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.
Is it true abotu the e-mail that says to cough hard?
Thanks for the post and especially the advice about 911 ... I would probably have insisted on being driven were I in that situation.
Have been to ER's more times than I care to remember with an asthmatic child .. only once did a triage nurse have us wait and by then I was so experienced, I ranted till we were seen. Immediately.
I work in 3 different emergency departments as a midlevel provider (P.A.) and am amazed at the number of people who get past the triage with symptoms that should SCREAM "Heart!!!!!!! and yet sit for a long time without the pretreatment that you apropriately detailed in your post. The youngest cardiac death (not congenital) I have seen was a 19 year old who came in with cocaine related angina and signed out against medical advice when we pointed out his ischemic changes on is ekg. He went out and did another line of coke and blew his myocardium out and DIED. And, Yes, I am sick to death of all the "FREE" CARE" WE ARE HANDING OUT TO ILLEGALS. I don't mind treating life threatening problems but recently saw a "Protocitizen" who waited in our ER for 3 hours so I could treat his ATHLETES FOOT!!!.
I would think so. But perhaps other circumstances surrounding the case led the coroner to be far more draconian. Maybe there were previous complaints or previous events. I don't know that much.
But the bottom line for every ER is chest pain + shortness of breath + nausea = heart attack until proven otherwise. I cannot tell you how many thousands of times that axiom has been driven into my brain. I don't know how or why this woman was blown off, but it killed her. And that is inexcusable in any ER.
The man was a smoker, so they disregarded his shortness of breath, and made him wait. He died.
The wife sued, and won. But no charges were filed.
Dear Varina, there are plenty more like me- I would dare say even better. The problem is that it only takes one negligent or malefecent nurse to muddy the whole profession. Nursing is the most trusted profession in America. We don't need sloppy, negligent, or calloused nurses. We need people who are totally committed to what they are doing and who they are doing it for. Altruism may be a thing of the past in many professions, but in nursing, it is, and will always be, a prerequisite.
OMG, that's horrible. Him being a smoker would make him an obvious candidate for an MI, I'd think.
Linn37, please allow me to give you my deepest condolensces for your loss. My heart goes out to you. I lost my mom to heart disease. It's awful.
You will have a 12 lead EKG attached to you and you'll walk, then hopefully jog on a treadmill. The speed and incline will increase every three minutes. A doctor and a nurse will be at your side the entire time.
Yes, it's extremely safe test. They always have a defibrillator on hand and someone is usually behind you to catch you, so the risk is extremely, extremely, extremely small.
Dumpster baby, I am sorry for your loss. There are no words to express that clearly enough. Your testimony bears that much more weight. Tell everybody you can!
He had always smoked, so the doc treated him for emphysema, while the nurse thought something was going on with his heart.
The doc wouldn't listen to the nurse. My Gpa died on the bathroom floor of the hospital.
Turns out he had a congenital defect in his heart that could have been fixed if they had found it.
Heh...I remember getting to the hospital and tellin 'em I was having a heart attack. They gave me that "oh sure" look and made me walk to the wheelchair which would take me to the exam room. They hooked me up, checked me out and said, "Well - clinically, you're having a heart attack". I responded with my usual, "No shit!".
About 3 minutes later I flatlined. But they got me back. Man - did I give 'em a scare...heh heh...haven't smoked since...:-)
Or if the patient is a baby with a high fever.
I can appreciate your comments. 20 plus years as a cardiovascular physiologist. It was September 16, 2003 I experienced those symptoms...first there was there denial. I know for a fact that if a cold Dr. Pepper doesn't relieve the symptoms get your butt to the ER. Within 2 minutes upon my arrival to the ER I had IV's going, ECG done, nitro onboard, 30mg morphine administered, first dose of the clot buster administered and a cardiologist at my bedside. Within 50 minutes I was at Baylor Medical Center in Dallas in the cath lab. 5 hours later I was the proud owner of 67mm of stents (97% occulsion of the RCA) and a new outlook on life. This coming Friday I'm scheduled for another PTCA and additional stents. I experienced chest pains recently and decided not to screw around this time.
Unfortunately many doctors still don't take symptoms that could be indicative of a heart attack seriously.
There are several posts in this thread, that relate such experiences:
Early Symptoms Can Warn of Sudden Cardiac Death
http://www.freerepublic.com/focus/f-news/1698367/posts
If you are having intermittent symptoms, it may be worthwile to have a cardiac workup. It's your heart- it's your life.
Heck, I went to the ER one day because I thought I had torn a muscle in my left shoulder working out in the yard. I was 39 back then. They had me back in a treatment room and gave me an EKG within five minutes of my walking through the door. (I made up my mind then and there that I wanted to work in an ER like that. Now I am working in that same ER.)
As it turns out, I did indeed tear a muscle in my left shoulder. But it sure had me thinking...
Yikes! Are you okay now? I've seen that before, and it's scary as all getout.
Interesting stuff. Just out of curiousity, how would you describe "shortness of breath" as related to a possible cardiac event V.S. "out of breath" as related to overweight and out of shape, or even someone who is reasonably fit and just ran a mile, and has to "catch their breath"? I've experienced both. The first from a pericardial effusion, which was sucessfully treated, and the latter from time to time from physical exertion beyond the limit we are normally used to.
What words would medical professionals use to describe the difference between the two? (And yes, I do have a reason for asking).
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