PE misdiagnosed? Not on your watch
Don't ignore potential danger
A truck driver parked his 18-wheeler outside the ED at Emory University Hospital Midtown in Atlanta, and he told nurses he had some mild difficulty breathing and "just feeling like something was not right."
"He was alert and oriented, and his vital signs were stable. Our triage nurse brought him to a bed right away, where she continued the primary assessment," says ED nurse manager Donna McCloud-Forbes, MSN, RN, CEN.
Suddenly, the patient became unresponsive and had a respiratory arrest requiring immediate intubation and resuscitative efforts. A CT scan was performed immediately and showed several pulmonary emboli. The patient was stabilized, administered heparin, and admitted to the intensive care unit. "
This was thanks to the experience and the 'intuition' of our ED nurse. She was able to recognize the signs and symptoms right away, and after obtaining a quick history, knew the potential danger this patient was in," says McCloud-Forbes.
Vague symptoms
If your patient presents with sudden onset of difficulty breathing, tachycardia, and tachypnea, you'd probably think of pulmonary embolism immediately. Patients also might have subtle and vague symptoms, though.
"The patient may present with stable vital signs and just complaining of mild difficulty in breathing. This is a symptom of many different disease processes," says McCloud-Forbes.
A pulmonary embolism patient might or might not be experiencing chest pain, hemoptysis, and/or a change in mental status, notes McCloud-Forbes, and the patient might be diaphoretic, weak, and hypotensive. "In these patients, time is of the essence. We would want to start high-flow oxygenation, start a peripheral IV, and monitor vital signs and cardiac rhythm," she says.
Ask whether the patient has a recent history of being immobile, recent travel of more than four hours, and/or recent surgery, McCloud-Forbes says. "These are all risk factors for having a pulmonary embolism," she explains.
To reduce delays in administering anticoagulants to the patient, these steps are taken by Emory's ED nurses:
- Lab studies are obtained right away.
- Continuous assessment and monitoring is done, to detect subtle changes in the patient's condition.
- Standing orders are initiated before the patient is seen by the physician. "This saves a lot of time," says McCloud-Forbes.
- Heparin is stored in the ED's automated medication dispenser for easy access.
"We don't have to wait to get it from the pharmacy," says McCloud-Forbes. "We also have a CT scanner across the hall from our department, making it very accessible."
A truck driver parked his 18-wheeler outside the ED at Emory University Hospital Midtown in Atlanta, and he told nurses he had some mild difficulty breathing and "just feeling like something was not right."You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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