How does your ED treat chest pain?

Specialties Emergency Nursing Q/A

I am wondering how your ED treats chest pain. We get EKG in 15 mins, start IV give IV nitroglycerin, Zofran,Ativan, Dilaudid.5, Asa, and Plavix and chest X-ray and cardiac panel. What are your guys orders like?

Specializes in Emergency Nursing.
My ER's docs & mgmt have no problem with the rn calling the stemi code prior to the doc seeing the ekg. I will not hesitate to get the ball rolling for mi's and cva's.

We let our docs call it, because it literally activates the cath team. But our docs see the EKG right away and if it looks sour I'll often call the doc over while they're doing the EKG.

Same for CVAs, I'll call the doc to the bedside or atleast tell them of the patients presentation ASAP. Simultaneous of having IV access and labs drawn so they're packaged up and ready to go for a Neurothrombopage.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
we do not get a large number of frequent flyers where I practice due to the fact they don't want to wait 4 hours to be seen so they got to neighboring hospitals usually. we have very few frequent flyers/drug seekers at the facility in which I work at.
You work in a Emergency department and you don't have frequent flyers? EVERYONE has frequent flyers. I have worked in some of the roughest hospitals to wealthy ones. I have worked huge teaching facilities and small rural/critical access facilities. Narcotics are not the first line of chest pain treatment nor is IV nitro unless the EKG is strongly positive.

There are 3 levels of protocol according to symptoms and according to the ACC/AHA guidelines and current standards of care.

As a nurse practitioner your scope if practice is different than the EDRN...I would think you would have a better scope if practice discussion, and EBP, in the APRN forums.

What school did you graduate again?...if you don't mind me asking.

Specializes in Emergency, Telemetry, Transplant.

Some of our docs like SL NTG, other paste. We only go to IV NTG if trops +, STEMI, etc.

As for EKG time, our goal is 5 minutes or less. This becomes less obtainable if we are really busy, but generally we are able to meet this goal.

Almost always morphine and not dilaudid for CP.

Drug seeker get toradol but I work in a trauma center and we have press ganey on our ::: so most docs give narcs and feed their habit

Specializes in Emergency & Trauma/Adult ICU.

OP, I'm assuming you don't give all of those meds to every patient who presents with chest pain ...

In the er I work we have a protocol in place to where we can initiate the morpHine or Dilaudid if necessary only have had to once because all docs were tied up but i am now an Arnp and I like to Hold pain Meds until EKG and chest x ray are done

Specializes in Emergency.
We're supposed to initiate the CP order set with in 3 minutes of presentation to registration. From presentation to registration we have 7 minutes to get the EKG complete.

Our standing orders include: place on monitor with q30 minute vitals, CXR, 12 lead, 02, start heplock, draw CBC, CMP, coags (which we hold unless the pt takes warfarin), and an i-stat troponin. After the EKG is complete, the EKG tech or the RN takes the 12 lead to a doc (any doc, doesn't have to be the doc that signs up for the pt) to verify if STEMI or not.

Forgot to add we also give 325 ASA if no contraindication/allergy

Specializes in Emergency & Trauma/Adult ICU.
In the er I work we have a protocol in place to where we can initiate the morpHine or Dilaudid if necessary only have had to once because all docs were tied up but i am now an Arnp and I like to Hold pain Meds until EKG and chest x ray are done

So ... as an RN you implemented protocol orders that pretty much threw morphine or dilaudid at a chest pain patient as soon as they hit the door? But now as an APRN you're more conservative and at least get an EKG before giving narcs?

Or perhaps I'm not following you ...

I would like to know what fall prevention protocols are in place at that trauma hospital, as all the pts seem to to get dilaudid or morphine.

As far as fall risk we use precautions we put be rails up give the patient A urinal or rarely a foley catheter and a call light and if they need to get up we help them

Specializes in Emergency.

My ER's docs & mgmt have no problem with the rn calling the stemi code prior to the doc seeing the ekg. I will not hesitate to get the ball rolling for mi's and cva's.

we do not get a large number of frequent flyers where I practice due to the fact they don't want to wait 4 hours to be seen so they got to neighboring hospitals usually. we have very few frequent flyers/drug seekers at the facility in which I work at.

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