Saturday, May 30, 2009

biggest oh shit moment ever

Holy crap. I have no idea even what to say, here, other than- I will never, ever, ever, ever again, get upset with a doctor for doing a full workup.
I had a patient last night who came in with epigastric pain- she had been in a week before and been diagnosed with GERD, gotten some nexium, which helped, and gotten a referral for a GI doctor. She told the people in triage and me that she only hurt after she ate, that she had no other symptoms, and that she wouldn't have even come back except for the fact that she was out of nexium and no GI doctor would take her insurance. I updated her vitals and put her chart in the doctor's rack and let her hang out, thinking she would probably get a prescription and get sent home.
I finally got orders back an hour or two later and the doctor had order an EKG and bloodwork. I was kind of annoyed by it all, as she was only in for a prescription refill and was putting her pain at a 4- I went back into the room and did her EKG while another nurse got blood.
If you hadn't guessed it by now- ST elevation. I re-ran the EKG. Same result. I nearly urinated on myself, and I got the doctor. We compared it to her old one, and there were definitely changes. We transferred her out within an hour. The odd thing was that her CIPs were negative- so it's still hard to say for sure what was happening, but she was a diabetic, so her chances of presenting with atypical symptoms was even higher.
It freaking figures that this would happen on my first night alone with critical patients. I felt awful, but the doctor and one of the other nurses on my team said they both thought the same thing. Lesson learned- I will never again bitch about performing and EKG or doing bloodwork.


  1. I had a pt. who got a full cardiac workup... difference was, there was absolutely no changes in the EKG, no positive cardiac enzymes, and the pain was totally related to the rotator cuff injury she had. What pissed me off was I heard the resident tell the pt. that the pain was probably related to the rotator cuff, and then he goes back and orders 4 sets of troponins. Meaning that I would have had to keep this poor woman an additional 12 or more hours in a recliner for a non-cardiac issue. She waited 4 freakin hours to be seen by this resident after he saw her EKG! Luckily for me, the attending came around and xnayed the whole thing, only asking for 2 sets of cardiac enzymes to be absolutely positive it wasn't cadiac.

    I'm stuck with this resident for another year... ech.

  2. That's generally how it goes with us- 25 year old girl with chest pain with coughing- let's do a full cardiac workup! I get why, now though- for every 100 of those there might be one who's actually having an MI. Yikes.