Be sure that all MI patients get equal care
Be sure that all MI patients get equal care
Protocols and 'STEMI team' ensure consistent care
When a woman came to the ED at Christiana Care Health System in Wilmington, DE, complaining of nausea, vomiting, and diarrhea, she was initially triaged as low acuity. "But when the ED nurse saw how uncomfortable the patient was, she decided to do an EKG on her," says Kelly Powers, RN, an ED nurse at the hospital.
The physician assistant took one look at the EKG and immediately knew the patient was going to need to go to the cardiac catheterization lab. He ordered the blood work and alerted the on-call cardiologist.
"If the on-call cardiologist is not in-house, the EKG gets faxed to them or they come down into the ED to evaluate the patient," says Powers. "This patient ended up being a heart code and was taken emergently to the cath lab to relieve her heart blockage."
Ask about symptoms, history
With any chest pain patient, you'll need to know any associated symptoms, such as diaphoresis; nausea; shortness of breath; radiation of pain to the shoulders, neck or back; what they were doing when the chest pain started; and whether anything makes it worse or better, says Powers. "Also, if the patient has diabetes, hypertension, or other medical problems, that can make chest pain more suspicious," says Powers. "I ask about family history also to see if it is relevant."
If there are no available rooms, the triage nurse obtains an EKG and, if possible, a previous one to compare. The triage nurse shows them to a physician immediately. "If the physician deems it necessary, the patient is moved into a room, or blood work is started at triage," says Powers.
Obtain this info
At Loma Linda (CA) University Medical Center, a ST-elevation myocardial infarction (STEMI) activation team ensures that all chest pain patients are treated consistently.
Sherry Nolfe, BSN, MICN, core measures resource nurse in the ED, says, "We treat all acute MIs the same, regardless of gender. On average, we can get our STEMI patients from the door to the cath lab in 45 minutes or less."
At triage, she recommends asking these questions:
- What type of medical history do you have? Diabetes? Hypertension? High cholesterol? Are you a smoker?
- Do you have a family history of heart disease?
- What symptoms are you having? Most women report unusual fatigue and sleeplessness for several days or weeks, are anxious, and complain of indigestion, notes Nolfe.
"I find that in the past, women were less likely to come in for chest pain," says Powers. "Lately, though, women are more aware and are coming in for chest pain, even with very vague symptoms."
When a woman came to the ED at Christiana Care Health System in Wilmington, DE, complaining of nausea, vomiting, and diarrhea, she was initially triaged as low acuity. "But when the ED nurse saw how uncomfortable the patient was, she decided to do an EKG on her," says Kelly Powers, RN, an ED nurse at the hospital.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.