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.
No. Think about it. If you were feeling that kind of pain, how would you be able to assert that kind of pressure in a cough!
Are they not taking comments any longer? I've posted twice, but it didn't show up. Anyway, my question, being an RN is this: Was there a triage nurse on duty, or present, at the time she presented herself with the complaints? Seems strange a nurse would instruct a patient that way.
Also, to answer another's question...NO, the cough doesn't work. If you are having aheart attack, you would probably not be able to muster a large enough cough to do the job that the compressions from CPR do.
Are you a reasonably fit female?
Out of breath on mild exertion, with no other symptoms at all and a fairly quick recovery, can be a sign of closing of a coronary artery in women.
It's a trivial appearing symptom and one of the reasons so many women have fatal attacks. The wait for pain or nausea that never comes.
Thanks for the ping.
After my recent experiences
"I needed that....thread" :>)
I had chest pains starting when I was in my 30's. My husband was in the military, the base was small, so I wasn't given a choice of doctors and saw the same one each time I went to the clinic.
He said that because I was a young female, and my EKG was normal, I was worrying needlessly. He told me that it was all in my head since my father had a myocardial infarction when he was 50. There were times I'd show up at the clinic and he refused to see me; he would send a nurse in to talk to me. It was so frustrating.
Once we moved, I went to another military hospital with the same complaints. I was given a stress test and an echo-cardiogram. That's when the physician told me I had mitral valve prolapse that was causing my pain. Apparently it's rather common, but I was advised to see a cardiologist annually.
I have an acquaintance in a nearby town whose husband, age 36, died in a manner similar to this. He went into the ER, complaining that he couldn't breathe. Let's see, this was the day before Thanksgiving, 3 years ago.
They didn't even triage him, hour after hour he complained and was told, essentially "soon" each time.
Finally, after 3+ hours, they brought him into the little room to take his BP, etc
He collapsed and died on the floor in front of the person. It wasn't heart attack, his throat had closed up due to something or other. He left a young, stay at home widow, children, 12 and 9.
I heard she's suing. I told my family they'll NEVER get me into Perry (GA) Hospital, unless i'm unconscious and have no say. (and as soon as i come to, i'm outta there)
Took my mom there once. She didn't die, but the experience was awful (muddy, dirty sheets on the bed in exam room, billed other people's expenses on her bill to Medicare)
Took my son there once, he'd had a bad frostbite burn on his hand. We left after 1 hour 45 min, never triaged.
They'll never get any of my loved ones in there again.
You might still be standing in line.
Ping my friend...have you seen this one yet?
You need a different doctor.
I had some classic chest pains, no shortness of breath, no nausea, and no sweats. Nonetheless, the pain was enough to have my wife drive me to a nearby clinic. Didn't matter that I kept on saying it wasn't a heart attack, but they treated it as such. I was taking Celebrex at the time and my mother's side of the family has a history of heart problems. My EKG was off so they drew blood, gave me aspirins, called an ambulance and I was in the hospital in short time.
Wound up to be an inflammation of the muscles around my rib cage, by it's good to know that the clinic crew wasn't listening to my protests and treated the episode as a heart attack. Better safe than sorry.
LOL!
I know a female (43) who went to the ER with shortness of breath, tingling arms, and sweating. Her father had his first heart attack at age 46 so she was keenly aware of heart disease. The hospital staff was very casual with her. Had her take a seat and wait for her turn. Finally, got her into a room. Did not draw blood. No urgency in her care. First they gave her what they called a GI Cocktail --- a combination of mylanta and lidocane --- to see if she was experiencing indigestion, nope. Finally they put the EKG leads on her. They were 'comfortable' that she was not having a heart attack. They gave her xanax and sent her home. She was sick for several months after the hospital episode. Very tired; just generally sick. It took months for her to get her strength back.
To this day she and her family continue to wonder if she did in fact experience a heart attack.
Suggestion ... if you are a woman or take a woman to the ER with shortness of breath, sweating, tingling ... DON'T leave until they do blood work to determine if it is a heart attack or not.
When I went to the ER, I didn't even get a chance to sit down except in a wheel chair before I was toted off and hooked up.
There were tens of people waiting admission when I showed up.
When the med chopper didn't show up to fly me to surgery, the ambulance took me during rush hour and when a lady didn't move out of the way, she was pushed into the ditch by the driver.
I guess I chose the right hospital...
Whoa! Someone wasn't being very concerned with patient confidentiality!
I was a head trauma rehab nurse many years ago and with the Terri Schiavo case, it was tempting to talk about some of my experiences, but wouldn't for fear of revealing confidential information. I did that work 15 years ago.
I know. I read the story. Asking twice in two hours is something I wouldn't do. I would DEMAND that my mother be given attention. I would ask to speak to the top person in charge. If they still didn't take my mother, I would threaten a lawsuit, and call the police if necessary.
I've had PLENTY of experience with heatlh care professionals....most of it pleasant, but I could write a book, literally write a book, on shoddy hospital care. Both of my parents became terminally ill a month apart, five years ago. My mother with lung cancer, and my father with a stroke and esophageal cancer. They ended up in a nursing home, side by side...died two months apart. Their hell lasted almost a year.
No way in hell would my mother wait for two hours in a emergency waiting room, with those symptoms.
Would you mind explaining what you felt and what the diagnoses was? For the benefit of others who may be feeling the same and not know how much danger they could really be in!
BTW...I'm really glad you chose the right hospital!
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.