Chest pain do you need an EKG order?

usRNs · Aug 28, 2011

Tnx Roy :)

jujuseah, RN · Sep 6, 2011

Patients with chest pain should be assessed immediately with ECG, fast-tracked at the entrance and have the ECG seen by a doctor stat - if it is an AMI, he/she will be uptriaged immediately to meet the door-to-balloon time. In the ward, patients' complaining of chest pain, are assessed immediately by VS, ECG and draw some cardiac enzymes and call the doctor immediately and notify them the VS and actions done. There you save time and all he needs to do is to read the ECG and wait for the cardiac enzymes to be out.

Chest pain must be taken very seriously (even though I don't believe some of them) but to be on the safe side, we do all these so that we have a clear conscience lol.

PediNurse3 · Sep 6, 2011

When I worked in the ER, there was no need to get an order from a physician to do an EKG. The triage nurse could put it in upon arrival. If the patient started complaining of chest pain after arrival, we would obtain the EKG, show it to the physician and make sure that someone put the order in. I don't think that anyone would ever get upset over getting an EKG for chest pain.

Guest27531 · Sep 6, 2011

Patients with chest pain should be assessed immediately with ECG, fast-tracked at the entrance and have the ECG seen by a doctor stat - if it is an AMI, he/she will be uptriaged immediately to meet the door-to-balloon time. In the ward, patients' complaining of chest pain, are assessed immediately by VS, ECG and draw some cardiac enzymes and call the doctor immediately and notify them the VS and actions done. There you save time and all he needs to do is to read the ECG and wait for the cardiac enzymes to be out.
Chest pain must be taken very seriously (even though I don't believe some of them) but to be on the safe side, we do all these so that we have a clear conscience lol.

Absolutely right! You do not need a doctor's order to do an EKG for chest pain and, as described previously, one would wonder about an RN who did not do one stat but this is a good example for you to use to talk to your Nurse Manager about how "standing" orders vs "verbal" orders vs "prudent action" are handled at your institution. Excellent new nurse question.

NeoPediRN · Sep 6, 2011

I think you have to use your best nursing judgment. If you call the doctor and say a pt is having chest pain 99% of the time they are going to want an EKG...and if a pt is having a heart attack, the time you spend putting a call out and waiting for the doctor to call you back is valuable heart muscle that is dying in the process.

carolmaccas66, BSN, RN · Sep 6, 2011

I work ED alot now, so if the patient comes in c/o chest pain, I quickly check out their history (see if there is a pacemaker in place, what meds they take that may affect the ECG/EKG, etc) and then do an ECG. I always ask the patient (or if they have a relative there if patient has dementia etc) if doing an ECG is OK first. Then I just write on top of the tracing anything the doc needs to know re the patient. I would never wait for a doctor's order; we don't need one where I work and I certainly would not be letting anyone tell me off for it either. That is senseless. Thinking ahead and performing autonomous duties is part of the RN/nurses job and should be commended, not told off.

Check your faclities policy though, it may be different where u work.

~Mi Vida Loca~RN, ASN, RN · Sep 6, 2011

Hello everyone I have a question I understand that RN's must have an order for an EKG to be able to run it... but what if the patient walks in with a chest pain is the nurse supposed to wait for an order? I know many hospitals if not all have standing orders but I wonder what if one is not in place?? sorry for the silly question but being a new grad I wonder about these things...

It's part of our emergency response order set at my facility along with cxr, narcan, epi, bolus and various other things.

ANH_RN · Sep 6, 2011

In our facility the standard is if the patient suddenly complains of chest pain we call a 'rapid response' and a couple ICU RN's come over and that automatically gives us the right to obtain an EKG. Then according to how the rapid action response goes we give Nitro, Morphine, whatever. Now if you suspect that the patient is developing an arrhythmia (the patient is not on tele and they have a heart rate of 120 and it's irregular) then for that scenario.. I would call a rapid action to have them sort of evaluated and get an EKG. I actually like our rapid action protocol because if you ever have any serious concern over anyone you can call them and they have their sort of order sheet... they can order labs, ekgs, stuff like that....

The other night I had a patient with a HR of 80 but it was irregular. The pt denied history of a fib or irregular heart beat and I didn't find anything in her chart about it. She had no idea what I was talking about. She did say that she went to a cardiologist and they did an EKG when she was at their office last. I did call the doctor and ask for an EKG .. you know, just beccauuseee ... and the doctor was NOT HAPPY with me (she was admitted with cellulitis).. "Now, do we do an EKG on every person that is admitted with cellulitis??"... "well it's just that... her heart rate IS irregular" ... "well, what would you do differently for her if it IS a fib???!1!" "Well she says she sees a cardiologist and I just thought that maybe I could just you know, check it!!!" Turns out she had a fib. He increased her fragmin, put her on tele, and ordered a cardio consult for the AM. Maybe that is something differently I would have done, for example. sorry for the rant..

usRNs · Sep 6, 2011

It is really good to hear from so many experienced nurses... And as NY lady mentioned "prudent action" is key... Thank you all for this information...