Pt with chest pain

CoffeeRTC, BSN, RN · Jan 21, 2016

Is this an after the fact question?

I would do my assessments, call MD. A chest X-ray and ekg could take hours. Do they have nitro? Cardiac history? What were vitals like? Did you rule out gastrointestinal? Anxiety? Resp issue?

If it's a 911 situation, I don't wait for the MD to return the call...5 minutes can make a difference. I'd also get the AED and crash cart ready.

Fishmm · Jan 21, 2016

not after fact for me. The other day a patient c/o chest pain and the nurse called MD, MD ordered EKG and that's that. Two days later Pt c/o chest pain, MD ordered CXR. The nurse on shift did not think of anything wrong with it . But I did not think it made sense. So I asked. yes, Cardiac history, pt refused nitro. Not indigestion or Anxiety.

Cruella de ville · Jan 21, 2016

What was the patient's code status? Are they qualified to make their own decisions or do they have a health care guardian/POA? What did their family want? Aggressive care, or no hospitalization?

What were their vitals, assessment? Why did they refuse nitro?

Did the patient have a pacemaker or implanted defibrillator?

What did the nurse do to address the pain? Did the patient receive any pain meds or were they just expected to sit in pain for days?

Did the nurse offer Maalox?

Was there a charge nurse or DON, always go up the chain of command if you are unsure about what most people would consider an emergency situation? You would want to know if they would back you up if there was a negative outcome.

Cardiac patient with chest pain can be an emergency, usually safer to err on the side of caution rather than waiting.

Fishmm · Jan 23, 2016

the pt's code status was full code. Had pacemaker and ACID. Not sure what the vitals were and whether the nurse offered Maalox. It was an after fact when I heard of it.