SOB and Chest Pain....

[lm8539]

If a patient with a history of asthmatic disorder came in to the ER w c/o chest pain and shortness of breath, based on this patients history, what would you do?

[MassED, BSN, RN]

And no it's not a HW question....none of them are. I have already graduated and have my RN. The problem is I graduated a couple years ago and I am just now looking for a nursing job and I'm rusty so I need help. I already took one refresher course that did not have clinicals. I am going to take a course with clinicals in February. But in the meantime, I am reading up on nursing scenarios and trying to get help with my critical thinking skills....

I am rusty on hospital policies and procedures, what the standing orders might be, and things of that nature as I have not been in a hospital in awhile.....can I find that in a book somewhere? I will be glad for the recommendations....

policies are specific to where you work, so you wouldn't be able to brush up on those until you are working.

[mcknis]

Same here...chest pain protocol. ASA chewed, EKG, VS, CK/Trop, CXR and then we go from there. If the MD wants anything else, he can order...if STEMI noted, then its a 'hail mary' from there on. All hands on deck, if you will. I don't like to take anything lightly, but if you come in with complaints of jaw pain after a bar fight, and chest pain secondary to a few fist bumps, then no cardiac workup for you. All patient specific!!!

[msrn1204]

It depends on the age of the pt. if 30 and over...02, monitor, ekg, line/lab, nitro, asa....then continue with assessment until MI is ruled out. If under 30 but has a cardiac hx then the above mention appy as well. If under 30, no cardiac hx, then 02, breathing tx, saline lock and solumedrol, is pain with cough? is there pain with inspiration? Is the cough productive? If so what color? etc..etc

[MikeyBSN]

I can't believe most of the responses have EKG's and troponins on this patient without even asking her age. For all we know this patient could be five.

[MikeyBSN]

MIs can present similar asthma. chest tightness, wheezing. I would be careful giving someone in an MI situation brochodilators, as they can cause arryhtmias, and increase work on the heart. I would follow the ACS algorythm first.

I disagree. If this patient is wheezing then they have an airway problem. Technically, an MI is still a cardiovascular problem. Without the airway, the cardio issue is irrelevant. Of course, you would still have to use some clinical judgment to determine the extent of the wheezing and whether it is causing hypoxia. Again, the first thing I would want to know is that patient's age. Then I would want to know what their lungs sound like before going crazy with the cardio.

[celclt]

throw a d-dimer in there for good measure - I threw a PE last yr and sat my h/o asthma, chest pain, recent cross country flight, diaphorectic, swollen legged self in triage...

[amb_lyn]

Also, in the ED, you don't have to "contact" the MD. They are already there...

Some ED's the physician is not in house, you do in fact have to contact them via phone, pager, etc.. Especially in smaller rural hospitals.