Death after two-hour ER wait ruled homicide

I went into the ER the other night. I was feeling vertigo, nausea, chest tightness, sob on exertion and my b/p was in the 170's/130's just before my hubby took me in. I gave the nurse at reception my this information and told her of my hx of Mitral Valve Prolapse and Wolff Parkinson White Syndrome. She gave me a number and sent me to the waiting room. About 40 minutes later, after pts like a child who had been hoarse since 3am the previous day, I was finally taken back for 'triage'. At that point my b/p was 209/136 or 138. After that nurse was done with me I was sent over to the registration desk to register before I was taken back for an EKG, CXR, etc., almost an hour after I arrived. Once back in the ER, everything was done quickly. Fortunately my cardiac enzymes were okay and with different meds my b/p went down nearly to normal but who knows how it could have been.

This is a systems problem not one that any one person did anything "wrong". You can not blame one person but the system as a whole. I doubt if this particular hospitals ER functions that much differently than any other ER, therefore, it is not just a system problem at one facility but more a matter of how care is delivered across the health care industry. I don't now how you could sue a system , maybe hold the hospital accountable for this particular delivery of care system but them all hospitals will need to make changes too.

Hey there theofficegirl -

You can get mean if you want. Not too sure what it will accomplish - or where it comes from?

I am having a hard time figuring out if you are a REGISTERED NURSE or not. I note that your profile lists "other" as nursing education, so...

I see additional degrees, but...

Until YOU are the one on the LINE - and actual practice considerations that place YOU as the licensed REGISTERED NURSE, I think it is a bit heady and reckless to sit in judgement of a REGISTERED NURSE. It is so easy for other REGISTERED NURSES to be a armchair quarterbacks as it relates to another REGISTERED NURSE in many situations - still this is not a good practice. Now add the ancillary staff that sits in judgement and the issue gets murky at best! Until you are the one that "has it on the line" you opinion does not have the relevance of a peer! Is "this opinion" any more relevant than the opinion of a layperson?

I encourage all to list your credentials with your opinions! That way it is easy to see what "Practice Reality" you come from - and we all come from different practice realities. Also, our experience will dictate our understanding!

Practice SAFE!

RN, CEN, CCRN, NREMT-P, BA

Additional coursework:
ACLS, PALS, NRP, TNCC, ENPC, PHTLS and 16 YEARS OF EXPERIENCE IN EMERGENCY/ACUTE/CRITICAL CARE! Also instructor in many of the courses above! Also undergraduate instructor (didactic and clinical) in emergency care and nursing disciplines! Also, I have extensive experience as a subject matter expert in medical-legal matters that relate to nursing/medical practices!

I'm not trying to be mean either! Nothing is accomplished with mean! I just think it is important to be clear!

Excuse me, but it's bad enough that people who have never worked as ED triage nurses are passing judgement, let alone people who aren't even nurses period.

Now I'll stop before I get mean.

Ditto, ditto, ditto!

RN x 22y including ED (just spent part of last Sat. "in the cage," as a matter of fact).

