How does your ED treat chest pain?

[Esme12, ASN, BSN, RN]

We do EKG within 10, heploc, O2, ENCASA (Someplaces I have worked go for chewable ASA), SL nitro x3. Full cardiac profile w troponin, full coag profile. CXR. If unrelieved EKG and start IV nitro with MD approval. Further Rx pending immediate MD eval.

[inchii]

Almost the same, except we use morphine instead of dilaudid, start with sublingual nitro before IV, and add oxygen to the list.

[Sassy5d]

What do you guys do about drug seekers in your ER? I noticed most of your posts involve giving most pts dilaudid. My drug seekers would love to know where you work ha

[Racer15, BSN, RN]

EKG in ten minutes, line, labs, oxygen, CXR, ASA. No other drugs without a physician's order.

[ohiobobcat]

EKG in 10 minutes. Saline lock, cardiac labs, including a trop I and trop T, ASA 324 mg chewables, SL nitro, O2 if sats below 92%, repeat EKG in 30 minutes, port CXR. We have standing orders for IV morphine, beta blocker and Plavix, but I usually check with the doc before giving any of those meds.

[1fastRN]

Door to EKG time under 10 mins.

MONA (morphine, 02, nitro, ASA)

Portable CXR, cbc, chem, trop, coags

Treatment is different and much more aggressive if EKG is positive for MI. Coags, type & screen, heparin initiation, cath lab activation

[zmansc, ASN, RN]

Pretty much the same as 1fastRN, although we don't activate the cath lab, we activate the whirly bird, TNKase or equiv, nitro/heparin drips, and 3 lg bore IVs, hopefully before the flight crew is ready to take them.

[Loo17]

EKG, line and labs, cardiac monitor, oxygen, aspirin, nitro SL, morphine, CXR.

[psu_213, BSN, RN]

On thing I want to clarify here. For the posters talking about morphine/dilaudid and/or a NTG gtt--do nurses start these independently as part of a protocol or do you wait for a physician's order before going there?

In our ED, there is a "chest pain protocol" that nurses can initiate if the docs are behind--EKG, labs, chest Xray, hep lock, cardiac monitor. However, the protocol does not include any meds. Those must be ordered by a doc. Obviously if it is a STEMI a doc gets called right into the room. If there is a "severe" chest pain--i.e., not just 6/10 chest ache for 3 days--then a doc would also be called in so that we can get control of their pain.

Technically there has to be a doctor's order for an EKG, but we do one basically right away on almost all chest pain patients. We will then put the order in after the fact so we get paid for it.

[msjellybean]

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.

[CodeteamB]

We very rarely give any narcotics for chest pain, if we can't relieve it with a nitro gtt, then maybe, but it is last line treatment. The vast majority of our chest pains are unexplained (referred to outpatient cardio clinic for further follow up), heartburn (pink lady and a tecta prescription), and cholecystitis (they get the morphine). We give ASA by protocol to anyone with suspected cardiac chest pain, and for many of our CP patients that is the only med they get. I cannot imagine giving out as many narcotics as you describe OP. Do you get a large number of frequent fliers?

[Esme12, ASN, BSN, RN]

Are you asking this from a bedside nurses standpoint in the ED....or an advanced practitioner?

I would think as an advanced practitioner you would make your own orders.