Pt with Chest Pain in a docs office

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Situation today: Pt was in to see doc on a f/u. before seen he c/o chest pains. i was called over. This is an ortho docs office with a surgery center and PT/OT dept attached. i do triage calls at this office ("campus" its called) i am new on the doc side (i work surgery center too). took a few min trying to find a BP cuff and stethoscope. got his vitals and assessed, called 911. asked hey, can we get some nitro from the surgery center? someone went to get it. after its all said and done...am thinking we should have an emergency kit on the docs side (for times when the surgery center is done for the day and if a pt has CP again--noone there to get the nitro...)...my question is this:

anyone work in a docs office? do you guys have a kit? is there nitro and asa and o2 available?? or just call 911. this is not like a reg docs office (like a PMD or family doc) where they do BPs on everyone. we did find a cuff and stetho, but would it not be a good idea to have everything together in one place, easily accessible and everyone knows where it is?? please give me some input and if there is such a thing...what do you ahve in your kit?? thanks everyone!!

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As a patient, I have noticed here that the Dr. offices have a nitro taped right to the cabinet door in each individual room. I think it is a good idea.

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Specializes in med-surg.

I stopped by to make a an appt about regular chest pains. The receptionist refused to make an appt and told me I had to go to the ER.

I went to the ER where I was left sitting for hours. When the ER nurse updated vital signs (after I had been there for 3 hours with tears running down my face because it hurt so much), she decided to not update mine. At that point I left and went to another ER a mile away where I was seen immediately.

Not a heart attack, its probably an ulcer--but I am waiting on getting a new doc now that I have health insurance. My former primary provider was great until I no longer had insurance, and then my aches and pains simple had to do with stress.

Just griping about crappy docs I guess. Many offices are unprepared for emergencies. I think I would be safer coding in my VET'S office.

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Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

I think it would be a great idea to have a kit put together for emergencies. I have worked in a Drs office for quite awhile and have had a car vs. pedestrian accident patient, a few MIs, a stroke or two, and many other assorted things come through the door. Even specialty offices should be prepared, many patients see a Dr as any other Dr and don't give a thought to their speciality, as evidenced by requesting BCP refills from their psychiatrist or Lanoxin refills from their podiatrist. Our "kit" has a stethoscope and cuff, ammonia capsules, ASA, Nitro, IV starter kits with a bag of saline, bandages, sterile gloves, and other things I can't remember now. We also have an AED.

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Some things to think about before making NTG available at an ortho outpatient facility:

- Would you be able to ensure that all employees who could access the nitro would receive training in its administration? This is a particular concern since they likely won't be regularly giving it in this type of setting.

- Is 12-lead EKG available? It can help you determine when it might be unsafe to give, like patients with suspected right ventricular MI.

- Can staff members initiate an IV and give fluids in the event that the pt becomes hypotensive after NTG?

- How long does an EMS response typically take?

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Thanks so far for all the comments, keep bringing them! Thanks Eric for food for thought.

There is always a bunch of ortho docs in the building while on hrs are going....then after 4pm there is a clinic for emergent, non open breaks (ortho) so there is always a PA at least on premise. i think it would be great to have at least a box where a central cuff and stetho is readily available....

I defintely smell a new P&P to be created so we can get some basic guidelines...seems like these things are really thought of until an emergency occurs.

Please keep the comments coming! i appreciate it!

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Specializes in ER.

If I knew my doc's office didn't have equipment available to take vitals I'd switch, even if it was a dermatologist.

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Specializes in Nephrology, Cardiology, ER, ICU.

To add to Eric's post:

1. I'm an APN in a nephrology practice. I am the ONLY mid-level (including NPs and PAs) that has EVER participarted in a code or is ACLS certified). What I'm getting at is just because you have a PA or even a physician, if they are not comfortable with codes, you are still lost.

2. Agree with having ASA, but disagree with NTG - first - you have to have an individual bottle for each patient, you have to be able to monitor the patient's vital signs and you need to be able to start IV and infuse fluids if pt becomes hypotensive. (Are ALL your staff able to start IVs VERY proficiently in an emergency?)

3. You do need an AED, oxygen, ambu bag, suction canister and machine that WORKS ALL THE TIME, ability to take BPs on all size patients and a stethoscope. For an outpt office, that is about all I would want.

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awesome input, thanks Trauma. these are things i have never had to think about as i work at the surgery center, where we have all of that equipment (obviously). my concerns are new and it is unknown territory as i have never worked in a docs "office" til just recently. so my inquiries are very fresh and dont know what SHOULD be there, just think something is missing. BTW we do have an aed in doc area and thankfully FD is right around the corner...... thank you all so much!

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We give NTG to patients all the time in our nursing home. We do not have an EKG machine nor do we have the supplies in house to start an IV. We call the pharmacy to put one in on the rare occasion we need one inserted. Just a little nervouse now

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Patients also self-administer it at home all the time as well. When you're dealing with patients who are being followed/educated by a primary provider and have an established diagnosis of angina, it seems at least a little bit safer.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
You do need an AED, oxygen, ambu bag, suction canister and machine that WORKS ALL THE TIME, ability to take BPs on all size patients and a stethoscope. For an outpt office, that is about all I would want.

Agree with traumaRUs. This should suffice for any BLS-equipped clinic.

One thing to add to the above. Pocket masks. Some individuals are not proficient with ambu bags and often bag the stomach. Until someone can effectively operate the BVM, pocket masks will suffice.

Also, taping medications to the cabinet doors in individual rooms is not good practice. Anyone left unattended (including children) could gain access, take the meds, etc. No drug should be left unattended.

Medico-legally speaking, if Practices utilize a resuscitation kit, they must be complete; all drugs and/or equipment in working order, all drugs and equipment with current dates (nothing expired), equipment necessary to carry out any ACLS scenario, and Policies and Procedures in place. Also, all personnel must be current in BLS and AED and licensed personnel current in ACLS.

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