Chest pain protocol in the ER - page 2
Does your Emergency Room have a Chest Pain protocol? If so what are the orders?... Read More
0Jan 23, '07 by scrmblrQuote from StillBelieveRNof course. monitor, b/p, sat monitor. I was adressing the c/p protocol. I guess I just assumed everyone would know that any pt presenting with c/p would be put on a monitor.Do you place the patient on a monitor?!?!?Last edit by scrmblr on Jan 23, '07
0Jan 23, '07 by RunnerRNQuote from neneRNThis is an interesting concept. If a pt looks crappy do they go straight to the main ED room? How about the patients that are most likely not cardiac CP? We had a 29 year old the other night with no risk factors, no hx, with CP and SOB with cough...ended up with positive enzymes. Our CP protocol starts at age 30, but luckily triage was on the ball and thinking.All CP pts go through a chest pain screening area, staffed by an RN and a tech, where a cardiac risk factor/PE screening flow sheet, EKG within 10 minutes, monitor, O2, IV and labs drawn, bedside troponin and Chem 8, ASA x 4 are completed, then pt is sent to different ER room to see MD. Nurses love this, because all the chest pain pts are already worked up when you get them. And its a nice break for the nurse working the screening area, never have a pt longer than 15 minutes!
0Jan 23, '07 by rjflynVS
Monitor- 12 lead EKG with in 15m of arrival
IV labs CBC, CMP, Troponin, (PT, PTT if EKG changes indicate MI or on anticoags)- 2 and 3rd line if MI
ASA chewed and swallowed if not had or not allergic
Nitro paste 1" if pain free
NTG SL or IV /Morphine/Lopressor/Pavix/Heparin on MD order
Page cath team/Cariologist if ACS/MI- can do so on EMS report of cardiac alert
0Jan 23, '07 by rjflynI agree with interesting concept comment. These days everyone and there brother that comes to the ED c/o CP. The triage nurse needs to be on the ball and should not be a nurse who has little or no experence. As it is any one regaurdless of age gets an EKG with chest pain complaint.
As far as a 29 y/o with said complaint and positve enzymes there almost always has to be something that would lead one to the path of doing enzymes on them in the first place. It might be only gut instinct, but often times that all it takes. Would like to know what the follow up showed- ie was the trope elevated due to renal disease- we see it often. I have yet to see anyone less than 30 have a MI that didnt have a history ie drugs, congenital defect, or just bad luck ie family members with early MI.
Quote from RunnerRNThis is an interesting concept. If a pt looks crappy do they go straight to the main ED room? How about the patients that are most likely not cardiac CP? We had a 29 year old the other night with no risk factors, no hx, with CP and SOB with cough...ended up with positive enzymes. Our CP protocol starts at age 30, but luckily triage was on the ball and thinking.Last edit by rjflyn on Jan 23, '07
0Jan 23, '07 by Larry77What about the patient that somehow gets CP after sitting in the waiting room for a couple hours even though their initial CC was toe pain....LOL.
We do almost the same as all above mentioned except we do not administer MS without an order. If the patient is having symptomatic CP or Hx of MI's they are seen by the MD as soon as the EKG is done.
Question about the Troponin do you guys get a preliminary result from the lab? Often times we get a call from the lab stating the preliminary Troponin is say 36 (had this last week), but they are going to verify the results. Then they call back to say that the enzymes are actually negative!!! Usually it seems that the initial results are very high (had one that was 88) then they always seem to come back negative. So what's the point in getting preliminary results if they are so unreliable? Any others have this situation or can explain it to me?
0Jan 23, '07 by neneRNQuote from RunnerRNIf pt has unstable VS, or just looks bad; pale, cool diaphoretic, etc. then they do bypass the screening area and go straight to a regular ER room. (the CPSA is in the back with all the other rooms, not in triage) ALL stable pts with chest pain do go through the screening area though. But our ER is separated into critical care(CC) and intermediate care(IC) areas (different staff, separate charge nurses); so pts under 30 with a negative workup and no risk factors are sent to the IC side and pts more likely to actually be cardiac stay on the CC side.This is an interesting concept. If a pt looks crappy do they go straight to the main ED room? How about the patients that are most likely not cardiac CP? We had a 29 year old the other night with no risk factors, no hx, with CP and SOB with cough...ended up with positive enzymes. Our CP protocol starts at age 30, but luckily triage was on the ball and thinking.
0Jan 23, '07 by MomNRNOur standing protocol is very similar to those previously posted.
We just recently started using a "chest pain flow sheet." It is very user friendly and by-passed computer charting. It is mostly boxes and brief narrative.
If we have an EKG which indicates a MI, we immediately call an "MI alert." This to alert all involved staff that we have a hot one and to be ready. Our goal is to be on the cath lab table within 30 minutes.
We have had 3 MI alert's in the last 3 days! We are a smaller 150 bed hospital.
0Jan 27, '07 by NicoleRN07EKG, IV, LABS, CARDIAC MONITOR, O2, CXR, THEN WE WAIT FOR THE MD TO SEE THE PATIENT FOR FURTHER ORDERS.IF IT IS AN AMI, THEN WE DO ASA, NITRO, HEPARIN, AND HEPARIN DRIP, LOPRESSOR PROTOCOL, HEMOCULT, AND IF THE CXR AND HEMOCULT IS OK, WE THEN GIVE TNKase, (if indicated) AND CONSULT CARDIOLOGY