It is Heart Awareness Month. As an Emergency Room nurse, I have seen so many different symptoms present to triage. Triage is one of the more important areas in a hospital. We see every type of patient. We do not discriminate or turn anyone away and our doors are always open. As human beings we have a genetic make-up that is different from the next person; which can lend to various types of symptoms for the same ailment. We see the complete gamut from young to old and healthy to critically ill. Heart attacks come with a multitude of symptoms. As the front-line health care provider, we need to be very understanding, patient, and knowledgeable in advanced protocols and really listen to what symptoms that patient is describing to prevent further heart tissue damage as early as possible.
There are several orders that should be done if a nurse suspects a cardiac event. Nurses have the ability to order certain tests without a physician as an advanced protocol. An EKG is a very important test in determining cardiac damage. An EKG or electrocardiogram measures the electrical activity of the heartbeat. Some heart attacks will disrupt that electrical activity thus changing the normal rhythm. The national standard for door to EKG time is 5 minutes. Once complete, an ER physician needs to read it to determine if the patient needs immediate intervention.
A patient you suspect having a cardiac event should also take aspirin. If they have not had any prior to arrival or any contraindications, a patient should be given aspirin. It is recommended to have the patient chew the aspirin to aid in the digestion process and speed up absorption. The total dose of aspirin is 325 mg a patient should take including what they might have taken prior to arrival.
Labs should be drawn as soon as possible. This should be done in triage if a room is not available. Labs should include a troponin. A troponin level helps to measure cardiac health. Troponin is integral in muscle contraction in skeletal and cardiac muscle. This protein is released when the muscle is damaged, such as in a heart attack. The more damage, the greater amount of troponin there will be in the blood.
The patient will need an IV (preferably 2 if the patient will be going to the cath lab) and will be placed on a cardiac monitor. Controlling the patient’s pain is important as well. Pain during a heart attack is derived from the local hypoxia. When blood flow is restricted, oxygen and nutrients cannot get through thus resulting in tissue damage. Nitroglycerin should be the first medication given. It dilates blood vessels thus allowing a better chance of blood to flow around the blockage that is causing the heart attack. The narcotic morphine is also commonly given due to its vasodilatory properties in addition to treating acute pain. However, a few recent studies have shown a correlation between an increased mortality rate and the administration of morphine during certain heart attacks.
Randomized clinical trials need to be performed before an official link can be established.
If it is determined the patient is having a heart attack, the patient should go to the cath lab (baring any contraindications) to have the clot removed. National standards measure the interval between the patient’s arrival in the emergency department and when the catheter guide-wire or balloon reaches the clot. From the time the patient comes through the doors all these steps need to take place quickly because time is muscle. Any delay in treatment will increase the likelihood of cardiac muscle damage. The National Standard for Door-to-Balloon time is 90 minutes or less. This will produce the best patient outcomes!