Thursday, January 26, 2006

Gut Feelings

Not every chest pain is a heart attack, and not every heart attack has chest pain. This is a truth known to ER nurses in all areas of the globe. So how do you know when it's serious - before you've done any interventions at all?

ER nurses develop a talent for gut feelings. We can tell when someone walks in the door if they will triage to a Level 2 or a Level 5 - just by the way they hold themselves. We can also tell if they are a narcotic seeker. Do not ask me how we develop this talent. We just do. The secret is closely guarded - one you will never find out unless you become one of us (insert evil laugh here)!

The other day Mr. Jones walked in - slightly bent over, a little pale, saying "My back hurts". I immediately pulled him through triage to the protests of 8 other people in the waiting room. "Hey! I was here first!" and "I have an ingrown toenail right here! I am before him nurse. I've been waiting 3 hours already!" rang out across the room. Some people truly believe that their infected hair follicle is more important than a gunshot wound, heart attack or a trauma. I had a person tell me once "I don't care if she's having a heart attack. I have an ear infection and I was here first." Well OK - let me take care of your life threatening ear infection instead of this person ready to walk through deaths door any moment. Yeah - you need the doctor much more than he does.

I rushed Mr. Jones to a room and hooked him up to the cardiac monitor. Tombstones - right there in front of me. No chest pain, no shortness of breath, no diaphoresis - just tombstones on that monitor. Immediately called the MD and another nurse into the room. This man is having a heart attack. Right in front of us - only he doesn't know it. IV's in, oxygen on, meds given, drips started - it all happens so fast.

How did I know this was not a normal complaint of back pain? It's that gut feeling. Something about them is registering in my brain - an unspoken, unseen force. It takes a while to develop it, but every good ER nurse does at some point.

You cannot survive in the ER without it.

1 comment:

Melissa said...

I have a question, even though I probably won't get a reply back on it...
But occasionally maybe once or twice a year I get this extreme piercing pain in my chest and it hurts to breath. Wasn't sure what it was. I figure it's not a heart attack because it would probably hurt a hell of a lot more. But the second most recent one I was just playing around with my sister pretending to wrestle and the other was when I was doing my regular jogging and all of a sudden it started to hurt and at times i just wanted to lay down and push onto my chest as hard as I could.
You may not even end up reading this but I just thought I'd see..