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.
Sounds like the local VA.
But it goes deeper than that, Phibes. The triage RN missed this one and it should have been caught. This is basic stuff, the ABCs. It needs to be addressed so that it doesn't happen again.
I was in an ER twice today(allergic reaction-myself/pain and nasal bleeding-someone else). While I was there there was a sign saying that everyone will be seen on a need basis and not in order of arrival.
Apparently the ER screwed up and downplayed some very serious symptoms. I don't agree with jailtime but I fully back a civil suit.
In my mid-30's I went to E.R. with chest pains and shortness of breath (not the nausea) and could not even get checked in. The place was a madhouse (California of course, but in the suburbs), no nurse would even look me in the eye. After standing there crying for 10 minutes, I finally walked home. Next day saw my doctor, who ran no tests, telling me I was too young for a heart attack, and instead said it must have been a panic attack. I still have never had any sort of a heart exam, although every doctor visit I do report that I intermittently have chest pains. I've been told that maybe if they become worse some futher testing should be done. This has gone on over a period of 8 years now, so I guess I don't have heart problems or I would be dead.
I had a similar situation. I thought I was having a heart attack and got a ride to the hospital. They whisked me right back there despite the fact that I was so young at the time that the odds of it being a heart attack (according to the ER doctor) were infintesimal. It turned out to be non-cardiac in origin, BUT it turned out to be something almost as bad - a quickly spreading infection that was in my lungs and bloodstream.
My dad's cousin died almost 3 years ago in his forties. He had a minor heart attack and didn't get treated. A week later a massive heart attack came along and killed him almost instantly.
Good advice 60Gunner. I am shocked that this could happen, since as you say, the vast majority of ER treat chest pain and other such symptoms VERY seriously. In fact, they will insist on keeping you for observation no matter how good you feel later. I have seen this happen to a couple of people I know who went in for what turned out to be reflux and anxiety.
You need a cardiac stress test.
I really appreaciate that since I'm paranoid about dropping dead. There is so much more I have to do yet. Everytime I feel a buzz in my arm I get nervous. I suppose if I cack from something like that, I would rather be asleep and not even know about it.
It's sad, but we insured patients have to pay $500 for the ambulance ride, while the illegals ride for free.
I never heard of this, you are saying people pretend to pass out so they can go to the ER? Why? To get attention, get out of an exam, or some such stupid thing? I cannot imagine wanting to go to the E.R. unless really necessary!
$750 here in Columbus.
Your brother? This week? I am so very sorry.
Dude, I like your profile page. There is some good common sense there. I like the name too.
I must admit I have transported myself to the ER a few times and "fell out" right in front of the admission desk for legitimate reasons (rapid blood loss, relief of having actually made it there, pain from broken bones, etc). Honestly, about all I ever lie about is what I'm running under the hood of my street racer or real racing car.
I do remember one time in Daytona when I had a SEVERE allergy attack, so swollen my mom didn't recognize me when she arrived, that four groups of "minorities" got in ahead of me with conditions of far less lethal potential than I was experiencing.
Aren't you glad this didn't happen to you 75 years ago?
BUMP
Thank you bucaneer81! I have written that down. Now that I know the specific name of the test, I can suggest it to the doctor. Thanks!
Some conditions that present with these symptoms are not life-threatening, and that's what trips many MI victims up. They think it's probably indigestion, their gallbladder acting up, or that they are just upright.
Let me tell you the three most commonly-said final words of a heart attack victim: "IT'S PROBABLY NOTHING."
Here's a word of advice to all of you wonderful people: of you have to tell yourself that it's probably nothing, then chances are that it probably IS something and you'd better take care of it pronto.
So what if you're not sure it's a heart attack? If you are right, you at least get a cardiac workup for future reference and your primary provider will know a lot more about you. You still win in the end.
But what if you're wrong?
Here is the bottom line, dear reader: "When in doubt, come on out." That's why we're here!
It would seem to me that whichever person checked this patient in should have been trained to notify the triage nurse immediately--and that nurse should have acted without hesitation to get her back STAT!
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