Seeing red

[VickyRN, MSN, DNP, RN]

Please help me sort this all out if you can. Came on my usual night shift Tuesday @ cardiac step down unit in a level one trauma university teaching hospital. Has a patient who had been on the floor for several hours. This was a 70-year old gentleman who had been fairly healthy who had presented to an outlying hospital with an active MI. He was rushed to ambulance to us and sent immediately to the cath lab for emergent interventions. While in the cath lab, on the table, with cath in progress, another pt presents to ED in more emergent state. So they stop the cath on my patient, send him up to the floor with sheath in place, to do the cath on the other pt. Well, time dragged on, the cath lab was very busy, and my pt was lost in the shuffle. The brilliant doctors decide to wait until morning to finish the job on this pt. Mind you, he is actively infarcting and they are aware it is his LAD. Apparently the doc's didn't want to incovenience the cath lab by calling in an after-hours crew to finish the job on this patient. Just wait till morning!!! The residents seemed clueless and were writing their usual frequent, confusing and contradictory orders. Kept me in a tizzy most of the night so couldn't think enough to see the big picture. It took NTG @ 100mcg's to control his pain; had heparin and integrilin going also. VSS all during the night, thank God, but was having frequent nausea with emesis. Doctors aware. First set cardiac enzymes @ 1930 showed troponin of 7! Residents and fellow aware. @ 3AM MB's 120 range and troponin 32!!! Still didn't want to do anything. Charge nurse also aware. Everyone knows that time is muscle when actively infarcting. This patient would have been much better off if he had opted to stay at the outlying hospital and they had TPA's him there! His family was so sweet and didn't have a clue. As soon as dayshift came on, they of course rush him down to the cath lab first case. Have not been back, so don't know how the gentleman fared.

[olympiad27]

If what you describe is accurate then I find it unexceptable and impossible to believe. If they knew enough to have the patient on nitrates, heparin and integrilin they obviously knew what they were dealing with. THe fact that he continued to have chest pain represented ongoing ischemia , infarction and should have been aggressively dealt with . THere is no explanation that I can think of .

[szerch]

I agree that this was unexceptable. It was obvious that this patient needed immediate intervention, and I don't know of a patient who would need it or be in a more "emergent state" that would need cardiac intervention than an active MI. In any case, your patient could have gone to the recovery area, and at the very least, had his intervention immediately following the ED patient. Do you have a medical director or quality assurance department that this could be reported to? I have found that if nothing is done, the MD's/residents will continue practices such as this.

[jadeheart]

Totally unacceptable practice!! Hopefully with the Grace of God this man fared well. I probably would have called the attending physician just to cover my butt and make sure he was fully aware of the situation. This case definitely needs some review by the higher-ups. This poor man now has major damage to his heart thanks to "not wanting to inconvenience anyone". That's what they get paid for. Not to mention the fact that the man had to lay there all night with a sheath in. Not fun!! I hope you were giving him Morphine also, just a thought.

[mattcastens]

Cause for a lawsuit if you ask me! What should have been done, if the cath lab really was that busy, was to finish the procedure in progress and use thrombolytics on the second patient.