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.
Great. I hate people who don't yield the right of way to an emergency vehicle.
In March I had my second heart attack. My shoulders ached like crazy and I was short of breath. Knowing that was what happened the first time, I went right to the hospital ER. They took care of me right away and all ended well (had a stent put in at a teaching hospital in Syracuse). Women's heart attack symptoms often differ from men. They're more apt to have the chest pain. I never have. It's a good idea to read up on these differences.
As much as I hate a chopper medvac that didn't show up when they were suppose to? ; )
I'm very sorry for your loss.
It is very common for heart attack victims to be embarrassed...They often go somewhere alone or refuse to allow an ambulance to be called.
Probably not. At least someone can do something about those drivers sometimes. I'm glad she got pushed into the ditch. I wonder what her ins. co. thought of that?
Oh no, it can't be for men and women are the same. ; )/s
Seriously speaking however, all in all we have the best medical capabilities in the world and when someone's life is in danger like mine was back in '00 (I'm six years old in my second life)there is no better place to be then the USA.
I was surprised to find that when I went to post heart attack therapy (I never had a heart attack and at my request was removed from this therapy) that a patient that was part of treatment was on insulin for diabetes for years before he had bypass surgery and after bypass surgery he no longer needed his daily dose of insulin.
Sorry for my babbling ....
I would like to thank you both for doing the jobs you do. My DIL is an emergancy room nurse, I always knew it was a stressful job but I will now treat her with even more respect!
Awful story. She probably had viral cardiomyopathy.
It is the flu that goes wickedly rampant and attacks the heart.
Usually the only treatment is transplant.
I'm sorry for your loss.
Always carry a heart attack first aid kit. I have one I carry all the time. It is home made but quite servicable.
I have a small metal can, the size of a quarter that contains two aspirin tablets.
Simple but very effective.
I'm sorry for your loss.
Sounds like your mom could have had a dysrhythmia...Could have been heart attack related but some times it happens without one.
Usually very sudden.
Chew the aspirin...Tastes awful but "works more better"....
The evening before she died she asked the nurse "Am I going to die tonight" the nurse responded "not on my watch". The nurse finished her shift at 11pm and Loni passed away at 5:30am.
I think my niece new.
Sad story..Viral Cardiomyopathy is a scourge for any one but it tends to attack the young..
Your niece may have known.
Thanks for lettimg me share my story with you.
Doctors suck.
Don't know about any other women, but speaking personally, I can tell you that my initial symptoms were a clammy, cold sweat-type feeling, heaviness in my arms, and a feeling of exhaustion. The chest pains came later.
This actually happened during a treadmill test as part of a job-related physical, with a doctor and a nurse right there in the room. I was also hooked up to an EKG, which didn't show any unusual activity.
I told the doctor and the nurse that I wasn't feeling well, but they insisted I was doing fine. The doctor told me I was too far back on the treadmill, and to step a little closer. He then increased the speed and the elevation.
After about ten minutes of this, I told them I had to stop. They informed that that this was OK, I had passed the treadmill test, and that I could lie down and rest for a few minutes, then I could proceed to go to work.
A few minutes later, they decided to get me up to send me on my way. At that point, I felt knife-like stabbing me repeatedly in the chest. Naturally, all hell broke loose.
Next thing I knew I was in the ambulance on the way to the ER. I went into ventricular fibrillation and had to be defibrillated TWICE in the ambulance. Thank God for the EMTs - they will always be my heroes.
I was 47 years old, non-smoker, and in excellent condition. The angiogram showed that I have a congenitally malformed left anterior descending artery. The cardiologists advised against a stent, because the wall of the artery is too thin.
The treatment protocol for the past 14 years has been medication, and attention to lifestyle.
No, I didn't sue.
I'm grateful for every day that I have.
From a longtime Freeper, dittoes!
Sorry to repeat myself, but just in case my post got lost unnoticed among those that appeared since...
People here mention a number of emergency conditions. Does anyone here have experience with pulmonary thrombosis? How common is it these days, and how best can it be detected?
Hug to you.
We all have lost someone we care deeply about.
Some times it seems so senseless and so useless and just so darn wrong.
I'm honored you shared with me.
That's scary.
Thanks for telling about your own experience. I found the page about women's heart attack symptoms that was linked on an earlier FR thread. By the way, did you have "feelings of impending doom"?
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