Real vs fake chest pain

  1. 0
    I am relatively new to working in corrections and am at a county jail. One of the big problems I am having is discerning who is lying and who is not.......particularly about chest pain. I am curious with what assessment parameters others use to weed out the fakers. When someone comes in with chest pain, do you automatically give aspirin and nitro? Do you stop if their vital signs are normal? I can ask 6 different people at work and get 6 different answers. Then I read the assessment protocol which says something different all together. Please help.
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  3. 28 Comments so far...

  4. 2
    Let me first preface by stating that I do not work corrections, but I do receive inmates on occasion in the Emergency Department.

    I would think about the harm that could come from making the wrong assumption. If you determine that the patient is lying, and it turns out they really *are* having an MI, they could die.

    If you determine that the patient is being truthful, you follow protocol, send them to the ED to r/o MI, and the workup turns out negative, what is the harm that can come from this? None, that I can see.

    My advice is to follow your facility's protocol to the letter, and leave the question of whether the person is lying or not out of it.
    Altra and casi like this.
  5. 1
    Follow protocol. It is there for a reason.
    Multicollinearity likes this.
  6. 1
    This is always difficult in Corrections the old MI vs anxiety. UUGGHH one of the worse. Are you staffed with more experienced nurses? Follow the protocol. If you can, get help. Observe what more experienced nurses are assessing. I can tell you that you develop a kind of gut intuition in nursing. You want to assess accurately, but...when in doubt ship 'em out.
    Multicollinearity likes this.
  7. 0
    I would treat everyone as if the are experiencing true chest pain. It isn't for us to decide is the are faking or not. Always cover yourself and follow policy.
  8. 0
    What I am currently seeing one of the more experienced nurses doing is the following:
    Check VSs; If normal, the assessment stops, and it is assumed it's anxiety or faking.
    If VSs are abnormal, an EKG is done. Then if the EKG is abnormal, the doctor is called and the protocol is instituted.

    I just perceive there to be a lot of liability with this approach. VSs alone don't seem enough to R/O an MI........and is doing an EKG enough to R/O an MI?

    I guarantee that if I send out every inmate with chest pain, I will be fired.

    I have been doing EKGs of everyone with a C/O chest pain, and custody is beginning to give me dirty looks. I want to be thorough and careful, but I would also like to keep my job.
  9. 4
    Quote from Findingmynitch
    What I am currently seeing one of the more experienced nurses doing is the following:
    Check VSs; If normal, the assessment stops, and it is assumed it's anxiety or faking.
    If VSs are abnormal, an EKG is done. Then if the EKG is abnormal, the doctor is called and the protocol is instituted.

    I just perceive there to be a lot of liability with this approach. VSs alone don't seem enough to R/O an MI........and is doing an EKG enough to R/O an MI?

    I guarantee that if I send out every inmate with chest pain, I will be fired.

    I have been doing EKGs of everyone with a C/O chest pain, and custody is beginning to give me dirty looks. I want to be thorough and careful, but I would also like to keep my job.
    Just screening vital signs sounds negligent to me. I do a lot of EKGs. I also look at the overall picture. Is the patient diaphoretic? Skin color? Is the inmate just off the daily transport bus, coming out of protective seg. and afraid? Is the inmate displaying signs of using medical to avoid being somewhere else? Does it look like he wants out of the cell block or off the yard?

    We cannot just ship everyone out who claims chest pain, and we've got to walk a fine line. You are absolutely correct that you would be fired if you shipped out all inmates who claim chest pain. A lot of their chest pain is muscular (non-cardiac), from excessive exercise. If it does not appear to be a classic MI which requires an emergency response and MONA, gather all your observations and evidence, call your on-call provider, and let them decide the disposition (i.e. back to cell, follow up with HCP, or ED, etc).
    Last edit by Multicollinearity on Jan 4, '12
    Oldest&Ugliest, kd7hfw, kimmyjonc, and 1 other like this.
  10. 2
    Quote from Flo.
    Follow protocol. It is there for a reason.
    This advice is your best friend. That being said, correctional facility or not, you have a doctor that is your medical director (or a group of doctors). It should not be your responsibility to "decide" if someone is lying about chest pain.
    Approach the supervising MD and ask for a protocol in writing, and follow it. Remember "When in doubt, ship them out."
    Oldest&Ugliest and amoLucia like this.
  11. 0
    Many thanks for all of the advice everybody. It has definitely helped.
  12. 3
    I work weekends with no provider, just me and another nurse. I also would be doing nothing but sending IMs out to the hospital if I sent everyone out that complained of chest pain.

    Here's what I do:

    1. If an ICS is called, I phone triage to assess what the current situation is. Is the IM A + O? How long has he been having the CP? If the situation seems not to be truly emergent, I pull the medical file to see if he has a Hx of cardiac issues.

    2. Then when I actually go to the IM, I can better assess the situation. At the yard, I take vitals and assess. Often times, the IM is showing S & S of GERD or anxiety more than true CP.

    3. If the IM is brought up to me at the ER, then I would take vitals and further assess. By now I have the medical record in front of me and can determine if the IM is FOS or if he is symptomatic of something - cardiac or otherwise.

    4. Our protocol for CP includes, ONA (we have no morphine). EKG, and an IV with NS at keep open rate. By this time, I should be able to determine if I need to send the IM out or back to his house.

    I've found that unless the IM is in distress, simply talking with them and letting them stay on the gurney for a while usually takes care of any CP symptoms.

    And as for the question of a more experienced nurse, there are none where I work.


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