Pt with Chest Pain in a docs office

Neveranurseagain, RN · Aug 21, 2008

In addition to an AED, nitro, IV supplies, pocket mask, ambu bag, O2 and BP cuff/stethoscope, you should have supplies in event of an anaphalysis in the office. Benadryl, both IV and oral as well as Epi 1:1000 for subQ use should be available and part of a code kit. The kit needs to be checked monthly for completeness/expiration dates.

Also you should have a yearly drill (or any time you hire a new employee) and how to handle an emergency in your office as well as a P&P to follow. Remember to include things like what door the ambulance/fire dept door is going to use, who responsibility it is to meet /direct them to the right area, who calls 911 and where is the ambulance going to park. Be sure the staff is CPR certified also.

I used to have a health care services business and one component was teaching MD offices CPR/First aid and training in emergency care.

As far as having to look for a BP cuff, I feel EVERYONE that is seen in an MD's office, no matter the speciality, should have a BP every visit. There is a reason hypertension is called the silent killer. Heck, even my dentist takes a BP every visit!

Bluehair · Aug 21, 2008

Not sure I am in agreement with some previous posts. What is your/staff liability in using much of the equipment if you aren't ACLS certified? I agree, an AED would seem to be minimalist equipment, along with some O2, ambu, & vital signs equipment. Who checks and refills your O2 tanks? How comfortable are your ortho doc's in writing an order for nitro s.l., especially for someone with no known cardiac history? Does the staff know how correctly administer Nitro, to use an AED/ambu/any/all of the above?

A number of facilities I have worked at in the past preferred to have the policy of calling 911 immediately, rather than try to maintain real competency on equipment, dates on drugs (who supplies meds to your office?), etc. Especially if there is a high turn-over on staff.

Just a differerent view...

Nursonegreat · Aug 21, 2008

The comments are all excellent. i will be bringing this up when the main nurse gets back form her vacation. this particualr pt had hx of stents and used nitro in past. after reading comments, agree that nitro might not be the complete answer...but if we can come up with a P&P and training we can always handle situations that arise anytime.

like i said, i have never worked in an MD office, just PACUs so these were issues i had to deal with as we are already prepared there for these kind of emergencies......thanks to everyone for their comments and input, please keep it coming! Ignorance is not bliss.

ruralnurs · Aug 21, 2008

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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.

That is crazy! In any ER chest pain should be considered cardiac until proven otherwise. If we get anyone that complains of chest pain, chest pressure, chest discomfort, back pain with SOB, etc. they go right to the font of the line. We have standing orders that require we call the doc, do an EKG, cardiac monitor, VS, room air O2 sats then O2 4L NC, IV with lab draw, 81 mg ASA X 4 po, and Nitro SL, all within 10 minutes. And then we do chest X-ray ASAP.

That hospital is bad.............

Neveranurseagain, RN · Aug 22, 2008

AED training is now part of every CPR class. CPR certify your staff and they will know how to use an AED. The O2 tanks can be checked by the RN every mth.

You don't need to be ACLS certified to use an AED or O2 or perform basic care until 911 arrives.