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.
Also, thanks for the work you do. It must be exhausting, both physically and mentally.
Let the reader be advised that women do not always present with the classic signs and symptoms of a heart attack as do men. If it's above the ribcage, ladies, get out here!
Still, Torsades is nothing to take lightly since it can turn into V-fib in a hurry. But you are managing well? Tell me more!
Thanks!
Thanks for the info!
You passin dat gravy or not?
You mean above the bottom of the ribcage (within it) or up by the shoulders?
Not necessarily. Nausea is nausea. Everyone knows what that feels like. The actual barfing does not have to occur. If it does, it is called nausea/vomiting. Does that make sense? It does to me, but I work with it every day.
Thank you.
FO'SHO,,,Catch,,LOL;0)
Ya' OK ?
Let me ask for your professional opinion about this. There is a hospital in my area that shall remain nameless which has a reputation for slowness in the ER, regardless of your condition.
I fell down the steps about two weeks ago and banged my head on about five steps, hurt my neck, shoulder, elbow, and hand, but the worst was what I thought was a broken ankle.
After a two-and-a-half hour wait, I had my Mom wheel me out and take me to a hospital with a better reputation that got me right in.
The lady next to me had been there for five hours without being seen...she was an elderly accident victim. In the meantime, patients with no visible symptoms who walked in on their own power and were laughing and drinking coffee were being called in before those who seemed to need the help more.
As Mom was wheeling me out, one of the nurses came out and offered a wholehearted apology -- "I'm so sorry," she said. "It's these d$#@ people who come in here and treat the ER like a doctor's office."
What gives? Is that poor management, or are some people "entitled" to immediate healthcare because of their lack of insurance? If it's such a problem, why take them before someone that you have to apologize to for suffering from it?
Thanks. I have had three separate "events" and have not been treated. I'm not a person who vomits, but I definitely felt nauseous - as if I could've thrown up if I had tried.
That's why I asked. I won't go to a hospital as I have not a dime to my name and have no insurance. Was healthy as a horse until I went through some extreme stress for an extended period of time, then developed asthma symptoms.
I once had an anxiety attack in my mid-30s that had all the symptoms of a classic heart attack. My doc just told me to take 2 aspirin and keep taking them for every 6 hours for 2-3 days, so it would calm the tightened chest muscles. I did, and I was fine.
These others were just like that and that's what I did. Thanks for the info on nausea.
Is it possible that since she was classified semi-emergent that there were enough classified as emergent, and therefore first in line, that that much time passed even if everyone was doing their job? She seems a victim of misclassification but we don't know the seriousness nor number of other cases at that particular time.
No offense to the dear reader, but if you come to the ER, please express the same urgency in stating your complaint as you felt when you decided to come out here. You may find yourself back in a treatment room a lot faster that way.
What was that movie with George C. Scott and Diana Rigg? Hospital?
"They decided it was nothing serious, released her, and she dropped dead in the parking lot on her way out. The point is...women don't always have obvious symptoms. "
===
But doctors should know that and not ignore the symptoms.
What I have typed is commentary on the linked article. Did I goof?
I am not a doctor. I am a nurse.
"bump" or btt ("bump to the top") means that the poster may not have something to add, or doesn't want to or have time to add a comment, but by adding a "bump", keeps the thread alive and indicates their approval that it's a worthwhile thread.
Threads stay active based on the number and frequency of the posts, so adding a post with just "bump", still counts as a post and helps the thread stay active.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.