Suspected Ischemic Cardiac Chest Pain In Emergency Department

To determine if the patient’s chest pain is related to cardiac ischemia, you would look for ST-segment depression and/or T wave inversion. If the ST-segment depression is at least 1mm (one small box) below the isoelectric line, it is significant and occurs in response to inadequate supply of blood and oxygen, which leads to an electrical disturbance. Once this is treated, adequate blood flow is restored, the ECG changes will resolve, and the ECG will return back to patient’s baseline.

In the evaluation of patients with chest pain, the preliminary ECG is a more clear-cut tool for early risk stratification with more recent recommendations indicating that ECG should be performed as early as possible, within 10 minutes of ED admittance. Early indicators associated with MI or ischemic complication such as ST segment elevation or depression allows rapid treatment aligning with the indicated complication. While the ECG may reveal significant indicators in certain situations, in other circumstances findings may be limited due to low diagnostic sensitivity

“Long wait times could potentially result in worse patient outcomes, greater patient suffering, patient dissatisfaction, more difficulty retaining and recruiting staff, a higher risk of infectious disease outbreaks and an increased risk of medical errors” (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 456). This article explored how the addition of nurse practitioners and physician assistants in 6 Ontario emergency departments could help to reduce wait time, patient flow, and the number of patients who left without being seen (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 455). This study was seen to be the first of its kind in analyzing effects in an emergency department on patient flow by adding nurse practitioners and physician assistants to the healthcare team (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 459). The quantitative study design used for this study was the experimental design since it was based on implementation and evaluation of the effects (Keele, p. 41). The article does not address how the sample size was determined and actually

Recent updated NICE guidance recommends 12-lead electrocardiography as soon as possible in patient with acute chest pain but warns not to exclude ACS if the ECG is normal (Cooper, Timmis, Skinner, 2010).

A non-ST elevation acute coronary syndrome (NSTE-ACS) is a very common presentation to emergency departments everywhere, as well as primary care practices. Therefore, it is important that all providers be well informed on the effectivity of certain treatment regimens.

The purpose of this paper is to discuss a new best practice, the necessary steps for implementing the new practice, and support this change in practice with current literature. Heart disease is the leading cause of death in the United States. Evidence-based clinical practice guidelines regarding patients with ST-segment elevation myocardial infarction (STEMI) seek to reduce variation in practice and improve outcomes for this patient population (O 'Gara et al., 2013). Current evidence-based practice includes immediate reperfusion therapy to the involved coronary artery in this patient population. However, it is often challenging for emergency department nurses to implement the initial steps of this evidence-based practice, which includes obtaining a 12-lead electrocardiogram within ten minutes of arrival, as some patients present with symptoms other than chest pain, or atypical symptoms. For instance, atypical presentations include shortness of breath, altered mental status, upper extremity pain, upper back pain, generalized weakness, and abdominal pain (Glickman et al., 2012). Ultimately, this results in delays of reperfusion therapy.

Time is obviously a critical factor when seeking medical attention. Emergency room nurses triage incoming patients based on the severity of their illness or injury. While an ER is required to attend to all patients, many find themselves waiting a very long time as other individuals

Mr. Smith is a 56-year-old Caucasian man who is being evaluated in the emergency room with progressively worsening chest pain that began 2 hours ago. The patient describes the pain as pressure in the center of his chest. He rates his pain 7/10. He reports the pain is now radiating down his left arm and through to his back, he is diaphoretic, and complaining of shortness of breath. He denies nausea or vomiting.

Several surveys among health practitioners and nurses have revealed satisfactory usage results. The respondents stated the system was simple to use, reduced the subjectivity of the triage decision and was more accurate than other triage systems (Singer, Infante, Oppenheimer, West & Siegel, 2012). The rapid identification of patients that need immediate attention is one of the benefits of the emergency severity index. The system focuses on the fast and accurate sorting of patients in cases where there is shortage of adequate resources for treatment of emergency patients. The emergency severity index (ESI) uses a five level categorization process that is used to rapidly sort emergency patients into five groups that are based on clinically meaningful differences and projected resource needs available. Another positive outcome of the emergency severity index is the improved flow of patients through the emergency department as patients categorized as level one and two can be immediately taken to the treatment area for rapid evaluation and treatment. Patients determined by the triage nurse to be lower acuity can safely wait to be attended to after the higher acuity level patients are cared for. There are other benefits of the system that include determination of the patients who do not need to be seen in the main

Chest pain has many definitions ranging from a sharp stab to a dull ache. Chest pain can be described as crushing or burning. In certain cases, the pain travels up the neck, into the jaw, and then radiates through to the back or down one or both arms. Many different problems can cause chest pain. The most life-threatening ones involve the heart or lungs. Because it can be difficult to determine the exact cause of chest pain has been associated with a short-term mortality of 2%, as well as major risk of liability. Identifying patients with chest pain who are at risk of adverse events is important not only to ED physicians but also to all physicians who evaluate such

The clinical diagnosis can be determined by performing a careful physical examination and an assessment with an electrocardiogram (Wilensky, 2012). A full clinical testing as well as blood tests can be done to diagnose unstable angina. Blood tests include testing for myocardial necrosis with troponin I, troponin T and myoglobin (Marshall, 2011). The presence of these biochemical markers are indicative of a myocardial infarction and not unstable angina. Additional testing includes an echocardiogram to assess cardiac wall abnormalities and left ventricular function (Marshall, 2011) as well as stress testing for ischemia testing (U. S. Department of Health and Human Services,

Myocardial infarction in most cases is usually experienced in the setting of coronary artery disease. A sequence of events is followed

Several existing problems precipitated the creation of the triage system implemented by Kathryn Angell in an effort to deliver improved medical care. The main problem was a lack of coordination in service delivery. This lack of coordination caused excessive wait times on the order of anywhere from 23 to 40 minutes to see a nurse, 40 to 50 minutes to see a doctor, and as long as 55 minutes to get a prescription filled. The practice of all nurses being involved initially in seeing all patients caused duplication of efforts, including repeating questions and examinations, and resulted in procedural bottlenecks. Additionally, there were inconsistent levels of service and extreme variation in treatment because of the different experience

Coronary heart disease have three clinical types; Non-ST segment elevation acute coronary syndrome (NSTE-ACS), unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI).Among them NSTE-AC have high mortality rate. Correct diagnosis and early management are important to improve clinical cardiac events in patients with Non-STEMI. The manifestation of serious cardiovascular adverse events varies markedly in ACS patients with enzyme markers, typical clinical features and electrocardiogram (ECG). Risk stratification may be helpful for the planning of early treatment program with drugs or coronary angioplasty. However, the accuracy of disagreement risk stratification such as normal or elevated value of troponin, normal or abnormal ECG is inadequate for prognosis interpretation, more information is needed.

Patients suffering from acute Myocardial Infarction (AMI) /Coronary Heart Disease (CHD) are common incidents regularly attended by the Ambulance service on a daily basis. In the United Kingdom, CHD accounts for about one-third of all deaths in people aged 35 years or over and is the leading cause of death (British Heart Foundation 2010).