!Please help this school nurse!

[intellinurse]

An employee came to me the other day and told me about her "heart problem" but could not tell me the name of it! She said she sometimes faints and her heart stops for "up to 40 seconds". This has been happening less and less since 5th grade, when it first happened. She is now in her twenties, and said that her doctors said she could get a pacer or perhaps "grow out of it". She does not want 911 called because, once at the hospital, they put her through "all the same tests every time", and she already knows what she has. She said she has the ability to stop these events, by "icing herself all over" but will pay for it the next couple of days as that causes the events to increase. Can someone please tell me what this condition is, and perhaps point me to a website where I can get more information, for myself and the employee? Also, any advice would be a godsend. I am very uncomfortable dancing in the dark, especially since administration doesn't have anymore information than I do. Sinus block? Sick sinus syndrome? She said it has a "really long name". THANKS!

[All_Smiles_RN]

Neurocardiogenic Syncope?

[deeDawntee, RN]

OMG! It could be one of any number of conditions, but knowing what it is won't do much for you except to realize there won't be anything you can do for her (except do what you can do to convince her to get a pacer).

Have a pacer placed is really a minor procedure. The patient is awake the whole time and the pacer unit is placed under the skin...it is in NO WAY a major surgical procedure. People often require little to no pain medication afterwards. They wear an arm splint for about 2 weeks afterwards, mostly so the probes can heal into the heart muscle without being pulled out.

Does this woman drive? If so, she is a ticking time bomb who will kill herself and likely others if she passes out while she's speeding down a busy freeway!

Good luck...this is really terrifying. Someone ought to speak some sense into her.

[Bonny619]

That's very surprising that she doesn't know the name of her heart condition. That sounds pretty major.

[TachyBrady]

Sounds awefully fishy to me. Unless this girl and her parents have some sort of religeous or cultural beliefs that prohibit surgical intervention, I can't imagine any physician allowing periods of asystole and symptomatic bradycardia to go untreated. A pacemaker is indicated. And I agree with deeDawn that doctors would not allow this woman to drive with untreated syncopal episodes regardless of the cause.

Maybe she meant that her heart rate dropped to 40 bts/min instead of stopping for 40 seconds? If that is the case and she is symptomatic, a pacermaker is still indicated.

If anything, I think "icing" oneself would cause a vagal response and slow the heartrate initially (not increase it).

Do you not require complete medical histories, illnesses, conditions, etc on employees? You need more accurate info from this woman.

[intellinurse]

Thank you all for your most helpful advice and direction. I have no access to employee hiring records or health histories. I will attend Cardiac Rehab Education with a family member tomorrow at the local hospital, and see if they cannot shed more light on this. I, too, find it "fishy" that one cannot name what sounds like a most serious condition. I have tried to "talk sense" to no avail. I would think that the cardiologist would prevent this employee from driving!

[RN1989]

That doesn't surprise me at all. LOTS of patients do not know their meds or the names of their conditions. I've had people refuse to allow me to tell them about their condition or a pending surgery. They often are so freaked out that they feel uncomfortable knowing anything. So they tune everything out and then make it hard on the next health care provider. That is probably why they "do all the same tests over and over". If she were willing to take responsibility for her health and know what her condition is, how to treat it, meds, etc. They wouldn't have to keep repeating things. She obviously has some issues or this wouldn't be a recurring problem. And by not calling 911 - if she died, her family could try suing the people that were present but did not call 911 because she didn't want it. That is why EMS should always be called and THEN if she doesn't want care she can sign their refusal to consent to treatment.

[intellinurse]

I spoke to my Nursing supervisor and my school principal about everyone's helpful comments. Nursing said it was district policy to call 911-she needs to get us confirmation about just what it is she has, and treatment, from her doctor. The principal then presented this to her, and she is supposed to bring documentation, otherwise, 911 will be called. I am still waiting at this point. Many thanks to you all.

[purple_rose_3]

Any updates on this situation yet?! I'm kind've curious how it all turned out!

[intellinurse]

Administration told her we needed documentation. So far, none has come.