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.
By the time I got there (about an hour drive) they already had an ambulance ready to transport her to Loma Linda U.
thanks, bfl
I have had many ER experiences that were less than great. My husband had a stroke in 1999, we took him to an urgent care type clinic and they diagnosed stroke and sent him by ambulance to the hospital. At the hospital the ER doc on duty acted like it was all a joke and was convinced hubby was not and did not actually have a stroke. The ER doc changed his tune when the CT scan was done and only then got in gear and acted like it was really an emergency situation. Thank goodness our regular Dr showed up then becuase I was about to murder the doc in the ER. The nurses were trying to tell him what the ambulance people had told them about hubby's vitals and he was blowing them off too. I can only imagine what could have happened if we had taken him to the ER to begin with, Doc ER would probably have sent him home.
In contrast, when one of my daughters was away at college her roomate called us and said she thought my daughter was very sick. I went over and took her to the ER, as I was trying to sign her in, the triage nurse peeked out the door to talk to the people at the desk, my daughter was literally hanging on me in the hall- the triage nurse grabbed her and took her right to a bed and started checking her out. I was caught by surprise- not sure what that nurse saw when she looked at my daughter- but daughter had a raging kidney infectiion and her kidneys were not working properly, it did turn out to be very serious.
I guess it is like everything else- when you go to the ER you may get good help- or not.
I really really feel for you. It's very hard to get good insurance for the non-multi-millionnaire self-employed. And of course ALL OF US pay for the illegals though none of us want them here.
We were on Maui recently and my little son needed to go to the ER for a couple hours. It could have been appendix, said the doc we saw, so we took him in (it was just bad constipation).
The wait to get in was maybe 15 minutes. Inside, the doctors and nurses were so friendly and efficient, with plenty of time to talk to my little boy and make him comfortable (he had to endure an IV). THERE WERE NO ILLEGAL ALIENS in there. There were plenty of patients of all stripes, but NO ILLEGALS.
After the experience, when I was relieved my boy was OK, I said "What are we doing in CA? What are we ACCEPTING? We are like those FROGS!" We are like the frogs who, if placed in boiling water, will hop right out to save themselves, but if placed in tepid water, with the temperature rising slowly, will be fooled into being boiled to death. We are slowly being boiled to death here with these illegals in our ERs and schools and everywhere.
I'm glad you pointed out that women do not always have classic symptoms. My neighbor was complaining of aches and pains in her neck, back, legs. She is in her 70's and walking quite a bit and we all just thought she had general old age aches and pains- arthritis or what have you. She and her husband were on a trip to Boston and along the way in a motel she started hurting bad enough she couldn't sleep. Her husband did not like the way she was looking or acting and called an ambulance. Her symptoms were pretty vague but she was having a heart attack and got stints put in. She still did not relate this to her aches and pains but she told me later it dawned on her that after the stint was put in her aches went away. The achiness was the only symptom she had before the heart attack. She said her chest was not tight or hurting at all. Her Dr told her it is sometimes hard to diagnose heart problems in women from symptoms.
Every single person in that ER needs to be charged with murder and put in jail for 30 years.
That is incompetence beyond the pale of any logic or brains and by walking among us, they put us all at risk. They need to be locked away from the rest of humanity.
It is ER 101 that possible heart attack victims come above other things. This is just common sense.
Nobody in that emergency room has any, and that is flippin' scary.
Your immaturity is showing. What this post and a large number of the responses show is that there are competent folks and incompetent folks. The failure in our society is not so much that we mistreat competent professionals - we do that to - but rather that, in the name of fairness and due process - we can never deal with the fundamentally incompetent folks who have no business being in, for instance, an emergency room.
Tell your doctor to do the tests. You can tell him to do it. Don't ask. Tell.
So glad you're still here!
Same thing with a friend of mine. Her only symptom was heartburn.
Ping.
I understand that happens, but what gets me is at time I have known people who were treated as though they were fakers, when they were people who rarely go to the ER or even see a Dr. I would think common sense would say- I don't think patient A just woke up today deciding to fake a problem. I would think the fakers would be known by their records.
I can see in a large city the faker may be going to different Drs and hospitals and no one person sees their entire record. Where I live there is only one hospital in a hundred mile radius- they should know the culprits- yet will treat patients with serious problems as if they are faking- when the patient is the type to stay away from Drs and hospitals- not the repeat faker type at all.
So, you have read read the e-mail that is going around, and you believe it is a hoax?
Just getting you to spell it out! :)
Thank you.
In all fairness I could have reminded them about policy but I really wanted to hear what had happened and I knew that if I asked they probably would have stopped talking.
Bah! I'm jealous!
I went to the ER with a 103+ temp . . .shaking, major ummm how to say it . . . not delusions, but confusion. I was 33.
The triage nurse made me strip down to shorts and a tank top (pajamas with no underclothes) and made me sit in the waiting room.
Nearly 3 hours. When I got to the back the doctor yelled at her for a good 20 minutes (I could hear him) -- he was furious.
Turns out my gall bladder was very, very infected. I was really really sick. It took nearly 24 hours to break the fever.
The only "pain" symptom I had -- was my back right shoulderblade. That's why she blew me off. She decided (and notated) that she felt like I had the flu.
I spent 4 days in the hospital.
BleH! *laugh*
He said he never really felt that bad. But the peritonitis almost killed him.
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