It was a regular day in the ED. I had the back rooms, the "non-critical" patient's that are sick, but not needing to be in our (the nurses) line of sight the entire time. A woman came in complaining about n/v for four days. Through lab work and CT it was determined that she had gall stones, non-obstructed bile duct, but due to her n/v and dehydration she would be admitted to the hospital for 23 hour observation and IV fluids. No other medical hx, not even HTN! A nice, sweet lady.
I had just finished writing up her case, calling the floor to let them know she was coming, etc. I stopped by her room to ensure I had dispo vitals before taking her to the floor. She looked paler, a little more lethargic. Her VS were all still "in the normal range" but she was saying she was really nauseous again. I'd given her Zofran only 30 minutes before and it had worked well on her n/v the first time, so I was a little suspicious. I told her I would talk to the ER doctor.
Walking up to the ER doc, I asked the tech to do another EKG on her. I knew we had one one only four hours earlier, when she first arrived, but something just felt off. I put in the order and was going to talk to the ER doc when another, emergent pt. came in. He went to that patient's bedside and I decided to wait two minutes to talk to him, instead putting in the EKG order and entering my patient's newest vital signs.
Two minutes pass, the tech comes up to me with the completed EKG. It showed definite changes from the previous one four hours ago, but nothing "screamed" STEMI to me. Either way, I took it (and the previous EKG) and went to the doc. He looked at it and listened to my update. He immediately ordered another, right sided EKG and went to assess the patient.
Ten minutes later we called for Code 3 transport to another hospital with a STEMI center. She was having a right-sided infarct. I did all appropriate actions within that ten minutes--started a second line, administered aspirin, and gave another dose of Zofran. Total time from her complaint to transfer? Less then twenty minutes.
I shudder to think about what would have happened if I had just passed her complaint of feeling nauseous off on her gallstones. Transfers to a STEMI center from the floor can take *much* longer then transfers from the ER. I don't know what happened to that patient but I like to think that she's doing better now.