Hanna Wright went above and beyond while providing excellent nursing care for a critically ill patient! The January 3rd overnight shift was a particularly busy evening in the ED. The hospital ICU was full, so we were boarding multiple ICU patients among our already full ED. Consistent foot traffic to the waiting room, along with a steady stream of ambulance arrivals, kept patient volume high.

Hanna was managing a toxic DKA patient when I came on for the night and did a great job managing the frequent lab draws and medications typically done by an ICU nurse while helping out with the rest of the ED. There was no let-up in volume and no room upstairs for some of our boarded patients when a 40-something male “chest pain” came in via ambulance in the early morning.

I was busy trending to another patient and mentally preparing to jump directly to another room to reassess an ICU hold patient on VIPAP when I was handed an ECG of the new “chest pain” arrival. The ECG was totally normal – no signs of ischemia. However, a moment later Hanna came to find me and said, “I hate to interrupt, but can you please stop what you’re doing and come and see this patient right now – I think his aorta is dissecting!”

When I entered the room, I immediately saw why Hanna was so concerned. I found the patient to be extraordinarily distressed and anxious-looking, diaphoretic, and moving all over the bed trying to find a position of comfort. Hanna told me, “The patient told EMS that his pain woke him from a dead sleep, and the pain was right between his shoulder blades!” The patient was immediately sent off for a stat CT Dissection study, showing that he was indeed dissected from bilateral carotids all the way down to his bilateral iliac arteries.

Aortic dissections have one of the highest fatality rates of medical emergencies, making rapid action paramount for patient survival. Over the next hour Hanna drew lots of labs – gave pain meds – started a Labetalol drip to emergently control the patients BP -talked with multiple family members – spoke to the accepting team at Northwestern -transitions the patient over to the care of the Flight Crew and got the patient on his way to Northwestern expeditiously.

A less experienced nurse, or a nurse not as dedicated to their patient’s care as Hanna was that evening, could have simply waited for me to eventually see this patient after seeing the other patients already waiting in the emergency department. This patient had a normal ECG and appropriate vital signs upon arriving, and his trip to CT for imaging could have easily been delayed if it wasn’t for Hanna recognizing the situation called for immediate emergent action. I followed up with the Vascular Surgeon at Northwestern 36 hours later, and the patient was, at that time, neurologically intact and doing remarkably well.