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.
YOU WILL BE IN MY PRAYERS POLITICALWIT.
Well as a lay person I really don't know if it was a "nurse." The ER is set up with 3 cubicles a patient enters and tells the person what is wrong. They take a pulse, blood pressure, symptoms, log in your name and insurance.
Those symptoms also mimic panic attack symptoms. The first time I had a full on panic attack I had all of them, especially the impending feeling of doom. It really sucked. :-(
Where I used to live, Syracuse NY, there was a 24 hour clinic that was specifically for, "Not life threatening but really cannot wait until the morning" types of things. From what I heard, it really helped the hospital ERs.
I wrote instructions......
Chew the tablets, call 911
I'm glad to do it. Thank you in turn for your encouragement!
I wonder how many illegal Mexicans were clogging the ER for their routine health care stuff at the time.
Boy, do I agree with THAT. I once saw a receptionist tell a guy with chest pains to sit down and wait while she got the paperwork completed on a guy with the flu. I had to flag down a nurse to get the 'chest pain' guy seen quickly.
There's a book that's about thirty years old now, written by a physician and called something like "how to be the world's best doctor". One of his highlighted pieces of advice: If you hire a receptionist, watch her like a hawk.
Through the miracle of the internet, here's a link to the book I mentioned.
http://www.galenpress.com/00315a.html
I like the piece of advice he offers in the title, too: the key to being a good physician is to kill as few patients as possible.
That goes without saying. However, they weren't busy. There were maybe 3-4 other people in the waiting room, obviously in no distress. And when they finally took me to the back, I found the same level of inactivity. A treatment area full of staff, cutting up and telling jokes, etc.
MM
When I was a brand-new cop, we were fairly close to a hospital when we saw a 12-year-old kid fall off of his bike. We pulled over and asked if he was OK. His breathing was labored, and he said that his chest hurt. We gave him a lift to the hospital and took him to the ER.
Turns out he was having a no-kidding heart attack. The doctor later told us that if we hadn't been there, he probably would have died.
I wish that had happened to me--getting off insulin. Unfortunately my blood sugars aren't really good. I've always had good care in the hospital ER so I can't complain. Mxxx
Shoulda been more attentive once you're put on notice.
That's what distinguishes manslaughter from a mere accident..
I see only one *possible* variable that was left out of the story and that would be the conditions of those ahead of her. Perhaps they were perceived to be much worse than she was.
I was taken to the ER by friends 4 years ago and looked terrible. I am morbidly obese (say the damn doctors) and at the ER admission process my pulse was 153 and the nurse dropped everything and called for a stretcher. She started to panic. I told her that the quickened pulse was the result of the pain that I was in and that the pulse would return to normal within ten minutes once I was able to sit or lie still.
She responded appropriately, but in my case unnecessarily. Ten minutes later, I was on a monitor and my pulse was back to normal. In fact, I think my pulse was normal before hers.
PS -- I was trained as an army medic and had triage training, worked in a hospital, and knew that I was only in a lot of discomfort, but not at all in a state of distress as the vitals seemed to indicate. Perhaps this woman, once in the ER downplayed her own symptoms and patients who were seen as being more serious were seen first.
Too young?
A friend of my son died of a heart attack at age 19. He was the specimen of health and very active athlete. His final moment was at the end of 2 minutes of horseplay with his brother. He was dead before he hit the floor.
Another friend had his first heart attack at 28. He died about ten years later waiting for a heart transplant. It was a family thing. Both his brothers either had or were waiting for a transplant.
Tom,
Two rules:
1] Never p*** of anyone bringing you food.
2] Never get p***y with someone who might be resuscitating you a minute later.
Glad that you made it back.
Welcome to FR.
It's been over 30 years since I worked in a hospital and never had to deal with conditions nearly as bad as you listed here, but you are exactly right. Sometimes doing all you can to try to help cannot overcome the system with which you have to work and the patients you have to fight with so that you can help them.
(Former 92B20 -- IIRC)
I loved that movie. Thanks for reminding me of it.
I am a medical recruiter. If you ever get happy feet and want to move somewhere else, I'd be honored to present such an impressive nurse with common sense!
;-)
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