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.
lol! It's actually not funny but the way you said it (typed it) it was.
And that's not a joke.
I'm so sorry.
I finally approached the desk and ask if I could go back to work if they weren't going to do anything. "Oh no," the woman said, "you might have a serious head injury."
I walked out of there, untreated, recognizing I was not the only person present who needed his head examined.
I found out later this negligence is more the rule than the exception.
I will take a taxi to the Boy Scout Council Office next time. At least the Boy Scouts can render first aid.
A hospital emergency room is a dangerous place where you will likely not get treated at all.
I'll Be Glad To See The Geese ;0)
.
I've heard recently that the symptoms of an approaching heart attack in women are often different from the symptoms that are common in men. Do you know anything about this?
Are you ex-military? There's always the VA if nothing else...
After all, you make the comment that symptoms are taken more seriously when the patient comes in with a full reservation - ambulance, EMT's, etc. if the patient can't afford an ambulance ride along with medical care at the hospital, having this woman die in the waiting room should not be a surprise.
Homicide defined -
http://www.lexisnexis.com/lawschool/study/outlines/html/crim/crim24.htm
They're talking involuntary manslaughter.
You think that's sad...We lost our insurance when my husband shut down his business, so we have to pay for that same $500 ambulance ride out of our own pockets---for us and the illegals!!!
They get every kind of test and treatment available, while we pay for it!!! We, however, have to ensure that any tests or treatments are truly necessary...and hope we're right!
How many AMERICANS have to die waiting for an Emergency Room Doctor or treatment because of ILLEGAL ALIENS??? Well, that's too many!!!
Using a take on the liberals' argument, "If even one [American's] life can be saved by..." arresting and deporting illegal aliens,...it's worth it.
Early signs of detection are paramount. At the beginning of last year, my wife experienced chest discomfort and I took her to the ER. An overnight stay insued with no major problems detected. A few months later, there we were again. No problems. Scheduled a stress test and after completing that she was diagnosed with about 25% blockage and told not to worry, given medication to help dissolve the blockage and a diet to follow. Two more times to the ER over the next few months got us overnight stays in the hospital again to run tests with no additional problems detected. About a month after the last episode, we decided to bypass our local hospital and try to make an appointment in Nashville. Of course, a long wait would be expected to schedule a visit. One day my wife called me from work (she's a teacher) and said she just didn't feel right. I called my sister a local nurse and said can you get me into today to see a heart specialist ion Nashville. She said no that our best bet was to drive there and be admitted through ER. We did and again the bloodwork showed no problems and an overnight stay with a stress test the next morning was ordered. As she was on the treadmill, her heart went crazy, she started to suffer extreme chest pains and began to pass out. She was immediately taken to have an arteriorgram done and I was told that if problems were noted they would go ahead and fix it then. A few hours later, my wife came out of surgery with a stint holding open the artery around her heart that had over a 90% blockage.
Advice, when dealing with matters of the heart, go to a hospital that boasts about it being their speciality. I know my wife wouldn't be here today if we had kept going to our small local hospital.
I hear that. I paid for my own for over 20 years. It was more than my former house payments and more than my former car payments.
I never put in a claim. Paid for my own medications, didn't have dental, so paid for that. Paid for my own exams. That's all. I was never sick.
Finally, to cut back on expenses, I canceled it, so I'd have extra money for my 2nd business. Two years after that, I became very sick. Tried for a year to fix it with antihistamines, anti-inflammatories, better nutrition, more exercise, the usual. Only got a little better, then worse - now it's chronic, an asthma-like condition that may be asthma or may be heart disease mimicking asthma. It's triggered by mold spores and humidity.
Still haven't seen a doctor - no money, no car, no one to help me. Can't do much of anything most days. Didn't qualify for SSDI because they didn't count my SE tax in SocSec.
Play by the rules all your life, pay your bills and taxes, take responsibility for yourself, don't commit to long-term debt if you can't afford it - and where does it get you? On the garbage heap, if you miss 3 payments on a $300 Target charge card while trying to make money by selling off some things of yours, to satisfy a landlord - who kicks you out, anyway.
That's life. "Sort of."
Good post, thank you. Very useful info. A friend of ours was a very heavy smoker and recently died of a heart attack in his early 50s. Don't think he believed it could happen to him.
Nonsense, that never bothered m
One question: Was she even seen by a triage nurse first? I would hope that there was one, but maybe not.
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