Young chest pain patients wait longer for EKGs
If a young patient walks into an ED with chest pain, he or she will wait longer than an older patient to get an EKG, according to a new study.1
Researchers looked at 214 patients with a chief complaint of chest pain, who also were at low risk for ST-segment elevation myocardial infarction (STEMI)/acute coronary syndrome. They found the overall median time to EKG was 29 minutes, but time to EKG was 42 minutes for patients 18-39 years old.
At Tallahassee (FL) Memorial Hospital, ED nurses use protocols that initiate an EKG even before triage, if a patient presents with chest pain or other symptoms related to MI at 30 years or older. "Our protocol allows the triage tech who signs the patient in to order the EKG if the complaint is chest pain and the patient is 30 years or older," says Freda Lyon, RN, BSN, MHA, service line administrator for the Bixler Emergency Center at Tallahassee Memorial Hospital. "If younger, they have to ask the triage nurse," she adds.
Lyon adds, "Any patient with chest pain, no matter the age or reason, is on our 'Immediate See List.' This means the triage nurse must lay eyes on them immediately and determine if they need an EKG or not. Our staff is taught to err on the side of caution."
Lyon has seen many patients younger than 30 who ultimately were diagnosed with an MI. Two recent cases did not involve chest pain. One 29-year-old man had been seen at another ED the previous week for elbow pain. He'd been given nonsteroidal anti-inflammatory medication and instructed to follow up with his primary care physician. He presented to Lyon's ED with severe elbow pain, a pain scale score of 10, and diaphoretic. "The triage nurse stated he just 'looked bad' and obtained an EKG. He was having an ST-elevated MI," says Lyon.
Another patient was a 25-year-old woman whose father had died a week earlier at age 44 from a massive MI. She presented to the ED with indigestion, fatigue, anxiety, and elevated blood pressure. "The triage nurse, for several reasons — the patient's family history, the patient was anxious, and something about the patient just did not look right — did an EKG," recalls Lyon. "Both times, the triage nurse saved these patients' lives by following their instinct."
Patients with crushing chest pain, indigestion, and left arm or jaw pain are "easy to pick up," she says. It is the female or diabetic patient with atypical symptoms that you must watch for. "Not everyone with an MI presents the same," Lyon says.
- Pearlman MK, Tanabe P, Mycyk MB, et al. Evaluating disparities in door-to-EKG time for patients with noncardiac chest pain. J Emerg Nurs 2008; 34:414-418.