Thanks everyone .ChseZ,I see now where you are coming from, yes PE is a great call.I am impressed that you are a student and putting it all together already using critical thinking Skills.
Esme12, Thanks you are always supportive.To answer a couple of your questions.I have absolute faith in paramedics who consistently impress me with their ingenuity and speed. My concern was more for a confused pt arriving in the ED who could not represent herself well.I personally feel no one should attempt to go to a hospital without an advocate and statistics would support me on that one. Would I have gone if the center wasn't closing,probably not.
Cardiac rehab is a very different type of setting and nursing.Many pt have been with us in the preventative program for 10+ yrs.(which this pt was in ) For pts it is their own community in many ways. We visit pt at home or when they are in hospital,have attended their families weddings or pt funerals and watched their grandchildren grow.We, visit pt on break time/off time in case anyone is wondering. For a select few we are their health proxy which was the case in this situation and why I felt a greater responsibility to go on my own time to the ED with her.In this situation and thank you for validating it that "the Dr. was a donkey " so I am glad I went.
Regarding the pt. Her family called me at home today. I had used my cell phone
to let pt know that I had called her attending that she was in the ED (that's why they had my cell number ) They were a little unclear of the facts but were able to tell me that she had remained in a stupor for about 12hrs. CT was negative,first 2 CPKMB's were flat. (I'm not sure if a 3rd was ordered ) However they said they were" looking into her heart muscle for damage". Whether that meant she had had an MI and they weren't understanding I am not clear on yet. They were clear that the Pt was dx with hypertensive encephalopathy and was getting an echo done. I will get a clearer pic on Monday when I speak with her PMD.
Simma: while I would love to have given the pt a little nifedepine or in hospital setting Nipride in an out pt setting without a Dr. you don't have those choices. Yes,there is a crash cart but if the situation progresses you have the problem of (other than using the defibrilator, inserting IV access) am I willing to intubate/run a code without the Dr. In this environment it is a clear "No ". This is beyond my scope. Stabilze and "bus to ED is my focus.
I will keep you posted on her progress . Thanks again. Your help was much appreciated.