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.
Let me guess, you didn't pass through any tunnel with a bright light at the end of it either did you.
I'm asked quite often if I have had any life long changes in attitude since and I always respond with the same "Nope, I'm STILL ornery as ever"! ; )
A sharp chest pain for just a second and from then on feeling like I had a golf ball lodged in my throat.
Remember however I didn't have a heart attack, it was different however just as deadly.
I do remember that...with knowledge of what it felt like, and what the problem was...your testimony could save lives. If the person waits too long, it WILL be too late.
Some homes were destroyed just by strait winds without rotation.
Good morning to you! I had been praying after your email...asking for your protection and that of your friends and family. I'm thankful, and will give praises to God for his blessing!
Perhaps so, but does medical malpractice ever become criminally negligent homicide? No? No matter how negligent?
Just curious.
Ask some one with the flu if they have these symptoms, and the govt (aka taxpayers aka you and me) will be giving them $5K doses of nyquill at the end of their "ER visit".
No, not me.
There are people who actually physically damage themselves
in order to be seen and treated. There are people who
also know all the symptoms of a disease and repeat them to
the physician in order to be treated. These are well
known syndromes....So if someone presents with too many
complaints, but the physical, ekg, labs, etc are negative
they get put on low priority..,
Thank heavens we have so many medical people on this thread to make it known that these are serious symptoms...hopefully people wont be swayed from seeking appropriate treatment due to your comment
What if it were your mother, father, child, etc...who was having a serious cardiac episode, Would you want them to get immediate treatment? If it turned out to be the flu, would you be thankful or resentful that you would have to pay for a portion of their treatment with your taxes?
The only problem with that viewpoint is that many hospital
administrators, 3rd party payers, and patients expect nurses
to do everything at once, and do more with less..
It's amazing, we have money for SUV's, plasma TV's,
gambling, cable TV, cellphones, botox., diet products,
going out to dinner daily, sports entertainment, liquor,
cigarettes, dangerously fast cars, high fashion, lattes,
money for failing public schools, 22 inch wheel rims on
cars and trucks, car DVDs, legal and illegal drugs,
money to pay for illegals schooling and health care, portable
backyard barbeques, motorhomes, time-shares, world wide
vacations, $150 dollar sneakers, $500 sunglasses, $150
steaks, $600 bottles of wine, home theaters...
but got no money for our own health care...
Just an observation, mind you, not a condemnation.
One of my friends used to tell me about the "womens" hospital
he had to train at, where a lot of the pregnant
women would come in and complain of stomach pain, and would
get a free sonogram. The suspicion was that many just wanted
to get a sonogram done, so would complain of symptoms which
a sonogram was needed for diagnosis...prety slick, no?
I personally knew a health professional, who pretended to
have a very sore neck, was wearing a brace, but what he
was doing was going around to different doctors, getting
prescriptions for opiate (read morphine) based painkillers.
We found out later, that on the day he got a potent opiate
based painkiller, that he had checked himself into a hospital
with chest pain (morphine is used to relieve the chest pain
as it is a decent vasodilator)...fortunately he was
fired from his position as soon as his behaviour was
discovered.
Hopefully not.
It is getting harder and harder to get emergency treatment, was my point.
When the ED if filled with people that claim chest pains just to get in a bed, and get seen first. It becomes difficult to know who to actually see first. I worked in an ED back in 95 , and saw many abuses of the system. People giving affirmatives to the simple questions, only when in the presence of the MD, did the real problems surface. My ankle, my ghonorreah, my infected toenail, why yes everyone I know has the flu.
When the ED is packed with everyone claiming MI symptoms, who do you see first?
When people do that, they should be escorted back to the waiting room and made to wait until all other cases have been seen. Eventually, they will learn to not take advantage of the system.
Then I thank you even more. All the stress and exhaustion, without the possibility of a six figure income.
How long did she wait in the waiting room, behind non emergency cases?
"Nope, I'm STILL ornery as ever"!
You too, huh? :-)
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