Standing orders for chest pain - page 5

by wellstar

28,157 Views | 41 Comments

Does anyone have standing orders or a practice guidline for pts with chest pain at thier facility? It seems to me that pts get faster care for chest pain if they out in the community than if they are already in the hosp. If... Read More


  1. 0
    Quote from GoNightingale
    . Pt. complains of MI, whether symptomatic or not, I call the doctor because in the long run, it's the nurse that gets dinged if the pt. had an MI and didn't call the doctor.
    Pts rarely, if ever, c/o of an "mi"

    MIs that are missed are those that complain of nausea, indigestion, DB/SOB, shoulder pain, etc, etc. In fact, lots of NSTEMIs present with very vague symptoms. Many do not get troponins drawn, or only have one set and they are negative. Many have angina, but no real damage, no troponin bump, and s/s so vague that they don't even consider cardiac.

    Recently, we had a NSTEMI, with a very mild troponin bump. Still <1.0. Pt was ambulating and feeling fine. Came in feeling like he had the flu. The flu has been really running around our hospital lately...
    Anyhow, we almost didn't cath him because he didn't look like a "real case"
    He had triple vessel disease, with his left main, (left main!!!) hanging on by a thread.

    Anyway, my rambling point was, MIs can be insidious. They may lurk and look like something completely different. You'd be surprised how easily they can be missed...
  2. 0
    Quote from CCL RN
    Pts rarely, if ever, c/o of an "mi"

    MIs that are missed are those that complain of nausea, indigestion, DB/SOB, shoulder pain, etc, etc. In fact, lots of NSTEMIs present with very vague symptoms. Many do not get troponins drawn, or only have one set and they are negative. Many have angina, but no real damage, no troponin bump, and s/s so vague that they don't even consider cardiac.

    Recently, we had a NSTEMI, with a very mild troponin bump. Still <1.0. Pt was ambulating and feeling fine. Came in feeling like he had the flu. The flu has been really running around our hospital lately...
    Anyhow, we almost didn't cath him because he didn't look like a "real case"
    He had triple vessel disease, with his left main, (left main!!!) hanging on by a thread.

    Anyway, my rambling point was, MIs can be insidious. They may lurk and look like something completely different. You'd be surprised how easily they can be missed...
    Thanks so much for your input. Definitely was not rambling. You are right on target. I meant to say c/o chest pain not MI. But either way, your answer is right on target.


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