May 2, 2006, 2:04 am

Chest Pain: It Isn’t Just For Patients Anymore!

wierd pants

Ummmmmmmm……

I prefer our old friend Beulah France, RN (of New York!) and her lectures on harsh toilet tissue to this trio of psychedlic derrieres.

Trust me, even if Cottonelle was made of freakin’ silk I would never feel confident enough to wear those pants.

Torture wouldn’t make me wear those pants.

Offer me a date with Harrison Ford, I still wouldn’t wear them.

I’d look like a walking advertisement for a Wide-Cinemascope version of my grandmother’s old drapes!

Trust me, people.

It wouldn’t be pretty.


It began at rest.

A slight indigestion.

Maybe that chocolate muffin and cup of coffee that she had an hour before were not such a great idea.

Frequent burping and a bit queasy.

A couple of Tums should take care of it.

Should have.

Now there was a deep aching pressure in her left chest below the clavicle. Nothing she did changed it. No position was comfortable. A deep breath didn’t change it.

She sat there for an hour. She tried to call her husband at the office, she didn’t like what she was feeling. He wasn’t there.

An hour after onset she thought maybe she should take some aspirin. She had baby aspirin in the cupboard and took four of them. After all, she had a history of hypertension, high cholesterol, a family history of heart disease, mild ventricular hypertrophy and poor diastolic relaxation (or something like that).

But she didn’t want to overreact. Her labs had all been normal just yesterday.

Transient aching pains were radiating up her jaw and the aching pressure in her chest was radiating back into her left scapula.

The pain was constant. She knew something wasn’t right.

She got up and got dressed in case she had to go to the hospital.

When it reached her left upper arm, she sent her daughter next door to the neighbor’s house, where her husband had just gone after parking the car.

She grabbed her insurance card and a book in case she had to wait. You never know how long you’re going to have to wait.

On the way to the ER, she became slightly cool and moist, but that went away after she was in triage.

A room was found immediately.

Sinus Rhythm without ectopy. Blood pressure 136/92. O2 Sat 96% Pulse of 96.

Pain 8/10.

The ER doctor was nice but businesslike. Said they’d check for cardiac enzymes and get an EKG but he wanted to give her something for her stomach. He was busy. It was change of shift and he gets a chest pain fifteen minutes before he is due to go home. She could tell.

(Interestingly enough, the patient board didn’t have that many people on it, maybe seven, and she counted five nurses with assignments, not including the charge nurse or triage nurse. But the place sounded like a major disaster was in the works.)

Oh great, she thought. Female, fortyish and they aren’t taking this seriously. Hello, people!!!!! She didn’t HAVE heartburn. She had left sided upper chest pressure radiating to her left arm and scapula. Did she need to draw them a picture?

They gave her Maalox and Protonix.

Gee, don’t overdo it, guys.

EKG normal.

IV placed and a little over an hour later, labs were all normal. The pain was slightly better and had localized into the left shoulder with a heavy left arm sensation.

The ER doctor suggested Toradol, as he felt this was musculoskeletal.

Huh? Was she crazy? Weren’t they just talking GI? Toradol, sure, okay, why not?

Chest x-ray normal.

The Toradol worked.

Second EKG normal.

She was discharged with a prescription for Protonix, a diagnosis of Atypical Chest Pain and told to lay off the ibuprofen she was taking for her back.

Oh, and follow up with her doctor in one week.

She reached over to a drawer, found a two-by-two and dc’d her saline lock. She silenced her monitor and unhooked herself from the cables. After she dressed, she threw her saline lock in the sharps container, stripped the gurney, threw the linen in the hamper and waited for the paperwork.

And thanked God she wasn’t having an MI.


And that, ladies and gentlemen, is how I spent my Monday evening off.

In someone else’s ER as a patient.

I’m home now and doing fine, although a bit achy.A virus, perhaps.

But let me tell you something – IV Toradol is fantastic!

It took the pain I was having in my chest AND for the first time in five months, it took the pain in my lower back!

Dang!

That was a nice perk.

And it relaxes you, too. Who would have thought?


Here’s an interesting irony.

When the pain started I was reading Julie’s blog Life In the NHS and when I got the to the ER, my nurse had come over from England one year ago!

Hey Dr. Crippen, maybe all those English nurses are coming over here!

25 Comments

  • mary
    mary

    May 2, 2006 at 4:47 am

    Reminds me of a gall bladder attack I had once, the first and only (and hopefully last) time I have ever actually called 911 and said I needed an ambulance (well, OK, my husband called). I thought I was dying, sweat was dripping off my head onto the floor.

    Of course, in typical gall bladder fashion, miraculously almost as soon as I got there and monitored up and IV started—the pain went away.

    So I said: “I’m fine now, actually, just fine. Why don’t I just get dressed and go home?”

    But they wouldn’t let me! Hah, imagine that.

