NARRATIVE A 85 year old female patient presented to the emergency room with chest pain radiating to her jaw and neck. Patient states she has had episodes of dizziness for the past two weeks. Patient states she was sitting in a chair this morning when she developed chest. She took 81mg of aspirin and 1 nitro with no relief. Patient’s daughter brought her to the emergency room. Upon arrival, an EKG showed normal sinus rhythm. Vital signs were stable with BP 135/82, HR 90, RR
22, O2 94% on room air, and temp. 36.8c. CK was within normal limits and her troponin peaked at 0.03. Chest x-ray showed no acute disease processes. The emergency room doctor informed the patient and daughter all tests were within normal limits and he would be discharging the patient home. The patient and daughter were not comfortable with being discharged. They wanted further testing. I approached the doctor with their concerns, but he decided to proceed with the discharge. I then contacted the patient advocate and case manager to intervene for the patient. After they consulted with the doctor, it was agreed upon to order further tests. Patient suddenly became short of breath, diaphoretic and dizzy. Vital signs were BP 165/95, HR 109, RR 30, and O2 80% on room air. I immediately administered oxygen, and then contacted the doctor and respiratory therapy. Patient was stabilized after respiratory therapy placed patient on BiPap. Patient was taken for a CT scan of the head
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