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.
What I suggest is the "911" maneuver, which involves picking up the phone and calling EMS. You can't go wrong with that one.
I hear ya. It's becoming more frequent in my ER, too.
A bump just means that you want more people to see a particular thread and you help that cause by posting "BUMP". That sends the thread to the top of the "Latest Posts" page and helps keep it going for comments.
A bump is a good thing.
Regards,
LH
how many Illegal Mexicans were in front of her getting treated becasue they don't have insurance.
Sadly this won't be the last time.
A man died in a Mississippi ER in very similar circumstances several years ago, after which the hospital instituted practices exactly like you describe. I personally showed up with chest pains and was whisked to the back and put through the cardiac assumption.
I'm sorry to say that aside from that one category of symptom, the ER staff remained the coldest, most indifferent group of human beings I've ever had the misfortune to encounter. A little over a year ago, I went to the ER with a kidney stone. Fellow Freepers who've been "stoned" will understand the level of pain that comes with the process. The place wasn't even busy and I was curtly told that "pain isn't a critical emergency, no matter how bad it is." (That's a paraphrase but the meaning is dead on.)
MM
I think that since my ER happens to be in the Seattle area, we are more "cardiac conscious." I don't know what it's like in other regions. Can others here help me out in as objective a way as possible?
I absolutely agree with your philosophy. In my ambulance days I had a 'chest pains' patient who was ambulatory when we arrived. He refused a gurney, but agreed to take a ride to the ER with us, so the attendant got in back and the guy rode in the passenger seat, complaining about having to do to the hospital the whole way.
At the hospital, we persuaded him to get in a wheel chair, took him to an examining room, he insisted on getting on the examining table himself, got out of the chair, and went nose down. Resuscitation attempts failed. That was forty years back. These days, our local paramedics do c-spine precautions on anyone who could even remotely possibly have sustained damage. They take a similar approach with cardiac patients.
The "Latest Posts" page (as opposed to "Latest Articles") gives you a good snapshot of all the threads that are going strong at the moment.
Regards,
LH
Is there a difference between "feeling nauseous" and actually having "nausea"? Do you have to be vomiting?
Shortness of breath means that you simply cannot get enough air to satisfy your body's craving for it. It stems from the injured heart muscle's lack of oxygen. It's different from simply being "winded" in that with being out of breath due to exertion, your need is gradually overcome by simply resting. With a heart attack, that doesn't happen. It literally can feel like it is impossible to get enough air.
Thanks. This is an issue that is near and dear to my heart- if you will pardon the expression.
Health ping. Great thread.
Feel free to come by anytime.
Having worked in a Level 1 trauma center for 10 years, I can agree with some of the points made by the other posters here. However, some of the other comments have served to remind me why I no longer work in public healthcare and why the average service life for an ER nurse is 8.5 years in my part of the country.
Sure: Chest pain + SOB (shortness of breath)+ nausea = Cardiac until ruled out, but not every patient will present with these symptoms or even admit to them in as many words even when fully assessed at triage. Remember that another factor to add to the classic cardiac presentation is denial:
"Ma'am/Sir, are you having any chest pain?"
"No, I just have a little twinge... but I've had that for years. Its not a problem"
"What about shortness of breath or any difficulty breathing?"
"Not really.. I mean I'm a smoker and have been for years and I've got good days and bad days."
Now, lets continue this hypothetical: You are the triage nurse in one of the busiest ERs in town. Its a Friday night at 11pm. The next largest ER across town just when on ambulance diversion which closes thier doors to ambulance traffic (usually due to being already overwhelmed) and as a result there are 5 EMS units en route to your facility from all over town. Your high acuity section is already full with gunshot wounds, screaming suicidal drug overdoses, cardiac cases and acute surgical cases which take up the lion's share of the availale staff. Your routine treatment section is full of 'non-specific abdominal pains' and 'Migrane Headache x3 weeks' patients which will take hours to diagnose and clear, and your minor emergency section is full and they should have closed 3 hours ago. There is about a 6 hour wait for a patient that is triaged with a 'routine' complaint.
So here you sit with a patient who isn't very clear with you about why exactly they have come in tonight, you're having to chase them all over triage just to nail them down to a chief complaint of: 'My chest is kinda sore' and you've got a line of eight other people waiting for you to triage and the line isn't getting any shorter. Your 'Sore Chest' patient's vital signs are good and they have no significant personal, family history or even a good history of present illness so you classify them 'Urgent' and sit them down in the waiting room.
Now you try to get the other eight people triaged, and for every one you see, two walk in. One of the people walking in pretends to faint so they can go to the top of the list; this ties you up for 15 minutes. Other patient's family member starts screaming at anyone wearing a hospital badge that he knows the CEO of the hospital and we'd better take is wife with her earache that she's had for 30 minutes to see a doctor NOW, dammit.
You've dealt with all of this, and you aren't even one hour into your shift yet.
Think about dealing with this 12 hours a day. Consider this before coming to the emergency room in the middle of the night on a weekend for a problem that you've had for weeks. And take all this into account before you start talking about how the nursing staff and doctors 'should be charged with depraved indifference to human life.'
Wow! That's a helluva toothache!
No medical professional should blow off pain at those levels.
what you typed, is it the article or are you using your own words?
DMedic, some of the people replying in this thread are EMTs and ER nurses, and they all pretty much seem to think that the charges seem reasonable based on what we know.
Too much Cochon De Lait if Ya' Ask Me,,,;0)
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