Discuss, in essay format, the out—of—hospital management of ONE of the patients described below (choose either the cardiac or respiratory

Discuss, in essay format, the out—of—hospital management of ONE of the patients described below (choose either the cardiac or respiratory
patient). Include the following:
1. An explanation of the pathophysiology of the chosen pathology, particularly as it relates to this patient. Include a short discussion of
the epidemiology and associated risk factors.
2. Correctly and systematically interpret the 12—lead ECG provided. Comment on if, and how, this would guide the management of this patient.
3. Comprehensively describe the out—of– -hospital management of this patient. This should not be based solely on any one jurisdiction’s
protocols or clinical practice guidelines; instead you should discuss the general management, referring to national and international guidelines
and literature. Include any controversies/differences in management (again, ensure you reference your discussion), and consider
regional/geographical/hospital differences that will impact on management.
4. Discuss the ongoing in—hospital care that this patient is likely to receive, as well as their prognosis and any potential complications of this
clinical episode.
5. Your essay should be in essay format, that is, it should include an introductory and summary paragraph, other paragraphs should each
introduce a ‘new’ idea in your discussion (you may use sub—headings), all tables and diagrams must be referred to in the text (as well as
referenced if they are taken from elsewhere). If you use bullet points, use them sparingly and only as necessary. Check your spelling, and check
your grammar. Use Vancouver referencing.
6. Please use 12—point font and double spacing. All comments will be made on the paper.
7. DO NOT plagiarise – you MUST acknowledge all other sources.
8. If you are not sure what is required, email me or make an appointment. Better to be sure than sorry.
CAA 206 Assessment Task 3 – Case Study
Patient Care Record – Ambulance Service (Patient 1)
Name: Amit Singh Date of Birth: 21/01/1960 Age: 58
Presenting Complaint – Chest pain and vomiting.
History of Presenting Complaint – Patient works as an NBN installer and is travelling for work. He became ill while working at a remote
property, the client called triple zero immediately. Mr Singh describes a sudden onset of nausea and vomiting with pain in his chest, left arm
and jaw thirty minutes ago. The bystander describes Mr Singh quickly becoming pale and sweaty before vomiting.
Past Medical History – Hypertension, hypercholesterolaemia and type two diabetes mellitus.
Drug History – Perindopril, atorvastatin & metformin. Taken daily as prescribed.
Allergies – None known.
Family History – Father died aged 57 of a “heart attack”, brother had “stents” aged 58.
Social History – Lives in Canberra with his wife and two children aged nine and eleven. Sedentary lifestyle travelling thousands of kilometres
each week. Diet appears poor, consisting of take away foods high in fat and sugar as he eats away from home. Twenty pack year smoker, quit
ten years ago. Mr Singh’s extended family live in India, he is engaged with his community and has many friends at his local Sikh Temple where
he worships. Both parents were born in India, as was he, moving to Australia at age nineteen.
On Examination
Patient has capacity and consents to assessment.
Pain using SOCRATES:
Site: Central chest pain with discomfort in left arm and jaw.
CAA 206 Assessment Task 3 – Case Study
Onset: Sudden onset thirty-five minutes ago while completing paperwork.
Character: Chest pain is described as “heavy, like someone sitting on my chest”. It is constant and this is the first time he has experienced this
pain. He rates severity as 7/10.
Radiation: A tingling/numbness is felt in the left arm and jaw.
Associated symptoms: Nausea, vomiting, pallor and diaphoresis.
Timing: Thirty-five minutes of persistent non changing pain.
Exacerbation/relief: Pain remains the same on deep inspiration, palpation and movement.
Focused assessment:
Inspection: Pallor, diaphoresis and in obvious discomfort with some anxiety. Vomit appears normal with no blood.
Palpation: No abnormalities detected.
Percussion: No abnormalities detected.
Auscultation: No abnormalities detected.
Observations:
AVPU scale: Alert. Orientated to time, place and person
Respiratory rate: 18
SpO2: 97% on air
Heart rate: 104bpm (regular, taken radially)
Blood pressure: 142/87
Blood glucose: 8.4mmol/dL
Temperature: 36.4oC
ECG recorded on next page.
It took you 30 minutes to reach the patient. The nearest Emergency Department is a small hospital with no cardiac facilities and is 45 minutes
away. The nearest pPCI facility is 3 hours and 50 minutes away. The helicopter can not fly due to weather surrounding the airport.
CAA 206 Assessment Task 3 – Case Study
Name: Amit Singh Date of Birth: 21/01/1960
CAA 206 Assessment Task 3 – Case Study
Patient Care Record – Ambulance Service (Patient 2)
Name: Ben Henderson Date of Birth: 12/10/1992 Age: 25
Presenting Complaint – Difficulty breathing.
History of Presenting Complaint – Ben has a twelve-hour history of increasing difficulty in breathing while at home having called in sick for
work as a software developer as he woke with dyspnoea in the night. His boyfriend called for an ambulance on arriving home at 17:30 as Ben
could not speak and appeared “blue”. Over the past week Ben has had a cough and increased the use of his rescue medication. Today he has
used his inhaler “a lot” and has felt little to no relief.
Past Medical History – Asthma, eczema and hay-fever.
Drug History – Salbutamol, beclometasone. Previously has taken courses of prednisolone.
Allergies – None known.
Family History – None relevant.
Social History – Lives with his boyfriend in a city apartment. Employed. No recreational drug use, non-smoker and occasional alcohol with
friends. Exercises and has regular contact with his asthma nurse.
On Examination
Patient has capacity and consents to assessment.
Primary survey:
Airway – Clear.
Breathing – Rapid rate, central and peripheral cyanosis with audible wheeze without auscultation.
CAA 206 Assessment Task 3 – Case Study
Circulation – Rapid pulse.
Disability – Alert on AVPU scale and appears exhausted.
Exposure –Tripoding position.
Focused assessment:
Inspection: Tripoding position, cyanosis to lips.
Palpation: No abnormalities detected.
Percussion: No abnormalities detected.
Auscultation: Globalised expiratory wheeze.
Observations:
AVPU scale: Alert. Orientated to time, place and person, appears exhausted.
Respiratory rate: 34
SpO2: 90% on air
Heart rate: 150bpm (regular, taken radially)
Blood pressure: 119/75
Blood glucose: 5.4mmol/dL
Temperature: 36.8oC
ECG recorded on next page.
It took you 12 minutes to reach the patient. The nearest Emergency Department is a metro hospital with all facilities and is 15 minutes away.
CAA 206 Assessment Task 3 – Case Study
Name: Ben Henderson Date of Birth: 12/10/1997

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