May, 2006 Archive

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!

Read »

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...

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