Background: Spontaneous coronary artery dissection was first described in 1931.  Since 1931 less than 350 cases have been documented.  A significant number of spontaneous coronary artery dissections present as sudden death with many cases only being diagnosed at autopsy.  As an ANCC Magnet designated hospital, this organization demonstrates the expertise of nursing care through Exemplary Professional Practice and New Knowledge, Innovations and Improvements These are just two of the components of Magnet that are  engrained in the nursing care of this community hospital. 

Case: On May 3, 2010 a 32 year old, gravida 2, para 1 Hispanic women presented to the emergency room of a community based Magnet hospital with a chief complain of chest pain.  She was immediately seen by a triage nurse who recognized the critical situation and activated the cardiac alert algorithm.  This allowed her to obtain and electrocardiogram and immediately bypass triage and obtain care by an emergency physician.  With the information provided by the nurse regarding the electrocardiogram, history and chief complaint it was suspected that the patient was experiencing an acute myocardial infarction.  This hospital also has an obstetrical first responder program, which was immediately activated.  With the obstetrical first responder program a registered nurse from the labor and delivery department immediately reports to the emergency room to begin fetal assessment and notifies the in house obstetrician.  Further evaluation involved a cardiac catheterization which diagnosed a spontaneous coronary artery dissection.   A team of nurses, ancillary staff and physicians met to begin formulating a plan for delivery of the fetus and care of the mother.  What began as a visit to the triage area of a community emergency room at 0230 resulted in a term, male infant admitted to the Well-baby nursery following a successful transition period and the mother transferred to the Intensive Care Unit on a ventilator following surgery. The mother and baby discharged to home together just 5 days after major cardiac surgery following a rare disease. 

Conclusion: The culture of nursing care and collaborative practice model allowed a multidisciplinary group of staff to come together to provide life saving care to a mother and her infant. A successful outcome to a rare and often fatal occurrence.  Through the transformational leadership and structural empowerment nurses are encouraged to make decisions based on what is best for the patients and implement algorithms and protocols based on their nursing assessment. 

Keywords: Magnet Model, Exemplary Professional Practice, New Knowledge-Innovations-Improvements, Spontaneous coronary artery dissection.