several reasons; illegals using them for primary care, those without a PCP using them for primary care, people INAPPROPRIATELY using ED's for non-emergent non-traumatic problems (sore throat, cold, sinus infection), and lack of financial motive for those on Medicaid to use the PCP office rather than the ED(while an HMO patient gets whacked a $75-100 copay or more, Medicaid patients don't; who do you think is more likely to visit an ED?).
2. We don't know the facts here, although it does appear that the staff were negligent. We only know what we are told; did the patient truly come in c/o chest pain and SOB? Everything is not always as it seems; I've seen it happen several times during my career.
3. I'm no lawyer, but I doubt that this is homicide; manslaughter maybe, but not intentional murder.
Finally, as an ED nurse, you'll appreciate this one: I once worked with a Pediatric Emergency Medicine physician; her pet peeve was when you called it an "Emergency ROOM"; "it's a department, not a room".
Perhaps, though ER brings to mind the proper image; ED brings to mind something else.
Actually, in my ER at least, we are pretty good at sifting through the bogus stuff and the non-emergent stuff. Vital signs and labs do not lie. If a person complains of chest pain, as a rule they are seen first, for obvious reasons. But when a heart attack has been conclusively ruled out (and not just by a 12-lead EKG), the patient's acuity is downgraded, and they are moved aside into a lower-acuity bed in order to clear room for a more serious case.
Now here is the simple reality about the reasons you might wait, straight from an ER nurse:
1. We can only go as fast as the number of available beds allows. You may not know this, but state-of-the-art emergency rooms happen to be just a skosh expensive to build and equip, and they also take a little time to build. My bedroom-community ER is operating at over 200% capacity because of the massive exodus of people out of the metro area. On a positive note, we are getting a new ER with twice the capacity of our present ER and with a better patient flow design. But that means that when it opens, we will start at 100% capacity. Why did we not build a bigger ER when we knew this? Behold, the simple economics of public funding: The taxpayers demand we build a new ER, but they'll be damned if they spend one dime for it. We can only build what we can afford. Sorry about that.
2. I don't give a damn if a person is from Mexico, China, Haiti, Canada, Pakistan, or Lower Slobovia. I don't care if they are legal or not. I know full well how much it costs to provide healthcare to people who won't pay for it. It pisses me off too. But if they are sicker than you, they get in first. Sorry about that. Does treating illegals make things more expensive for us? Yes, it does. But they are also human beings. That takes precedence over legal status when a person is blue and pulseless. Turning deathly ill persons away because they are of questionable legal status or uninsured ain't in my job description, pal. And think about it: would you want to face me in triage if it was?
3. People using the ER as a family clinic is not a practice exclusive to the uninsured or to Mexican immigrants. More caucasian, English-speaking, insured families follow that practice in my ER than any other demographic. Why? Because they seem to think that if they come to an ER with a toothache or a head cold, they will be seen sooner. After all, we're an ER- right? We must assume that anyone who comes into an ER must certainly have a real emergency- right? Wrong. Take your headcold to the local drug store, buy some Nyquil, some Vick's Vapor Rub, some saline nose spray, and some chicken soup and deal with it. Don't clutter my ER if you aren't bleeding, puking your everlovin' guts out, convulsing, febrile over 102 degrees, or if you don't have a bone sticking out, don't have a kidney stone that feels like it's the size of a cinder block, have not been in a car accident or have not been or are not now blue and pulseless. Those are emergencies. Your ingrown toenail is not. Sorry about that. And no, I will not look at your little Jimmy's splinter or your mother's corns since they are in the room with you anyway. They'll have to go through triage just like everyone else. You can find family price packages at the Ballpark, not in my ER.
4. I am a highly trained medical professional with years of state-of-the-art education (graduated Magna cum Laude) and further years of ER nursing experience behind me. When you come into my ER, you will get the best I have to give, no exceptions. So please do not come sauntering into my ER and tell me you are having a stroke, a heart attack , or kidney stones. I ruled all three of those out when I watched you get out of your car and walk briskly the 100 yards between your car and my door smoking that cigarette and putting it out in the faux-marble birdbath that I put out there with my own frigging money. I ain't buying what you're selling. Sorry about that.
