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.
This nurse losing her license is probably warranted. Facing criminal charges is absurd. There is no evidence of any malicious intent; unless you've never made a serious mistake in your job, I wouldn't throw the first stone. Maybe the nurse misunderstood her symptom descriptions, maybe she just made a big mistake and should lose her license and be held civilly liable. But the moment you start throwing medical professionals in jail for messing up (even for serious mistakes) you're going to radically change the health care system and you won't like how it ends up.
BTTT
Thank you for the info. I am really quite new to this aspect of posting. Let me know if I goof!
Hopefully one person will read this and say screw it Im calling it in. People should not die because of poor self inflicted decision.
Your question requires a much more involved answer than I can give right now. I will post a more thorough answer tomorrow evening. I have to hit the sack- I am working tomorrow!
Okay, guys. I have to hit the sack. I'm on tomorrow! Take care of yourselves!
Doin jes fine now. You?
Thank you!
I am alive today after a full scale cardiac arrest in 1999
My thanks and prayers to ambulance people, paramedics, ER folks , Doctors and all the support folks
Thank you all so much
Actually, I should add that I'm kind of surprised at people's experiences at not getting enzymes run. Around here most of the ED providers are paranoid about malpractice and will run enzymes on you at the drop of a hat so as not to get sued that .1% of the time it was a MI with nonstandard presentation. It's all about defensive medicine.
Four instances that I'm aware of, two that I can be sure are Torsades due to the fact that I was wearing an event monitor at the time (those instances were very close together), and two that were very similar and thus likely to have been Torsades but one can never be sure. All were out of the hospital and all were self-correcting. That's the reason I feel so blessed. It was my blackouts that really started to get my doctor to realize that something was up. I had gone in repeatedly in the weeks before to my doctor with sharp and short chest pains and a productive cough. He pretty much seemed to think "no biggie" even after my first blackout until he got the call from the monitoring service that "Ninofan" had sent in two recordings that showed the ominous rhythm that is Torsades. Of course he sent me to the hospital immediately. They did testing and discovered the cause. They put me on the usual ACE inhibitor, beat blocker, and dieuretc, and since only a small part of my heart had suffered actual damage from the virus (as opposed to inflammation), my EF is good and my risk now of SCD is pretty small.
Glad it cooled off,,;0)
I was treated terribly once I was taken back to see a doctor. He made me feel so bad, that I almost left in the middle of his evaluation and treatment. I told him I had been a lot of stress and that I felt that my chest pain was probably nothing. I had never been to an emergency room before. However, he implied that I was a overacting and probably a hypochrondiac. I told him that the only reason I was there was because my heart doctor told me to come there. He gave me a slight sedative and sent me home. The bottom line is that now I feel that no matter what happens I will not go to an emergency room because of that doctor.
Did you read the response that one poster gave about coroner's juries? Apparently these "charges" aren't necessarily criminal charges, but this is just the first step to a lawsuit. It's somewhat confusing and I'm going to have to read up more on it
Check and find out if you have free medical places, where they can check you out.
In Los Angeles there is County Hospital, which sees people with no insurance for free. It's a long wait, but it's better, than ignoring potentially serious symptoms and not seeing a doctor. You should find out if they have similar places in your area.
In both cases I described, I was able to overcome the feeling simply by resting. There is a difference between the two, and I'm simply not able to find the right words to describe it. It might have to do with recovery time v.s. endurance. I understand the distinction you are making with a heart attack, in that resting does not alleviate the craving for air or oxygen. The symptom is persistent.
The weather or the pig?
Good article.
"I was treated terribly once I was taken back to see a doctor. "
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I have heard that from a lot of people. Some doctors and articles tell people to NOT ignore symptoms, which could potentially be serious and to go to the ER, but the doctors there VERY often treat the patients as if they were idiots and just showed up there, because they were bored and wanted attention.
But that shouldn't dissuade you from going to the ER, if you think you need to. If you have a choice, you might try a different hospital, and if you can, have a healthy person go with you, who can be your advocate and fight for you, and demand that the doctors perform the test to confirm or rule out some serious possibilities.
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