I have a patient experience that I need to share. In sharing, I hope that at least one other person visiting an Emergency Department with an aortic dissection, is diagnosed and on an operating table for repair hours sooner than I was.
I live in Canada and in September of 2018, I was a healthy, 52 year old woman. I didn’t have hypertension. I didn’t have an aneurysm. I surely didn’t know that genetically, I was
predisposed to familial arterial disease!
One day I was shaking out a heavy floor mat, while holding my breath as not to breathe in the dirt and dust, when suddenly I felt a searing, sharp pain from my sternum to my back. I thought that I pulled a muscle really bad. I tried applying a heating pad. I took ibuprofen. After thirty to forty-five minutes of excruciating pain, I asked my family to bring me to the local Emergency Department.
Upon arrival and after triage, an initial incorrect assumption was made, and subsequent incorrect therapy was given. The assumption was that I was having a MI. Since more people with complaints of chest pain are having myocardial infarctions (heart attacks) than aortic dissections, I was given two acetylsalicylic acid (ASA) tablets. Then I was worked up for a MI, which took over an hour. My “stat” troponin level and EKG took over an hour to do. Those tests came back negative for a MI, so we were back at square one.
I was in anguish. I was being given morphine at the maximum dose, and my chest pain was still severe. I couldn’t get comfortable. It was only at that point that I started to give my family history to the ER doctor and once I mentioned that my dad had died last year from an aortic aneurysm that dissected, I saw a light come on in the doctor’s eyes. Instantly, a CT Angiogram was ordered and finally, the diagnosis was made: A Type A Aortic Dissection! Well, as luck would have it, this big city hospital wasn’t equipped to do this type of surgery.
I was quickly moved to a trauma room. I was very scared as this room was where my dad was brought to the year before and where he lost consciousness forever.
I was given sedation. The process to move a patient to a move qualified surgeon in Canada is called CritiCall. Though this was initiated, this was also full of more delays in getting me to a qualified Cardiac Surgeon and onto an operating table. There were weather issues preventing ORNGE Air Ambulance from getting me to the first hospital that accepted me, so Plan B or maybe even C, was initiated.
All in all, from the time I presented to the ER Triage Nurse until the time of my emergency lifesaving open heart surgery with Dacron graft repair was almost 14 hours! I could very well have torn completely and died.
Emergency departments: You need to listen to patients and not automatically give ASA for chest pain! You must start asking about family medical history during your initial assessment. You need to do CT Angiograms for complaints of severe chest pain! Big city hospitals: You must have the capability to do complete cardiac surgeries!
I hope that in the very near future, no other patient seeking help at their big city hospital’s Emergency Department is told that they can’t help them. I am still affected by this helpless feeling and needless delays, two years later