This ridiculous and disgusting breach of every first year of nursing school basic cardiac guidelines reminds me of two situations. The first, involved my sister. After a half day spent at Kennedy Space Center, she began to complain of SOB; one look at her gray, pasty skin had me sitting her down and calling for an ambulance (her chest pain did not come into play until after she was in the nearest hospital's ER). My brother-in-law and I followed the ambulance and we sat quietly in the waiting room (based on experience, I felt it would be polite to wait at least 45 minutes before approaching the ER staff). Bear in mind, the ER was a small one (8 beds) and as I counted later, only three were filled, including my sister. We were allowed to see my sister, who at that point in time was seated upright on the stretcher with EKG monitoring (however, all the alarms were OFF on her monitor)and as we stood there, the physician FINALLY came in to assess her! Now where in the h..ll was he when the ambulance came in?!!! The initial labs weren't drawn until my sister had been there for over an hour!! Needless to say, my sister was transported to the hospital where I worked in Open Heart Recovery. She was cath'd, placed on a balloon pump and rushed into emergency open heart. She is doing quite well at this time!
Now for the second "incident": during my time as an ER nurse, I got a great deal of experience. At the time I worked either Fast Track, Med. Obs., Trauma, or Medical, Triage was frequently handled by "techs". (A policy which has since been changed). This particular night, a tech came into one of the rooms I had in Fast Track and asked me if I would take a look at a patient out at the Triage desk. I walked out to find an elderly man with his left foot in a black plastic trash bag; a piece of rope was tied around his ankle on the outside of the bag. I asked the tech if he had seen the man's foot (NO), so I knelt down and undid the rope and the plastic bag. To my utter HORROR, blood was oozing rapidly from the dirty dish towel he had hastily wrapped around the ARTERIAL cut !!!! We rushed the man via wheelchair to the TRAUMA room! The tech was not to blame - no one had really trained him for something like the man with his foot in a plastic bag; indeed, I was very relieved he had the sense to find a nurse to assess the situation instead of having the patient sit in the waiting room until the "suture room" became available!

"Excuse me, but she died of a HEART ATTACK, right? Them there's what we call 'natural causes' in these here parts. Failure to appropriately assist might be negligence, but it isn't and wasn't the primary cause of death.

A multi-million dollar judgment? Probably."

The question is, would the outcome been different if the heart attack victim would have received emergency care much sooner...

not to start a fight but

/cheer I love it when people think more education is directly related to patient care. A NREMT-B can see this patient is having a heart attack and they get paid minimum wage here.

Thats why we have those wonderful doctors who will not listen to an rn who says my PT has an infection and the doctor says "ill make that decision" turns around and doesnt look at the PT until hell freezes over.


Post more credentials because it sure impressed me.

Oh i have BLS, ACLS, PHTLS, PART, NREMT-B, (was a grader for NREMT practicals)91W, combat life saver, expert medic badge, and now im in a BSN program but guess what as a RN I can do less then I could in the military as a 91W.

Education credentials are linked but not directly to experience and knowledge

I've followed this thread pretty much from the begining, but haven't posted on it until now.

There are a large number of posters who keep commenting on how neglectful the triage nurse was.

It realy isn't that simple. At least, not with the info that has been provided. (Or will likely ever be provided).

Though not as experienced as many of the nurses that have posted before me, and not a full-time ER nurse, I have done triage.

You know what? It would be so wonderful if everyone that came to the ER gave a complete/accurate answer to the question "what brings you here tonight?"

It would be great if your patient actually let you get out the statement "On a scale from 0 to 10, with 0 being no pain and 10 being the most pain you could possibly imagine, where would you rate your pain?" before abruptly cutting you off and barking "10, it is a 10." (Now, again, I don't triage daily, or even weekly, but I can count on ONE HAND the number of patients who have given a number LESS THAN 10 when answering this quesiton. Makes it difficult to prioritize patients based on their perception of pain when everyone gives the same answer.)

It would be nice if the patients who are dragged in by their families didn't try to down-play their very serious signs and symptoms because: they don't want to be admitted; they are scared and in denial; they don't want to be a bother; "you need to attend to that young lady crying in the waiting room;" whatever.

It would be a flat-out relief if every patient who was sick of waiting didn't suddenly come start having chest pain/shortness of breath/"the worst headache of my life" when it becomes evident that the wait is going to be a long one.

And, it would be really, really great if everyone who was having an acute MI had predictable signs/symptoms, ones that screamed "I'm the big one."

The bottom line is that we don't know the true story. We don't know what the patient told the triage nurse. We don't know what the patient's vital signs were. And unless I've missed something, we don't even know if they DIDN'T do an ekg upon presentation. EKGs can be normal even during an MI, depending on the timing. We don't know what the patient load was like that day. We don't know how many other patient's with c/o chest pain there were that day/that hour. (Or major trauma. Or severe HA with elevated bp. Or outrageously elevated blood sugar. Or severe SOB with crappy sats......) We just don't know, and probably never will.

Preach on it sister !!!