    Anyway, I do hope you’re feeling better! Having been postop a time or two, I know Toradol is the best!

    mary


  • punchberry
    punchberry

    May 2, 2006 at 5:04 am

    Hi Kim: I am glad that you are okay and hope you feel fully better soon!


  • Mama Mia
    Mama Mia

    May 2, 2006 at 5:09 am

    Whew. Glad the ending was a good one!! Take care of yourself, Kim!!


  • may
    may

    May 2, 2006 at 5:34 am

    first of all i am so with you with the pants. even my all time fantasy richard gere has to pay me before i will even consider wearing that one 🙂

    as for your ER experience, amazing how we all see everything that is happening despite an 8/10 pain. and i’m sure glad it was not an MI.

    i totally agree with the toradol.


  • Rita Schwab
    Rita Schwab

    May 2, 2006 at 5:35 am

    First of all, glad you’re okay. Thought for a while that story was going in a different direction.

    Secondly, I suppose it’s difficult to come up with creative ways to advertise toilet paper, but I don’t think those pants would look good on anybody. Not to mention the fact that the thought process of “Look at my behind in these form fitting duds, it’s okay, I use good toilet paper” is just a little too weird for me…

    And last, but certainly not least – congratulations on being mentioned yesterday in the San Mateo County Times!

    http://www.enochchoi.com/thoughts/archives/002141.html


  • Patrick
    Patrick

    May 2, 2006 at 6:00 am

    Your story had a much quicker ending than mine, at age 49. Mine ended up in the cath lab, with a stent in my circ, and now almost three months later fighting the side effects of Lipitor.

    Of course, I should point out it’s much better than the temperature of the surrounding earth…


  • Jenn
    Jenn

    May 2, 2006 at 6:35 am

    Toradol is my drug of choice, personally and for patients 🙂

    Very glad it wasn’t an MI.


  • Bob
    Bob

    May 2, 2006 at 7:01 am

    Whew! I was thinking this was going to end with something like “Unfortunately, her labs were switched with someone else’s, and she keeled over half an hour after getting home.” To know the “she” was you, oy! I guess it’s good to know that what feels like an MI may just be a pulled muscle. Better safe than sorry, of course.

    And those pants – if they make a matching shirt in a men’s cut, I’ll take it! Louder is better!


  • Kelly
    Kelly

    May 2, 2006 at 7:38 am

    I knew it was you the whole time….

    ….but I was hoping all you had was indigestion!

    What DID you have? I’m medical saavy, but I can’t quite figure it out. What’s the significance of Atypical Chest Pain? Is that like your sternum having a bad day or something?


  • Dr. Deb
    Dr. Deb

    May 2, 2006 at 7:39 am

    Glad you are okay after all that.


  • TC
    TC

    May 2, 2006 at 9:19 am

    You know, I tell my kids all the time “Do.Not.Make.Me.Spend.My.Day.Off.In.The.Emergency.Room.”

    Glad you’re okay!


  • Julie
    Julie

    May 2, 2006 at 9:45 am

    I hope I am not responsible for the chest pain, cardiac, musculoskeletal or GI?

    Glad you are feeling better and glad the back felt better too!


  • Soar Loosers
    Soar Loosers

    May 2, 2006 at 10:58 am

    What? No GI cocktail. Just Maalox with out the viscous lido? Protonix? Doesn’t work that fast and rather expensive, ain’t it? Was it IV protonix? If you were in our ED, we would’ve gotten a GXT… then you’ll have a real heart attack after seeing the bill!


  • Susan
    Susan

    May 2, 2006 at 11:30 am

    I’m so happy you didn’t have an MI! Who would we read everyday then?


  • enrico
    enrico

    May 2, 2006 at 12:26 pm

    First of all, I’m glad it wasn’t an MI or anything (at least from what was studied) having to do with CAD. Excellent.

    I’m glad the Toradol worked for you, but I would have thought it would have ripped your stomach a new one if you were already having dyspesia/heartburn to begin with, but what do I know…the important thing is that you feel better and all checked out!


  • ltaylor
    ltaylor

    May 2, 2006 at 1:12 pm

    Kim – be sure to follow up w/your doctor. Hubby had same issue and enzymes & EKG were normal. However pain persisted and the tests were still normal – EKG was done while he was having another chest pain attack! Luckily we got an excellent ER doc…he would not just RX muscle relaxers & toradol and send him on his way. He ordered cardio consult and they decided to do stress test, at that time they noticed irregularities. Hubby was admitted and stented (in 3 places) the next day.

    There was a good vessel over the bad vessel so the EKG could not pick it up. There was evidence of a heart attack in the past. I brought him to same ER over a year ago thinking he was having a heart attack. All tests negative, said it was stress and they sent him home w/fiorinal. I believe it was around that time that he had the actual heart attack.

    I feel like warning everyone – during the first visit he was advised to follow up w/doc. Which he did (wow!) however, they recommended stress test…which he did not do (men!) This may have been avoided if I had tied him up and forced him to do that stress test.

