Seeing Red

[VickyRN, MSN, DNP, RN]

Please help me sort this all out if you can. Came on my usual night shift Tuesday in the cardiac step-down unit in a level one university teaching hospital. Had a patient who had been on the floor for several hours. This was a 70-year old gentleman who had been fairly healthy and who had presented to an outlying hospital with an active MI. He was rushed by ambulance to us and sent immediately to the cath lab for interventions (PTCA/stent, etc). While in the cath lab, on the table, with cath in progress, another pt presents to ED in more emergent state. So they stop the cath on my patient (no interventions yet--LAD occluded), send him up to the floor with sheath in place, to do the cath on the other pt. Well, time dragged on, the cath lab was very busy, and my pt was lost in the shuffle. The brilliant doctors decided to wait until morning to finish the job on this pt. Mind you, he is actively infarcting and they are aware it is his LAD. Apparently the doc's didn't want to incovenience the cath lab by calling in the after-hours crew to finish the job on this patient. Just wait till morning!!! The residents were clueless and annoying, writing their usual frequent, confusing and contradictory orders. Kept me in an uproar, so tied-up--difficult to see the big picture. It took NTG @ 100mcg's to control his pain; had heparin and integrilin going also. VSS during the night, thank God, but was having frequent nausea with emesis. Doctors aware. First set cardiac enzymes @ 1930 showed troponin of 7! Residents and fellow aware. @ 3AM MB's 120 range and troponin 32!!! Still didn't want to do anything. Charge nurse also aware. Everyone knows that time is muscle when actively infarcting. This patient would have been much better off if he had opted to stay at the outlying hospital and they had TPA'd him there! His family was so sweet and trusting. I, of course, feel like they have been betrayed. As soon as dayshift came on, one of the head doctors rushed him down to the cath lab first case. Have not been back, so don't know how the gentleman fared.

[hoolahan, ASN, RN]

Sounds like you are right, probably would've been better off where he was. What is more emergent than this man's condition?? A left main?? Wonder how much muscle this poor man lost. Very sad. It's seems like the elderly always get the shaft, doesn't it? We have all been in your shoes watching docs not do enough at one point or another, does this happen often where you are, bumping a pt off the table for another? Something very wrong with that in my book!