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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 can add abscessed teeth to your list.
Several years ago, I told my doctor about pain radiating down my left arm. He ordered a battery of tests, including a heart catheterization. Nothing was found.
A few days later, I woke up with the worst toothache ever. After the dentist treated the tooth, the pain in my arm and neck went away.
Yes, I'm VERY glad we live in the day and age of modern medicine. My initial EKG was fine (which makes sense, since the cause was non-cardiac), so they started to relax for a minute because they had to wait on bloodwork, but then they went back into overdrive mode once they saw how my blood pressure was changing and that I was complaining about feeling very cold. It was a very bizarre experience and there is almost no chance I would have survived such an infection 75 years ago.
Note to add: I remember very little after that, LOL, which I'm sure doesn't shock anyone.
I learned this the hard way--call 911 and be taken by ambulance to the hospital if you think you have a life-threatening condition.
Man, that's not right. Did they have their ACLU attorneys with them?
It's happened too often. This woman had classic signs, but not all women do. I read of one lady who complained of sharp pains in her back and arm. It was enough to scare her into the E.R. They decided it was nothing serious, released her, and she dropped dead in the parking lot on her way out. The point is...women don't always have obvious symptoms.
E.R. is SUPPOSED to be a triage situation, not "take a number". Obviously, some E.R.'s are better than others. One very big problem NOW... is that too many people use the E.R. as a clinic. Legally, they can't turn anyone away. The "E" stands for "Emergency". We need to get back to that.
What does "BUMP" mean?
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I'm not placing blame on the victim or her daughter. The hospital staff is clearly at fault. I'm simply saying, had that been my loved one, I never would have allowed that much time to pass.
Think Shirley McClaine at the nursing station in 'Terms of Endearment'. I've been there, done that.
How sad is that?
Wow, Basil! Johns Hopkins! I'm not worthy! (Bows down in awe.) That beats my suburban ER any day! The stories you must have. Thank you for your service!
Well, yes and no, I suffered no longterm problems from that instance of sepsis, but more recently I got a viral infection that caused cardiomyopathy and a little bit of damage, the effects of which I still deal with on a daily basis. But it's amazing what those modern heart drugs will do, so it's no biggie. I've survived sepsis and a few runs of Torsades, so I consider myself blessed.
For what it's worth, in most states a coroner's finding of 'homicide' is not the same as a criminal charge of homicide. As used by a coroner's jury, it just means 'death at the hands of another'. Self-defense deaths, negligence caused deaths, etc. are all classed 'homicide'.
It's more likely this case'll be filed in civil court.
I used to have a 1968 Cougar XR-7 with a 289 bored to 402. I had to sell her to pay off my college loans. My butt is near my shoulder blades now from all the times I kicked myself.
It's in Louisiana if that answers the question,
Overton Brooks in Shreveport.
I'm a doctor, not a lawyer, but AFAIK "homicide" is a legal term that means "wrongful death" or something similar. Not the same thing as "murder." Drunk drivers get charge with "criminal vehicular homicide" without malicious intent; it amounts to criminal stupidity. I think "negligent homicide" applies to taking an action that leads to someone's death, knowing that it was dangerous but without the specific intent to cause harm; something like firing a gun blindly, not realizing that there was a person hidden from view but in the line of fire.
Now the divine intervention happened on the way home. We were listening to local radio and a promo came on about our Cardiac center here at St Joseph hospital in Eureka. It was a friend of mine who had bypass surgery and he was praising the doctor, staff and hospital. He went on to talk about his symptoms and described the excruciating jaw pain he had that lead him to a stress test and surgery.
I called my doctor and a few days later I had a angiogram and later a stress test. I had a 3 way bypass but had to go to UCSF because of a birth defect that required a little more than St Jo offered...
You wouldn't happen to be the same ER doc who edits on Wikipedia, would you?
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