    Side note for medical personnel. He had a reaction to the heparin used in the first procedure. They actually did two stents in one procedure and the third about a week later. All went well, but at home he kept complaining that he felt strange. Not at all the same as the first procedure. When I saw a pinpoint rash all over his body and rushed him back to the ER. His platelet count was 1000 (or 1) he spent the entire month of November in ICU until his platelet count was back up to 70,000 (70) and he has continued to recoup those lost numbers. SCARY!! No clots thankfully, so it was a happy ending. He will not go near the hospital now for fear they wont let him go home ever again.

    Thought you might be interested in that tidbit – which is a rarity. We live in a large suburb but they could not remember one of these in over 8-10 years. He was the talk of the staff w/many docs reading his chart.

    Take care of yourself. I love reading your blog and I would miss it terribly. I am glad you behaved yourself as a patient. LTAYLOR


  • Jodi
    Jodi

    May 2, 2006 at 4:11 pm

    OMG! I’m glad you are doing better. Take care of yourself Lady!
    (I’ll bet the nurse appreciated you d/cing your own IV…lol) Did she make you write a narrative about how it was d/ced intact?
    Rest!


  • Janet
    Janet

    May 2, 2006 at 5:50 pm

    Whew! Close call! I’m glad you are okay. It’s and interesting experience being on the patient side of things, isn’t it? Take care of yourself.


  • marj
    marj

    May 2, 2006 at 8:51 pm

    Yikes! I’m so glad that you’re OK!!! It has been said that nurses (and docs) make the worst patients. So… Hmmm… Was that true for you? 🙂


  • Doc Shazam
    Doc Shazam

    May 2, 2006 at 11:03 pm

    You really should get a stress test this week. Maybe even today. I’m not so sure I would have let you go home, and I probably would have given you some nitroglycerin to see if that helped the pain at all.

    The issue that LTAYLOR is talking about is called “Heparin Induced Thrombocytopenia”. I’m not sure what the incidence of it is, but it’s not all that unusual, it just requires some different medications, one of which is derived from LEECHES! How cool is that? !


  • Flea
    Flea

    May 3, 2006 at 6:08 am

    A toast to Kim’s full recovery – A round of Toradol for my mates and I’ll take a double!

    Flea


  • NPs Save Lives
    NPs Save Lives

    May 3, 2006 at 7:29 am

    Dang! I was sure it was going to be an atypical woman heart attack. I’m so glad that you are okay.. Please consider getting a stress test anyway.. You know how cardiac symptoms in women are so vague… Big Squeeze to You!! P.S. Link is up on my other blog as well…


  • Hannah
    Hannah

    May 3, 2006 at 10:44 am

    I knew it was you–but didn’t realize it was so recent. I haven’t been “sick” since being in school…but have been to the doctor with my son recently. It’s different “knowing” a bit more than I did in the past. I wonder, did they know you are an ER nurse? I’m glad you well and that that the Toradol worked!

    Hh


  • ltaylor
    ltaylor

    May 3, 2006 at 12:41 pm

    Flea – I think the incidence of HIT is not as rare as the severe reaction he had and he did not respond to the above mentioned medication for almost two weeks. Most of the staff had never encountered a platelet count that low. He did not have any clotting at all (thank goodness because of his recently inserted stents) but did have spontaneous bleeding everywhere. We could never remember what it was called so we kept saying Heparin Induced Tiki Barber….(for those in other locals Tiki Barber is an American Football Player)maybe one of the medical pros can provide the additional terminology. He will have to have his blood checked again this year, but things are great now. Thanks Dr. Flea for the explanation.


  • Dreaming mage
    Dreaming mage

    May 4, 2006 at 11:14 am

    I had a similar experience only opposite in some respects quite recently. I had the crushing pressure/pain in chest, no radiating pains, no fluctuation. I have a history of anxiety attacks, the only reason I went was because something felt worse this time.

    They checked EKG and blood work and found nothing wrong. Nitro didn’t ease the pain, but an IV injection of Ativan stopped the pain in it’s tracks.

    What did they do? They admitted me, and over the next 28 hours subjected me to every expensive test and scan they had on the menu, just because nothing else is wrong. The blood work wasn’t just good, it was SUPERB. And there was the history of anxiety attacks.

    Now I’m out $2500 EXTRA because they wanted to be sure I couldn’t sue them. I’m not counting the ekg and blood work, they were totally called for.

    I wish there were a way to sue them for unnecessary tests, but alas…

    Mage


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

Continue reading »

Find Me On...
Twitter     Technorati

Subscribe to Emergiblog

Office of the National Nurse

Zippy Was Here


Healthcare Blogger Code of Ethics

  • Perspective
  • Confidentiality
  • Disclosure
  • Reliability
  • Courtesy

medbloggercode.com