I had a patient come back to me after cath lab one afternoon.  Her old stent was blocked; the stent itself was stented.  She returned with her sheath still in place.  A few hours and one ACT lab result later,  I pulled her sheath.  She tolerated it well, and the site looked great.  She still had another four hours to lay flat with the extremity straight.  I checked in on her frequently.  No problems.

I was giving report to the next nurse when she called complaining of chest pain.  She described mid sternal chest pain radiating to her back.  I medicated her and returned to the station to find her cardiologist sitting there.  Great, I thought.  I’ll go ahead and notify him in person of her current status.  If he hadn’t been there I would have immediately ordered a stat EKG and paged his nurse with any changes and/or continued pain.

He waved me away, saying  “Just give her medicine.”  As I started to walk away, he called out to me and said, “Don’t come to me unless its important.”

I went ahead and ordered the EKG – standing post cath orders, after all.  I let the next nurse know what he had said, and I documented my notification and his comment to just medicate her.  I didn’t add the rest of his statement; I wanted to do so, but I was sure it wasn’t appropriate to include.

I was standing there thinking the worst case scenario could be a re-occluding stent or new blockage from broken plaque particles.

His worst case scenario is a nurse bothering him with something so trivial as severe chest pain post cath.

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