It was Sunday night, 7 pm, and I was just starting my third 12-hour shift in a row. I was happy to see my assignment was the same as the previous two nights - two fairly stable patients. One was a “challenge-to-wean” patient who was recovering from ARDS and who had two restful nights on Friday and Saturday. The other was a patient who was post-stroke; she was not intubated, was minimally communicative, and had stable vital signs (I had been surprised that she had not been transferred out of the ICU during the day.)

I was a few minutes early so I went to print out telemetry strips for both of my patients before getting report. Part of our documentation each shift consisted of printing and interpreting each patient’s ECG intervals. We had a certain way to fold the strips so we could tape them in the appropriate spot on the flowsheet (next to the strip from the previous shift).

It was then, when I went to tape the strip on that I noticed something very different. The patient’s ST-segment was significantly elevated compared to the strip 8 hours before. The day shift nurse came over to start report and we compared the strips - same leads, definite ST-segment changes. She grabbed the 12-lead ECG machine and yelled for the resident while I assessed the patient. She was lying in bed and appeared comfortable. Her vital signs hadn’t changed and her oxygen saturation was 93%. She did not look like someone experiencing an MI. But she was.

Within minutes (or so it seemed), anesthesia had arrived to intubate her, cardiology was at the bedside, and we were hanging nitroglycerin and heparin infusions. After a very busy night and despite all of our efforts, this patient coded and died.

I tell this story because it is not often that “cutting & pasting” a six-second telemetry strip leads to this turn of events. As a critical care nurse, I was both exhilarated by noticing the change in her ECG and devastated by the outcome.

When I considered writing about this particular night, my first thought was that anyone could have noticed the change in her ECG. Would someone who was not a nurse have recognized the change and realized the implications? Perhaps. But is there anyone else but a bedside nurse who is present and in tune to the patients they care for 24 hours a day, 7 days a week, 365 days a year?

Nurses are there. Nurses are present. Nurses are paying attention.