5. I try to get you in as fast as I can. I really do. Sometimes things happen that make you wait a little longer- a five-car pileup on the interstate; a barbecue explosion; a father of three whose heart has the gall to stop beating while he is playing ball with his kids; a pregnant woman who starts hemorrhaging and goes through six pads in a half hour. If those come through my door, you may have to wait a while longer. Please do not stomp up to the triage station and ask me if I know just how g*dda*mned long you have been waiting. I know how long you have been waiting. I wrote down the time you came in. And when I apologize and tell you that you will have to wait just a little longer, please do not call me whatever filthy name strikes your fancy. Please do not threaten to wait for me outside the ER and beat me to death with a tire iron or cut my throat when I leave. It's been done. Believe me, pal- I have heard them all, even from upper middle-class people who speak marvelous English. I really do care. I wish I could get you in faster, but I can't. On that note:
6. If you can stomp up to my triage station after two or more hours of waiting and be loud and belligerent, then I can instantly deduce that you have the lung capacity and the cardiac capacity to keep that brain of yours perfused for a little while longer. I keep an eye on my triage patients, and I make a point of coming out to the waiting area and checking on folks who have to wait, just to let them know I have not forgotten about them and to recheck a blood pressure or temperature or two. In my ER, if you are really sick, you can bet your ass I will move heaven and earth to get you in. It's like that in almost every other ER in this country. Not all, unfortunately, but nearly all. But you don't hear about those. You only hear about the bad ones. They are not all bad. Most are pretty damn good. I know- I have been a customer in more than one of them.
7. I have studied in hospitals from Canada to Taiwan and have researched healthcare systems in dozens of countries. And I can tell you that all this talk about socialized medicine being superior to American healthcare is by and large a trainload of horsefeathers. They are most certainly not any better than what we have to offer. And the wait is at least as long. There are exceptions, but that's all they are. American healthcare is flawed, but I'd still take my kid to an American hospital first.
I mean no disrespect to anyone when I say this, but it must be said because it is the absolute bottom line, and there is no getting around it: If you want bigger, better, faster, sexier hospitals, then you will have to accept the unsavory fact that you are going to have to pay for them. Ours is a consumer-driven society, and our healthcare reflects that. If you expect Bugatti quality for the price of a Yugo, you are going to be very, very disappointed. That may not be palatable, but it is the truth. Sorry about that.
Look, my dear friend: all of those tests are unnecessary. A simple lung auscultation and chest CT is all it takes to figure out if a patient has a PE. Well, okay... that and a blue, gasping patient in the characteristic "tripod" position. Either way, it's cheaper and faster. Lawsuits pushed by jackpot-seeking trial lawyers are why you have to get all those unnecessary and very expensive tests. Thank you, John Edwards.
LOL! Actually, she formed this pet peeve BEFORE Bob Dole did his commercials.
The truth is very few healthcare professionals can actually afford either healthcare or medical insurance.
I doubt that is true.
So what do you think of the value of the heart scans they have as a preventative measure?
Why can't an ER turn away non-emergencies? After all, the title is EMERGENCY room, not athlete's foot room.
I feel your pain, literally.
A few years back, Xena's Guy had to tote me to the nearest ER for a kidney stone, and I waited four hours to be seen, behind kids with sniffles (whose entire families, incidentally, were there with them).
I finally told the receptionist that if they didn't give me something for pain, I was gonna throw up all over her and start screaming.
That worked, I'm ashamed to say.
Your threat was mild compared to the one I made a decade ago during my first stone: I told the doctor there were two available choices: 1) he could order immediate pain relief, or 2) I'd go to the drug room and take it myself.
Mine worked too. :-)
MM
That said, it seems to me that if you know that a family history of heart disorders exists, the best thing to do is simply take steps to reduce your own risk. Eat well, exercise regularly, monitor your blood pressure and cholesterol, etc.
In all honesty, I don't know what value a heart scan would be as far as prevention is concerned. It may detect problems that are already present, but by then it's a bit late to prevent, isn't it? What information do you have about heart scans? Can you point me to some sources that I can read up on, since you now have my curiosity up?
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