Have you ever had a patient come in to the ER
accompanied by a couple of police or court officers? Sometimes they don't even
get a chance to make it to jail, but most of the time they get a chance to
spend at least a few hours in the cell before they get hit by a severe case of
incarceritis. Most of the time it's a life-threatening condition that causes
the patient to experience extreme level of pain and anxiety. What makes it
really worrisome for healthcare professionals is when a patient has a
documented (although, in most cases, untraceable) history of a serious
preexisting health condition. It can be a MI (which stands for myocardial
infarction aka a heart attack), diabetes, CVA (aka stroke), necrotizing
fasciitis, testicular torsion (Google these last two if you need to), or any
other scary-sounding medical problem that makes you shiver and cross yourself
in the hopes that you or your children or your grandchildren or the next seven
generations never be cursed to suffer from.
So when a patient with a history of, let's say, MI presents to the ER complaining of severe epigastric pain accompanied by nausea, shortness of breath, and (according to him) diaphoresis at the onset of symptoms, you, as an emergency nurse, jump into action and unleash a whole slew of all the tests that you can possibly do prior to MD even laying his or her eyes on the patient. Cardiac monitor and a full set of vitals? Done! ECG? Done! Blood work including the troponin level? Done! IV access? Done! Maybe even a 160 mg of baby Aspirin? Done!
And then, finally, a doc comes into the room and assesses the patient, and orders sublingual Nitro spray q5min PRN for pain. And the first thing that comes out of the patient's mouth is that Nitro NEVER helps with this pain and only gives him headaches. And that if you give him Tylenol or Advil for his headache it won't do any good. And that he needs something stronger than that. And than you realize that you didn't even need to go to med school to confidently diagnose this patient with incarceritis.
And an hour later, as you've already predicted, the patient's blood tests all come back normal, and his troponin level is better than your own, and multiple ECGs that you did on him trying to catch any changes all turn out the same, and two Percocets mysteriously and suddenly relieve his pain, and you ask the doc to please re-assess the patient. The patient gets sent back to jail with the official diagnosis of chest pain NYD, and you give yourself a pat on the back and go buy yourself a latte because you knew all along that the patient suffered from acute incarceritis.
So when a patient with a history of, let's say, MI presents to the ER complaining of severe epigastric pain accompanied by nausea, shortness of breath, and (according to him) diaphoresis at the onset of symptoms, you, as an emergency nurse, jump into action and unleash a whole slew of all the tests that you can possibly do prior to MD even laying his or her eyes on the patient. Cardiac monitor and a full set of vitals? Done! ECG? Done! Blood work including the troponin level? Done! IV access? Done! Maybe even a 160 mg of baby Aspirin? Done!
And then, finally, a doc comes into the room and assesses the patient, and orders sublingual Nitro spray q5min PRN for pain. And the first thing that comes out of the patient's mouth is that Nitro NEVER helps with this pain and only gives him headaches. And that if you give him Tylenol or Advil for his headache it won't do any good. And that he needs something stronger than that. And than you realize that you didn't even need to go to med school to confidently diagnose this patient with incarceritis.
And an hour later, as you've already predicted, the patient's blood tests all come back normal, and his troponin level is better than your own, and multiple ECGs that you did on him trying to catch any changes all turn out the same, and two Percocets mysteriously and suddenly relieve his pain, and you ask the doc to please re-assess the patient. The patient gets sent back to jail with the official diagnosis of chest pain NYD, and you give yourself a pat on the back and go buy yourself a latte because you knew all along that the patient suffered from acute incarceritis.
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